Highfield

Highfield is a residential care home providing accommodation and personal care for up to 6 people with a learning disability, autistic people, people with mental health needs and people with sensory impairments. At the time of the inspection 6 people were living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Risk assessments and care plans relating to people’s known health conditions were out of date and not reflective of people’s current needs.

People did not always receive support that was focused on their quality of life outcomes. People’s outcomes were not regularly monitored in a meaningful way.

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; the systems and processes in the service did not always support this practice. Medicines were managed safely.

Right Care:

People were supported by staff who knew them well and who had been safely recruited. However, not all staff had received the relevant training to ensure they had knowledge of people’s health needs. The provider allocated new training to all staff immediately after feedback.

People, relatives and staff were given the opportunity to feedback on the service. However, there was no evidence to show how the feedback was used to drive improvements in the service

People received kind and compassionate care from staff who used positive, respectful language which people understood and responded well to.

Right Culture:

Governance processes were not effective and failed at times to hold staff to account, keep people safe, protect people’s rights and provide good quality care and support.

There was mixed feedback from staff about whether they felt supported in their roles. Staff did not receive regular supervisions and the lack of consistent leadership at the service resulted in a decline in the quality and safety of the service.

People and relatives were positive about the attitudes and behaviour of staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 28 March 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to management oversight and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.

At our last inspection in January 2016, we rated the service good. At this inspection, we found the evidence continued to support the rating of good, and there was no information from our inspection and on-going monitoring that demonstrated any serious risks or concerns.

This inspection report is set out in a shorter format because our overall rating of the service has not changed since the last inspection.

Staff followed the procedures for safeguarding people from the risks of harm or abuse. Risk management plans were in place to safeguard people’s personal safety and manage known environmental risks.

Staffing arrangements met people’s individual support needs. The recruitment procedures ensured only suitable staff were employed to work at the service. Medicines were appropriately managed and staff followed infection control procedures to reduce the risks of spreading infection or illness.

Staff had comprehensive induction training and on-going refresher training that was based on following current best practice. Staff supervision and appraisal systems ensured staff had regular opportunities to discuss and evaluate their learning and development needs and their work performance.

Staff supported people to follow a nutritious, varied and balanced diet. The staff supported people to access health appointments as required so that people’s continuing healthcare needs were met.

Staff understood the principles of the Mental Capacity Act, 2005 (MCA) and ensured they gained people's consent before providing personal care. People were encouraged to be involved in decisions about their care and support and information was provided for people in keeping with the requirements of the Accessible Information Standard (AIS).

People had their privacy, dignity and confidentiality maintained at all times. People experienced positive relationships with staff and received care that respected their diversity as staff supported people to maintain relationships with family and friends and make new friends. The care people received from staff was kind, caring and compassionate.

The provider operated an open and transparent culture. Quality assurance processes checked all aspects of the service. Events such as safeguarding matters, accidents and incidents had been reported to the CQC and other relevant agencies as required. Complaints brought to the provider’s attention had been dealt with in accordance with the complaints procedure.

People told us that they were happy living at the service and that they liked the staff who worked there. They also told us that they had recently enjoyed going out to the seaside with the staff and other people who used the service. One person told us that the staff were 'brilliant' and provided them with the support they needed to take their medication and keep healthy and well. They also told us that they had a meeting once a week with staff to discuss and plan the meal choices and to find out if they had any concerns or complaints about living at the home.

During the inspection visit we observed that staff spent time listening to people and provided them the support they needed. We found that people were well cared for and received their medicines in a safe way. We saw that people received a nutritious diet and people told us that they enjoyed the food. We also found that staff working at the service had received robust recruitment checks, carried out by the provider to ensure the safety of people living at the home.