Highlands Borders Care Home

We found the following examples of good practice.

The staff were following infection prevention and control guidance to help people to stay safe. This is a home with a long standing, small and loyal staff team who know the people they support well. They were working together to ensure shifts were covered during the outbreak and accessing all available support resources. For example, covering kitchen and laundry shifts so that care staff could focus on meeting people’s needs. Additional senior staff were being trained in managerial tasks and medicine management and a new administrator/care worker was about to start their induction to alleviate staff pressure during this time. Agency staff had not previously been used but agencies had been approached to provide some long term cover, these staff would only work at Highlands Borders.

Due to the majority of people living with dementia, the home had been unable to separate areas in zones but staff were allocated to support named people. People were being supported to isolate in their rooms. The deputy manager was ensuring that people had every comfort available in their rooms and regular reassurance. Staffing levels had been increased as some people required further support to maintain safe isolation. The deputy manager was looking at simple visual ways for staff to easily identify which staff were working in which area to further promote good social distancing.

There were posters and guidance accessible at the service. The registered manager and senior staff ensured staff understood why every measure was in place and there were regular updates and reminders.

There were clear risk assessments and staff were following the correct procedures. For example, staff were not car sharing and were social distancing, including for staff breaks. Staff were also ensuring they were following safety guidelines in their home lives to further protect the people they supported. The home was very clean throughout and the domestics were working hard to maintain an increased cleaning schedule. The provider was not accepting any new admissions at this time but were aware of the correct admission processes.

The provider had provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic. There was a good stock of the correct PPE and staff knew what to do. Each room had separate PPE stations. Staff were a close-knit group and were well supported. The provider and registered manager were very supportive in a difficult situation and staff said they felt well supported and valued for working additional hours. Their focus was on ensuring the people they cared for were as safe as possible and had their needs met. The provider was now available at the home to take on any roles to alleviate the additional time required to support people in their rooms.

Staff supported people to occupy themselves whilst maintaining their safety. Staff allocated to named people were providing additional one to one activity with people in their rooms and visited them frequently. An activity co-ordinator was also able to provide one to one support. The communal areas were not being used at this time.

Staff helped people to stay in touch with family and friends through phone and video calls but this was particularly difficult at this time. The registered manager was talking to families as much as possible and working with the local council to ensure supportive communication was maintained whilst focussing on people’s care needs. The home were unable to welcome any visitors at this time but were well prepared for safe visiting as soon as possible.

Further information is in the detailed findings below.

There was an experienced registered manager who was responsible for the home. 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. The provider, Highlands Care Home Limited, also has two other care homes in Exeter.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home.

People’s experience of using this service and what we found

People were positive about their experience of living at the home. For example, people said the home was “friendly”, “well-organised” and the staff “make you feel at home.” People said they felt safe; they received their medicines on time. People were protected from abuse because staff understood their safeguarding responsibilities. The registered manager took this role seriously and liaised with other health and social care professionals to ensure people’s legal rights were protected.

Staffing levels delivered responsive support to people. However, we made a recommendation linked to staffing levels and end of life care.

Our discussions with the registered manager demonstrated their empathy towards the people using the service; they recognised people’s emotional needs. Staff were attentive, whatever their role in the home, this was because they worked as a team to promote people’s well-being. Positive, meaningful relationships had been developed between staff, people and their families. The service respected and recognised the value of people’s life experience and their values, so people were supported to participate in events important to them. A number of people valued their independence and were pleased staff recognised this was important to them. This meant people still felt in control, which was important to their well-being.

There was a stable and attentive staff group; people described staff as “wonderful” People were supported by staff who respected their privacy and dignity and understood the need for a personal approach to reflect people’s individuality. Staff relationships with the people they assisted were caring and reassuring.

Care staff were kept up to date with changes in people’s health and spoke respectfully about the people they supported. They understood how they contributed to both people’s physical health and mental wellbeing. Staff received training at the start and throughout their employment to ensure they had the skills to provide effective care. Staff said they were well supported by the registered manager. However, the registered manager said due to some key staff leaving they were finding it difficult to ensure training and supervisions were up to date, which was reflected in staff records. Since the inspection, a full-time deputy manager now works at the home to assist with the running of the home.

Care staff were recruited to suit the caring values of the service and recognised the importance of team work to provide consistent and safe care. The home was well maintained, clean, and staff understood the importance of good infection control.

The registered manager and care staff worked well with community health professionals to ensure people received effective care. Referrals were appropriately made to health care services when people’s needs changed. People’s care needs were regularly reviewed. Risk assessments identified when people could be at risk. They covered people's physical and mental health needs and the environment they lived in. People's nutritional needs were met, and people socialised as they ate their meal in an unrushed atmosphere.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Information was in place to ensure people’s legal rights were protected. There were systems in place which enabled the registered manager and the providers to monitor the quality of care. For example, through regular reviews, surveys, meetings and observations of staff practice. Feedback from people using the service and quality assurance records showed this approach had been effective.

