Archived: Highlands Care Home

People’s experience of using this service:

• Insufficient staff were employed at the home to meet people’s needs. Due to the high level of care needs of 12 of the 25 people living at the home, the number of staff available during the day and at night was insufficient to ensure people’s needs were met in a timely way. Staff were unable to supervise people to ensure their safety and people were not provided with the opportunity to engage in meaningful leisure and social activity.

• The home was not clean. Some of the furniture in people’s bedrooms and the floors in the communal areas, including bathrooms and toilets, were dirty.

• People’s freedom to walk around the home was restricted with the use of half-height doors placed across hallways. These also posed a safety risk to people who might climb over them. Following this inspection, we were told these had been removed.

• Risks to people’s health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were mitigated as much as possible. However, some improvements were required with monitoring people’s food intake and with the use of equipment used to protect people from skin breakdown.

• Some environmental health and safety checks had not been carried out. These related to the fire safety systems, managing the risk of legionnaires disease and the temperature of the hot water in people’s bedrooms.

• Medicines were being managed safely.

• People told us they felt safe and well cared for at the home. Relatives also expressed their satisfaction with the safety and care provided.

• Staff knew people well and had developed close, caring relationships. We saw people enjoyed being with staff. Staff were aware of their responsibilities to safeguard people.

• Recruitment practices were safe and staff received the training they required for their roles.

• People and their relatives were involved in making decisions about their care.

• Further consideration needed to be given to providing engagement in social and leisure activities for people living with dementia.

• The home was being supported by the local authority to establish more effective quality assurance systems to assess, monitor and improve the safety and quality of the home.

We identified five breaches of the regulations and we made two recommendations for improvement in relation to restricting people’s movement around the home and engaging people in meaningful social activities.

The home met the characteristics of a rating of “Good” for one key question and “Requires Improvement” for four key questions. Our overall rating for the home after this inspection was “Requires Improvement”.

Rating at last inspection: At the last inspection in August 2016 the home was rated Good (report published September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section at the end of the report.

Follow up: We have asked the provider to complete an action plan detailing how they will make improvements to ensure the regulations are met. We will work with our partner agencies, including the local authority, to review the progress made in the home. 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

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

There were 25 people living at the home, and one person on a short stay. We spoke with people living at Highlands. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We also spoke with three staff members and the manager. We looked at a selection of care records, and focussed on how people's consent was gained by staff. We also looked at how people's health and well-being was supported.

We saw people looking relaxed and at ease with staff and each other. We saw people sitting chatting with one another about the activities around them. In the morning, we saw many people laughing and singing. When people felt unwell or anxious, staff were quick to recognise the need to change their approach, such as sitting with them to reassure them.

People's health and well-being was assessed, and care was provided in a way that suited people's individual needs. Staff were clear about their role to protect people and to report abuse. There was a clear recruitment process in place and appropriate checks were in place to help ensure staff were appropriate people to work with vulnerable people. The home had quality assurance procedures in place to measure the standard of care in the home.

All the outcomes areas that we inspected were compliant. We saw that people's dignity and respect was maintained, and their health and wellbeing was assessed and provided in a way that suited their individual needs. Medication was managed well and the home had a robust complaints system. Staffing levels helped ensure that people's individual needs were met and the atmosphere was positive and welcoming.