Teamcare Limited t/a Highcliffe Residential Home

Teamcare Limited t/a Highcliffe Residential Home (Highcliffe) is a residential care home providing personal care for up to 24 adults, including those who are living with dementia. At the time of our inspection there were 21 people living at the home.

We found the following examples of good practice.

There were policies and procedures in place, which provided staff with clear guidance about good infection control practices, including the management of Covid-19 and visiting arrangements during the pandemic.

Government guidance was being followed in relation to isolation criteria and testing programmes for service users, staff, visitors and visiting professionals. All employees had received both Covid-19 vaccinations and had completed specific training in relation to infection control and the management of Covid-19.

There were cleaning schedules in place and the environment was clean and hygienic. We were told ‘touch’ areas were being sanitised regularly and enough supplies of PPE were available. We saw staff wearing PPE correctly and there were well stocked PPE stations set up in appropriate areas within the home.

Highcliffe Residential Home is located in Whittle le Woods near Chorley in the county of Lancashire. The home is registered to provide accommodation and support for up to 24 people and cares for elderly people including those living with dementia. At the time of our inspection 23 people were using the service.

There was a registered manager in place who had been registered since 26 October 2012. 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.

At our previous inspection on 8 and 9 September 2016 we found several breaches of legal requirements. We found that some records related to medicine management could be improved. Potential safeguarding concerns were not being reported to the local authority and some care plans did not contain important information about people.

We also recommended that risk assessments were individualised particularly around the use of bed rails, that reviews were completed around do not attempt resuscitate (DNAR) documents and that audits at the home were reviewed to ensure that they picked up on issues found at the inspection.

In addition, it was noted that in some cases staff had not received refresher training for up to three years.

We asked the provider to make improvements in all of these areas and they kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements had been made in most these areas.

We found that medicine’s record keeping had improved but that some management issues around controlled drugs were ineffective and could give rise to issues. This has resulted in a recommendation in the 'well-led' section of this report.

At this inspection we noted that any incidents that may have given rise to safeguarding concerns had been reported appropriately.

Risk assessments were personalised to reflect individual risks and support needs and audits were being completed that were effective in highlighting issues and concerns to management.

All training was up to date and there was a program in place to regularly provide staff with refresher training that the service deemed to be important.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The registered manager conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the registered manager.

Teamcare Ltd are registered to provide accommodation for persons who require nursing or personal care at Highcliffe Residential Home. The provider is not permitted to provide nursing care. The home is located in a residential area of Whittle le Woods near Chorley and provides care for up to 24 older people. The home was fully occupied at the time of our inspection.

At this inspection we identified three breaches to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Within the main body of this report you can read the details of the identified breaches and see what action we have taken at the end of the report. We also made three recommendations within the report. Recommendations are made where regulations are not breached but steps should be taken to ensure quality and standards are maintained.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All of the people we spoke with who lived at the home told us that they felt safe. We did find a number of accident and incident records showing that people had fallen, many of which were unwitnessed falls. A number of these issues needed to be reported to, or at least discussed with the local authority safeguarding team.

The home had a medicines management policy in place and all the people we spoke with felt their medicines were managed safely. However we found a number of recording issues within the Medication Administration Records (MARS) we reviewed. It was evident from looking at MARS and from discussions with staff that there were different systems in use for how some medicines were recorded.

We found some issues with prescribed creams. This included opening dates not being recorded which made it difficult to ascertain whether some creams were out of date or when the use by date was due to expire.

We saw that risk assessments were in place within people’s care plans which were regularly reviewed. However some risk assessments needed to be more personalised to the individual. Some of the resulting actions implemented via risk assessments were done without the recorded consent of the individual.

The service had robust recruitment policies which meant that the staff in the service had been appropriately assessed, interviewed and received the necessary clearances required to work with vulnerable people.

The home had the appropriate level of staff in place to meet the assessed needs of the people living at the home. No agency staff were used to cover for staff absences as this was done via the existing staff team and a small team of bank staff.

Staff received regular supervision from their line manager and told us that they felt supported in their work. However we found a number of staff had not received up to date training in some areas. The registered manager told us that training was being sought and we saw some evidence that this had either begun to happen or had been arranged.

Staff were able to talk about consent and how they gained consent from people prior to delivering personal care. However staff understanding of the Mental Capacity Act and how this legislation could potentially affect people living in the home was limited. We also found some issues with regards to written consent. We have made a recommendation about this.

People we spoke with were complimentary about the food they ate in the home. We observed people who needed assistance were helped in a patient and considerate manner by care staff. We did however find some anomalies between recorded information and what the cook and care staff told us about some people’s needs.

People and their relatives consistently told us that the approach of the staff team was kind, considerate and empathetic. We received a number of positive comments in this area. This was also backed up by the comments of professionals who were involved with the service.

Care staff we spoke with were knowledgeable about the provision of end of life care. Some staff had received specialist training in this area and established links were in place with a local hospice.

Care plans were in place and were in the main person centred. However the information within them was not always consistent and the information was not easy to navigate easily.

People and their relatives told us they knew how to make complaints and were confident that if they did they would be listened to.

The home had a dedicated activities coordinator and we saw good evidence that activities took place both within and externally to the home. Feedback was positive in this area.

People, relatives and staff spoke positively about the registered manager and how the home was run. We saw that all the staff team had a positive approach and the culture within the home was positive. There were clear lines of responsibility and accountability in place.

There was a good range of communication methods in place for people and their relatives including monthly newsletters and quality assurance questionnaires.

There was evidence in place that audits took place at the home however we questioned the effectiveness of some of these as they had not picked up some of the issues we found during the inspection. We have made a recommendation about this.

Equipment used in the home was stored correctly and well maintained. Staff knew how to use the equipment and confirmed that there was always enough equipment in place to meet the needs of the people in the home.

The provider had an effective recruitment process in place that included checks to ensure potential employees were of good character and had the right skills in place to do the job.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.People's personal records were accurate, fit for purpose and securely maintained. Other records required to be kept were maintained and held securely.

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 23 November 2012, observed how people were being cared for and talked with people who use the service. We talked with family members, visiting professionals and talked with staff.

What people told us and what we found

People told us they were happy with the care and support they received. One person said, "The care and attention from staff is excellent". A relatvie we spoke to said, "The care and attention from staff is excellent, the proprietor is always available, it's a good team and it really shows".

During the visit, staff were seen to be interacting with people in a calm and considerate way. Activities were available for people and an activities co-ordinator is employed within the home.