23 & 28 October 2014
During a routine inspection
Highmead is a local authority run care home which provides accommodation for up to six people with learning disabilities who need support with their personal care. The home is part of a larger building complex with accommodation arranged over a number of different levels accessed by a series of stairs. The main living accommodation and some of the bedrooms were on the first floor. At the time of our inspection there were six people living at the home.
The inspection was unannounced and was carried out over the 23 and 28 October 2014. People who lived in the home had varied needs and abilities, and although they were not able to verbally communicate with us, they were able to demonstrate their understanding of what they were being asked.
We conducted this inspection because we had concerns about the service following a previous inspection. At the inspection carried out over the 13 and 14 February 2014 we identified the environment was not clean, hygienic and was not adequately maintained. As a result of our findings we took enforcement action and required the provider to meet the requirements of the regulations by 24 April 2014. The service had improved in respect of the above areas. People now lived in a clean and well maintained environment. However, we identied other failings in respect of people’s care and welfare, unlawful restrictions to people’s lives, respect and dignity and quality assurance. We have also recommended that the service considers the current guidelines regarding record keeping.
In April 2014 people from another of the provider’s homes were moved into this home on a short term temporary basis. This was to enable the provider to carry out essential maintenance work. Each of the homes had a separate management structure and different working practices. The manager for the second location was also co-located at Highmead. Each of the registered managers retained responsibility for their own staff, including deployment, care files, risk assessments and medication management. However, the care staff were merged and used to provide a coordinated response to care across both services. Although, the maintenance work had been completed by the beginning of June 2014, both sets of people and staff were still co-located in this home at the time of our inspection. This had led to a lack of clarity over working practices, creating confusion and frustration amongst staff.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff did not always interact with people in a positive way. There was a mixture of both poor and positive interactions by staff. People indicated that they were happy and liked the staff who looked after them. They appeared well looked after and were relaxed in the company of staff who appeared to know them well.
People’s rooms were personalised with their family photographs and memorabilia. Staff respected people’s right to privacy and dignity. There were sufficient staff on duty to meet people’s needs. Staff had time to spend supporting people in a meaningful way that respected individual needs.
People’s risks were not always recorded effectively. Although staff were aware of the risks affecting people, changes to their risk assessments had not been updated in their care plan since 2013. We pointed this out to the manager who took immediate action to ensure all risk assessment were up to date. We made a recommendation with regard to the provider’s approach to record management.
People were protected against the risk associated with the unsafe management, handling and safekeeping of medicines. Only staff who had received the necessary training were able to administer people’s medicines. There was an effective recruitment process in place to ensure that all of the appropriate checks were completed and staff who were recruited were suitable to work with people.
Staff’s training was renewed annually and staff had the opportunity to receive further training specific to the needs of the people they supported. However, there was an inconsistent approach to staff supervisions and we have made a recommendation for the provider to consider their approach to staff development and support. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Staff were knowledgeable about people’s care needs and their associated risks. However, people were not protected against the risk of unsafe and inappropriate care because records relating to their care and welfare were not accurate and up to date.
The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS requires providers to submit applications to a ‘Supervisory Body’ when people are subjected to restrictions to their personal lives. People at the home lacked capacity to make some decisions and were subject to restrictions to their personal lives, such as not being able to leave the home at any time. Although, the registered manager was aware of these requirements, no applications had been made.
People were provided with a choice of suitable and nutritious food and drink. Staff sought people’s views either verbally or by actions. Staff were aware of people’s dietary needs and preferences. Staff sought and obtained people’s consent before helping them. Healthcare professionals such as GPs, district nurses and chiropodists were involved in people’s care where necessary.
People were provided with both individual and structured group activities. People were offered a choice as to whether they took part in activities and this was respected. Accidents and incidents were recorded and remedial actions identified. There was a complaints policy in place, which included information in respect of advocates.
The values and ambitions of the provider were aspirational and were not always being delivered in practice. There was no structured system in place to regularly assess and monitor the quality of the service people received.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.