Highfield House Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the management and leadership team did not have consistent, robust oversight of care quality. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to 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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider was committed to providing a caring, person-centred service which promoted people’s rights and there was a culture of openness, learning and continuous improvement. The management team provided stable and effective leadership that had fostered an inclusive culture. Discussions with staff and the management team and our observations whilst at the home reflected this ethos. A staff member told us, “We have handovers, staff meetings and surveys, they [managers] do listen to us and listen to our ideas.” Another staff member said, “[Names of management team] are definitely approachable. If I have any issues and concerns, I can share these with them, and they will act straight away.”

All people and relatives we spoke with were positive about the atmosphere and culture at the home. A relative said, “Since [manager] came here things have vastly cheered up, the care staff are more interactive with residents. I have a good impression full stop. There is a cheered-up vibe.”

We observed staff were respectful, caring and committed to providing good quality care and treatment to people living at Highfield House Nursing Home.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There was a clear management structure in place consisting of the manager, the clinical lead, heads of department and registered nurses. Each had clear roles and responsibilities, and the management team worked well together. People, their relatives and professionals spoke positively of the leadership of the service and confirmed they were visible and approachable at all times. Representatives of the provider including the nominated individual and service manager visited regularly and were fully engaged with the overall running of the service.

Discussions with all levels of the management team showed they knew people, relatives and staff individually. External professionals were positive about the management team at the home and one told us, “[Manager] is very calm and has a great knowledge of all the residents, as does [of the clinical lead], who is also very calm, very competent; both are very approachable.”

People and relatives were positive about the overall running of the service and the management team. One relative told us, “The home is well run.” Another relative said, “Since [manager] came here there have been a number of improvements, things have vastly cheered up, there is better interactions between staff and residents and the information we are given about [person] is now clearer.”

Staff were positive about the management team and many felt improvements had been made since the appointment of the manager. Staff comments included, “There have definitely been improvements since [manager] has arrived. She is approachable and things get done”, “activities have really improved” and “[manager] is really good and we do feel listened to.”

There was a duty of candour policy in place and examples seen showed this had been followed.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People and relatives, as well as external professionals felt able to raise anything with the management team.

All staff said they felt able to raise anything with the management team and felt they would be listened to. Staff were positive about working at Highfield House Nursing Home and described the management team as available and approachable. There was no evidence of closed cultures. Staff at all levels respected and valued each other. All staff were complimentary about each other and the way colleagues treated them.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There was an inclusive and fair culture with equality and equity for staff. Staff told us they were happy at the service, felt supported and had the right support in place to enable them to do their jobs well. Staff told us, they felt valued and respected by the management team and each other.

A staff member told us, “We have more diversity in our staff group which does bring something extra to the team, it’s the best it’s ever been as historically we have had divisions on language and race.”

The provider’s systems of accountability, audits and governance had not ensured that all areas of the service were safe.

The provider’s senior management team oversaw the auditing and governance procedures of the home’s management team and regularly attended the service and there were a range of quality monitoring procedures in place including audits of various aspects of the service. However, audits and governance procedures had not identified the issues we found during the inspection as detailed in the various sections of this report.

The systems and processes in place failed to ensure people’s records were always detailed, complete or contemporaneous. We found a number of examples where people’s care records were incomplete, insufficiently detailed and did not contain sufficient information for staff to manage people’s specific needs or conditions. Risk assessments had not always been completed for known risks and people were not always repositioned as per their assessed need.

Additionally, the concerns we found in relation to safe medicines management and lack of formal involvement of people and relatives in relation to the care they received had not been identified through the providers audits.

The shortfalls we identified were brought to the attention of the manager and clinical lead who agreed action would be taken to address these issues.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The management team expressed an open positive attitude to receiving support and understood how and where they could access support. They had developed links with many local community organisations including schools, activities and religious organisations and people were supported to engage in a range of local community events.

Feedback from external professionals was positive about how the service worked collaboratively with them. A healthcare professional described the manager and clinical lead as “gently assertive – in the fact that they will advocate for residents to make sure that the best healthcare is received and they feel comfortable requesting reviews, as we have developed a good working relationship, this is dissipated to staff too.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider encouraged a culture of continuous improvement by ensuring systems were in place to promote continued oversight of the overall governance of the service. This helped to ensure areas of improvement were easily identified and the lessons learned could be shared. For example, information on the number and type of falls, specific issues or concerns that had been raised and types of incidents and accidents that had occurred was easy to review which helped to establish trends and patterns.

The service benefitted from links available with other services within the organisation and learning and skills were shared. A ‘Learning and Improvements Committee’ was also being established within the organisation. The aim of this committee was to study patterns of issues across the group and make recommendations on how to break the cycle and to discuss best practices and share with the relevant departments.

At the time of our assessment there was an ongoing and comprehensive action plan in place which detailed any actions required that had been identified through the services governance systems or highlighted through stakeholders. The management team were open to feedback provided during and following the site visits and were committed to making the necessary improvements.