Highfield House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We identified a breach of good governance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Safety events such as accidents and incidents were recorded and investigated and responded to appropriately to prevent reoccurrence and mitigate future risk. Following incidents consideration was given to why these may have occurred and what may be done to reduce repeat events. For example, for people who were at a high risk of falls, alternative equipment such as alert mats had been considered and implemented where appropriate and bedroom layouts, footwear and increased staff oversight were implemented.

Staff members were able to describe actions they would take should an incident or accident occur. This included, logging the incident, completing detailed accident forms and escalating to the management team. A staff member said, “We are always informed of incidents/ accidents that have occurred through handover meetings and updates on the care records.”

Family members and staff confirmed they were updated following accidents or incidents and duty of candour was followed where necessary.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and relatives confirmed they had access to GP services, specialist nurses, dentists and opticians where required. On review of peoples care records we found evidence that people received additional support as needed from dementia specialists, physiotherapists and speech and language therapists.

The staff and management team told us they worked well with health and social care professionals and had developed good working relationships. This was confirmed by professionals. A healthcare professional said, “The whole team have developed a great relationship with the surgery and liaise well with me and the practice paramedics who complete the home visits. Care plans are adhered to, and they are proactive with asking for help or support with residents and will ensure that onward referrals are made.”

People and their relatives said the service supported them to attend external appointments such as hospital visits. A relative told us, “They [staff] have escorted [person] to hospital and they are also accommodating with hospital appointments.”

Care files included a hospital pack containing relevant information if a person needed to be admitted to hospital or transferred to another service, this helped to ensure continuity of care. The service used a nationally recognised tool to assess and respond should people’s conditions deteriorate. This is a key element of safety and improving outcomes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives told us they felt very safe and were treated well and with respect. People’s comments included, “I feel very safe, the staff are excellent, they know what they are doing”, “I feel safe here” and “I am hoisted well, they [staff] always ask consent and check that I’m ok.”

There were clear processes and systems in place to help ensure where safeguarding concerns were identified, these would be investigated and acted on in a timely way. These investigations included the completion of action plans and root cause analysis to establish potential causes, themes and trends and mitigation to prevent future incidents.

Staff had received training in safeguarding and were able to describe types of abuse and what action to take if they had any concerns. There was a safeguarding and whistleblowing policy in place which gave staff clear guidance to follow in the event they needed to refer any concerns to the local authority. Referrals had been made to the local safeguarding team appropriately.

Mental Capacity Act (MCA) assessments, best interest decisions and Deprivation of Liberties Safeguard (DoLS) applications had been completed where required which meant we were assured staff protected people's human rights in line with the MCA. The management team kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

The provider did not work well with people to understand and manage risks. Risks to people had not always been fully explored or considered.

Where people had specific health needs which place them at risk of harm, risk assessments had not always been completed and the risks relating to these conditions had not been fully considered. For example, one person who had been in the home for a number of years had a diagnosis of epilepsy, however there was no care plan or risk assessment in place for this condition.

We could not be assured people who were at risk of choking received effective, safe and appropriate care. For example, we identfied a person had a medical condition which placed them at risk of choking. This person had also experienced an episode of choking, however no assessment of this risk or care plan had been completed. For another person we found conflicting information in relation to modifications they required to their diet to mitigate the risk of them choking.

During our assessment we identified two people living at the home had conditions that affected their breathing. On review of these people’s care records, we found very limited information was available for staff about these specific conditions and there was no information of how these conditions effected these people, how exacerbations of these conditions should be monitored and mitigated, and actions staff should take if a concern arose. This place these people at risk of harm of receiving unsafe care and treatment and not receiving care in a timely way to keep them safe.

We were not assured people at risk of developing pressure damage had been repositioned as required to manage this risk. For example, one person’s care plan stated, this person needed repositioning every 2 hours including overnight. On review of this person’s daily records, we found they had not always been repositioned as described. This shortfall had not been identified through the providers audits. This placed people at risk of experiencing skin damage. The risks in relation to these concerns were partly mitigated due to a consistent and experienced staff team.