Rating at last inspection: The last rating for this service was Good (published July 2017). At this inspection, the rating remained the same.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager who was responsible for the home and had worked there for some time. The registered manager was on holiday at the time of the inspection so we were assisted by the deputy manager. 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. The provider, Highlands Care Home Limited also ran another care home in Exeter and were in the process of buying a third home close by.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "It’s a lovely place, I never have to worry. I come regularly and I can join in and dance and sing with people.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. At the time of the inspection people were mostly relaxing, chatting and playing games in the large, airy conservatory or sitting at tables in the open plan dining area. They looked comfortable and happy to spend time in the large conservatory. People were encouraged and supported to maintain their independence. The majority of people living with dementia were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.

People were provided with good opportunities for activities, engagement and trips out. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or spent time in their rooms. Some people were spontaneously going out with a care worker to the high street close by or for a walk. The activity co-ordinator knew people well and engaged people in activities and games which suited them. For some people with limited understanding staff used smaller items such as ‘fiddle muffs’ or sensory items to touch and interact with when there was not an organised activity planned. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them. Most people preferred to spend time in the communal areas, including a smaller, quiet TV lounge.

People and relatives said the home was a safe place for them to live. Most people were living with a degree of dementia meaning they were not always able to tell us directly about their experience at the home. People looked happy and comfortable chatting with staff and each other. Staff knew people’s personalities and what they liked such as who liked to spend time with who. One person was able to tell us, "It’s like a hotel, I can do what I like. All the staff are really nice and there is a lovely manager. If I had a problem I could talk to them or anybody.”

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team. For example, a recent safeguarding process had resulted in appropriate supervision and disciplinary process to ensure learning and improvement. The relative said they would speak with staff if they had any concerns and issues would be addressed. People seemed happy to go over to staff and indicate if they needed any assistance. There was a robust recruitment process, ensuring potential new staff were suitable to work with vulnerable people.

Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. They used chatting and distraction techniques as they knew people well, showing patience and understanding. For example, records showed clear documentation of any incidents such as a person raising their voice at another person. Staff showed how they discussed with one person how their behaviour may have frustrated another person. We saw staff discreetly monitoring where these people were so the incident would not re-occur.

People and relatives knew how to make a formal complaint if they needed to through the home’s complaint policy but felt that issues would usually be resolved informally. The relative said they had never had any issues but were happy to talk to any staff. We looked a recent complaint which had been well managed in a sensitive way. Improvements had been made such as monitoring room temperatures and increasing the level of communication with one person’s family. They were now able to access the computer care system with a pass code so they could feel assured their loved one was well cared for. There had been no other formal complaints.

People were well cared for and relatives were involved in planning and reviewing their care as most people were not able to be involved due to living with dementia. Care plans showed that people were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people's repeated stories. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. One person’s care plan described how the person had become more nervous of the chiropodist as their dementia progressed. Staff now stayed with the person reassuring them through their treatment.

There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals. Staff monitored people’s skin integrity for example. One record showed how staff had noticed a red area on one person’s foot. They had applied appropriate cream and taken a photo to aid regular monitoring. No-one at the home had any pressure sores. Other people had had assessments by the speech and language team (SALT). Health professionals could input directly into the computerised care plan system. This information was then included in an updated care plan for staff to follow. Care plans and daily records were easy to follow showing progress. Staff said, “The care plan system is fantastic. We use electronic tablets so we can record as we go. We now have more time to care and it’s easy to share any new information or changes with the team as a pop up alert too.”

Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.

Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. The home had recently completed a move from paper documents to the electronic computer care plan system. Care plans were person centred and comprehensively reflected people’s needs when we spent time with them. There was a very stable staff team who knew people really well to be able to meet their needs. Handover and communication between staff shifts was good so there was consistent care. The service rarely used agency staff but were able to fill vacancies if they could not cover shifts within the staff team.

Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and many care staff had worked at the home for some years. They all enjoyed working at the home and we could see they all enjoyed working as a team and spending time with the people living at the home. They were attentive and visible. They felt well supported by management and valued. The deputy manager said, “We have a good staff team. It’s so good to see where staff are going with their carers and prospects. We all believe in what we are doing and working for the people here.”

People's privacy was respected. Staff ensured people kept in touch with family and friends, inviting friends and family to outings and events regularly. The deputy manager role included public relations and they were keen that family and friends were involved as much as they wished. The relative told us they were always made welcome and were able to visit at any time. They were enjoying tea and biscuits with their loved one and joining in with the activity. People were able to see their visitors in communal areas or in private. One person said they liked quiet.