Archived: Highcroft Care Home

Highcroft Care Home is a residential care home providing personal care to 22 people living with dementia. The service can support up to 23 people in one building across two floors.

People’s experience of using this service

People were protected from the risks of harm and abuse. Staff were knowledgeable about the actions to take if they suspected somebody was being harmed or abused. People had risk assessments to minimise the risks of harm or abuse they may face. Staff were recruited safely and there were sufficient staff on duty to meet people’s needs. People were protected from the risks associated with the spread of infection. Medicines were managed safely.

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 policies and systems in the service supported this practice.

People’s care needs were assessed before they began to use the service. Staff were supported to carry out their role with training and supervision. People were supported with their nutrition, hydration, health and oral hygiene. Staff understood their responsibilities under the Mental Capacity Act (2005).

People and relatives thought staff and the management were caring. Staff knew people well and understood how to deliver a fair and equal service. People and relatives were included in the decision making around the care provided to them. Staff understood how to promote people’s privacy, dignity and independence.

Staff knew how to provide a personalised care service. Care plans were detailed and personalised. People’s communication needs were met. People were encouraged to participate in activities and maintain family contact. People were supported to follow their religious beliefs and practices. Complaints were dealt with appropriately. People who were at the end of their life had their last wishes documented.

People, relatives and staff spoke positively about the leadership in the service. The provider held regular meetings for staff. The registered manager had a system of checking the quality of the service provided to identify areas for improvement. The provider worked in partnership with other agencies to improve outcomes for people.

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 19 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the previous inspection in April 2016, we found two breaches of legal requirements. This was because although improvements had been made, there continued to be an issue around infection control and cleanliness. The provider’s auditing systems had failed to identify and action the poor hygiene. This unannounced inspection took place on 10 and 13 July 2017 and we found significant improvements had been made.

There was a registered manager at this service. 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.

People and relatives thought the service was safe. Staff were knowledgeable about how to report concerns or abuse. The provider had a recruitment system in place to ensure the suitability of staff working at the service and there were enough staff on duty to meet people’s needs. Risk assessments were carried out with management plans in place to enable people to receive safe care. The home had recently been completely refurbished to a high standard. There were systems in place to maintain the cleanliness and safety of the premises. The provider had systems in place to ensure the safe administration of medicines.

Staff received appropriate support through supervisions and training opportunities. Appropriate applications for Deprivation of Liberty Safeguards had been applied for and authorised. Staff were aware of the need to obtain consent before delivering care.

People were given a choice of nutritious menus and staff were knowledgeable about people’s dietary requirements. People also had access to healthcare professionals as required to meet their day to day health needs.

People and relatives thought staff were caring. Staff were knowledgeable about how to develop caring relationships with people who used the service. People’s privacy and dignity was respected Staff had awareness of delivering care in a non-discriminatory way. People were given choices and their independence was encouraged.

Staff were knowledgeable about providing a personalised care service. Care plans were comprehensive and showed people’s preferences. A variety of activities were offered which included trips outside the home. People and relatives knew how to complain and the provider dealt with complaints in accordance with their policy.

Relatives and staff spoke positively about the management of the home. The provider had systems to obtain feedback about the quality of the service from relatives and people who used the service. Regular meetings were held for people who used the service and relatives to check they were happy with the service provided. Staff had regular meetings to keep them updated on policy changes, service development and to encourage good working practices. The provider had quality assurance systems in place to identify areas for improvement.

At the previous inspection completed on 7 August 2015, we found breaches of legal requirements and the service was placed in special measures. This was because the service did not have suitable arrangements to manage medicines safely, food was not stored and rotated to ensure it was safe for people to eat, the home was dirty, activities on offer did not take into account people’s preferences and the provider did not have effective systems in place to check the quality of service provided.

This inspection took place on the 14 and 18 April 2016 and was unannounced. We found significant improvements had been made and so the service is no longer in special measures. However we found a continued breach with regard to cleanliness and a continued breach with regard to quality checks which failed to identify the issue regarding cleanliness.

There was a registered manager at this service. 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.

People and their relatives told us they felt safe. Staff were knowledgeable about the procedures for raising safeguarding concerns and for whistleblowing. Risk assessments were carried out, reviewed monthly and included management plans to reduce the risk. General risk assessments were carried out including fire risk assessments and were up to date. Building safety checks were done and were up to date. People received their medicines safely and as prescribed. Safe recruitment checks were carried out.

Food storage had improved because it was moved from the cellar to a new food storage shed. People were given a choice of nutritious menus. Staff received regular supervision and training opportunities. Staff were working together to learn as a team. New staff followed an induction programme before working unsupervised. Staff were knowledgeable about obtaining consent before giving care. People had access to healthcare appointments as and when they needed it.

Staff spoke to people in a respectful manner and there was a relaxed atmosphere throughout the home. People thought staff were caring and respected their privacy and dignity. Staff were knowledgeable about people's care needs, their likes and dislikes and how to promote their independence.

There was an improvement in the variety of activities offered to people which now included activities outside the home. Staff demonstrated an understanding of what personalised care was and care plans were written in a person-centred way. People and their relatives knew how to make a complaint and complaints were resolved in line with the policy.

The provider and the registered manager carried out regular audits of medicines, care records, staffing and night staff. People and their relatives were asked for feedback to help the quality of the service provided. Regular staff meetings and meetings with people and their relatives were held to help to improve the service provided.

We observed people's behaviour and how staff engaged with them.

One person said the home was 'quite comfy.' One relative told us the person was 'happy there.' Another relative told us staff were 'polite and answered directly.'

People told us about the activities which they enjoy including walking in the garden and reading the newspaper.

Before people received care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People received the care and support that met their needs. We saw that meals were appetising and people were supported to eat but people were not protected from the risks of inadequate nutrition. We found that staff were supported by the registered manager and had access to training and development courses. We found that there was adequate information about making a complaint.

People we spoke with told us they "liked the care" and they felt "comfortable" in the home. We found people's needs were initially assessed when they first moved into the home. There was documentary evidence that risk assessments were undertaken to ensure the safety and welfare of people who used the service. Staff were adequately trained to deal with foreseeable emergencies and were able to tell us how they would respond to such emergences if they occurred.

We found there was information available to people who used the service about appropriate health and social care support. There was appropriate information in people's files about their health care needs.

We found staff were knowledgeable about the different forms and signs of abuse. Staff knew that if they had concerns they should report this to their supervisor and the manager. We found documentary evidence that the service had responded appropriately to any allegation of abuse.

Staff were given appropriate and relevant training for their roles and responsibilities. We found documentary evidence staff had regular supervisions and were enabled from time to time to undertake further qualifications.

We found complaints received by the service were responded to appropriately.