Although the issues described above were immediately addressed when brought to the providers attention we could not be assured that, had we not undertaken this assessment, these issues would have been identified, and necessary action taken as required. This was because the providers auditing processes had failed to identify these concerns.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had created a safe and well-maintained environment. People’s rooms were personalised, and they had the equipment they needed to keep safe. Communal areas were nicely decorated, clean and hazard free. There was an accessible and well-kept garden. There was signage around the home to support people to move around freely and safely. The home was warm, well-ventilated and appropriately lit. People using the service and their relatives were happy with the environment.

There were arrangements in place to monitor the safety and upkeep of the premises and the management team completed regular checks. There were appropriate risk assessments in place when required, for example, in relation to fire safety. Regular safety audits were completed including for utilities and equipment. Where concerns were identified records of required actions and outcomes were maintained.

There were contingency plans in place to be followed during adverse events for example during a power cut or adverse weather conditions.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed views from people and relatives about the staffing levels at the home. A person told us, “The staff are always on hand when I need them, I don’t have to wait, they come quickly” and another person said, “They always come quickly when I ring my call bell.” However, another person said, “I don’t think there is enough staff, I sometimes have to wait to get up.”

Staffing levels were discussed with the manager who confirmed these were determined by the number of people using the service and the level of care they required. Staffing levels were regularly reviewed to determine the numbers of staff provided remained sufficient to meet people's needs. Call bell audits were frequently completed to verify that people’s needs were met in a timely way. Staffing levels were also discussed daily during meetings and handovers to ensure there were appropriate levels of staff throughout the home. If shortfalls were noted, staff allocation would be reconsidered.

Throughout our assessment visits we observed staff were always available to people as required and there was lots of positive engagement between people and staff. Staff were positive about the staffing levels in the home. A staff member said, “We have enough staff – always enough. There is good teamwork, we work together to manage if a bell is ringing, we help each other help the residents.” Another staff member told us, “95% of the time [there are] enough [staff], Staff work really hard. The staff that are here know the people really well and I would have them short rather than double the number who didn’t. We rarely use agency and that helps because of the continuity of the workforce.”

Staff were safely recruited, and checks were carried out before they started work to reduce the risk of unsuitable staff being employed. Training was up to date and covered topics relevant to the service. A formal process was in place to support staff with staff meetings, 3 monthly supervision and annual appraisals.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

During our assessment visits we found the home to be clean and maintained to a good standard. People using the service and their relatives told us the environment was clean.

Staff completed infection prevention and control (IPC) training and understood their responsibilities. IPC audits were regularly completed to help detect and minimise the risk of the spread of infection. Staff confirmed they had access to personal protective equipment (PPE), when needed and we observed staff using this appropriately.

Housekeeping staff told us about the routines in place to ensure all areas were regularly cleaned using robust and detailed cleaning schedules and described the processes followed to ensure high standards of cleanliness was maintained. The cleanliness of the service was monitored by the staff and the management team through the completion of audits, regular spot checks and daily walkarounds.

The management team understood the actions they should take should there be an infectious disease outbreak at the home.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Although we found medicines were stored securely, we could not be assured they were continually safely stored. For example, only current room and fridge temperatures were recorded, and not the minimum and maximum temperatures. This meant, we were not assured that medicines were consistently stored within their recommended temperature ranges, which can affect how well they work. This was raised with the managerand following the assessment we were provided with evidence which demonstrated action had been taken to address this.

We identified revised in-use expiry dates or dates of opening were added to most relevant medicines as required. However, for one medicine we found the revised expiry date added was longer than the manufactures recommendations and for another medicine the date of opening and used by date had not been recorded. This meant this medicine may be used when it was no longer safe to do so.

Most people’s records contained information about how they preferred to take their medicines. These records included additional information which supported staff to administer when required and variable dose medicines. However, some were not individualise or, personalised, and did not describe how one medical condition was managed with multiple medicines. For example, where a person was prescribed different medicines to manage a bowel condition. This included one medicine that was taken regularly, another medicine that was ‘as required’ and a further medicine that had a variable dose. There was limited information and guidance to support staff on what medicine to administer, when and what doses.

Detailed records of controlled drugs (CD) were kept, including denaturing. However, services are only permitted to complete denaturing of CDs if they have a ‘T28’ waste exemption certificate from the Environment Agency relating to the denaturing of controlled drugs in place. At the time of the assessment visits the service did not have a ‘T28’ waste exemption certificate in place. This was immediately addressed by the management team when brought to their attention.