Archived: Highfield Manor Care Home

Highfield Manor Care Home is a large detached house situated close to the centre of Heywood. The home is registered to provide accommodation and personal care for up to 38 people. All bedrooms are single and had en-suite facilities. On the day of our inspection 34 people were living at the home.

There was a registered manager in post. However the registered manager was on maternity leave which the service had told us about. A person had been employed as an interim manager in the registered manager’s absence, supported by the area manager. 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.

We looked at the staffing rotas and talked to two night staff members of the three on duty. It was the first shift for one staff member. We found there were sufficient staff to meet the needs of people who used the service.

We looked at the safeguarding procedures and found the service adhered to their and the local authorities policies and procedures. Falls were recorded and reported to the local authority. We saw the manager reviewed any accidents and incidents in a timely manner and looked at ways of minimising any risks. We did not find any records relating to the possibility of people being pushed over or physically abused and staff told us this had not happened.

We looked at maintenance records and saw that there had been a disruption to part of the homes water supply but this had been repaired the same day by an external contractor.

We asked the manager about any possible offensive odours a person had reported in the hallways. We were shown that the carpets had been replaced some weeks previously because unfortunately some people who have a dementia are incontinent of urine and this problem had been identified. The new flooring was easier to clean and did not have any offensive odour at 7am when we commenced the inspection or throughout the day.

We looked at some of the systems for checking medicines and found no errors or missing medicines.

We saw the home had a range of policies and procedures to ensure the safety and well-being of people who used the service and the staff we spoke to were familiar with these.

Staff told us that the manager was supportive and approachable, and believed the staff worked well together. We were not able to talk to people who used the service because of their mental health needs.

The manager had implemented quality assurance checks to monitor and improve the service. They regularly communicated with the registered provider and area manager who would visit the service regularly to carry out her own audits of service delivery.

The registered provider had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We had previously inspected this service in February 2015 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us making six requirement actions. The service sent us an action plan telling us the action they intended to take to ensure they met all the regulations. They informed us they would be compliant with these by June 2015.

This was an unannounced inspection which took place on 12 and 13 May 2016 to check the required improvements had been made and to follow up on what action had been taken to address the requirement actions. We found the requirement actions had been complied with and significant improvements had been made.

Since our last inspection improvements had been made in the way medicines were managed to ensure people received their medicines safely. We saw medicines management policies and procedures were in place to guide staff on the storage and administration of medicines. We found that records were completed fully and protocols were in place to guide staff on administration of “as required” medicines.

Arrangements were in place to ensure people’s rights and choices were protected when they were unable to consent to their care and treatment in the service. Staff had received training in, and understood, the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA.

Care records were detailed, person centred and contained good information about people’s support needs, preferences and routines. Care records were reviewed regularly. People who used the service and their relatives had been involved in planning and reviewing the care provided.

The was a complaints procedure for people to use if they wanted to raise any concerns about the care and support they received. There was a system in place to record complaints and the service responses to them. People were confident that they would be listened to and action would be taken to resolve any problems they had.

Improvements had been made in how the quality of the service was monitored. There was a robust system of weekly, monthly and annual quality monitoring and auditing in place. We found these audits included; medication, accident and incidents, falls, cleaning, building maintenance, care plans and risk assessments, staff training, complaints and safeguarding.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. People were complimentary about the registered manager and said they were a good manager. We found them to be enthusiastic and committed to providing person centred care.

People we spoke with were positive about the registered manager, staff and the service.

People told us they felt safe at Highfield Manor Care Home. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor care to people.

There was a robust and safe system of recruitment in place to help to ensure people using the service were protected from unsuitable staff. There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to be able to deliver effective care.

Risks to people’s health and wellbeing were identified and direction was given to staff on how to reduce or eliminate those risks.

People had access to a balanced diet; food we saw was nutritious, plentiful and well presented. We saw systems were in place to monitor people’s nutritional needs. People had access to a range of health care professional to ensure their health needs were met.

The staff and managers knew people very well. They spoke fondly about people who used the service. We saw staff provided support in a caring, patient and unhurried way. They took time to listen and respond to people.

The service placed great importance on promoting people’s independence and choice. Care records contained information on what people could do for themselves.

We saw that the service had a range of policies and procedures to help guide staff on good practice. Staff told us they felt supported and enjoyed working for the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations, during the inspection, speaking with people who used the service, speaking with the staff supporting them, and from looking at records.

Safe

Where people were being 'deprived of their liberty'; the provider had not acted in accordance with legal requirements to ensure people's rights were protected.

Systems to protect people who were not able to independently leave their bedrooms were not in place. Clear procedures need to be implemented around any restrictions so that people are kept safe from risk of harm or injury.

People were not protected from the risk of infection or provided with a fresh and hygienic environment to live in because adequate systems were not in place.

We found insufficient staffing levels were available to safely and effectively meet the needs of people.

Effective

Suitable arrangements were not in place for obtaining people's consent to the support they received, particularly where people lacked the capacity to make decisions for themselves.

Staff had not received all the training they needed to support people effectively and develop their knowledge and skills.

Caring

We saw that care staff were polite and helpful to people. Those people able to communicate their needs and wishes were seen to enjoy a good rapport and humour with staff.

Responsive

Care records were seen not to contain accurate, up to date or detailed information to enable staff to support people in the way they wished to be cared for to meet their current and changing needs.

Well-led

We found there were no effective management systems in place to ensure good practice in infection control, that appropriate levels of staffing were provided or that all staff had received the training they needed to carry out their role safely and effectively.

We were told most of the people who used the service had a diagnosis of dementia. This made communication difficult. Some people we spoke with were able tell us, 'The food is very good', and 'I liked my dinner'. We observed people's body language with staff was good and their facial expressions were positive when staff approached them.

We looked at three care records and saw they contained relevant medical and health information, personal preferences and social history. There was evidence of working with other health professionals, risk assessments and monitoring charts seen.

We saw relevant policies and procedures were in place to quality assure the services. There was evidence staff meetings taking place. We were told that any complaints or concerns raised were taken seriously and responded to accordingly.

We saw a selection of compliment cards from relatives. Some of the comments included: 'Many thanks to everyone involved in my X's care and well-being' and 'Thank you very much, you are all stars'.

We saw relevant policies around safeguarding and we spoke with two members of staff who demonstrated an understanding of the issues. The staff with whom we spoke were confident to report any issues they may encounter.

Staff we spoke with told us, 'I love working here, it's brilliant'. Another said, 'We work well as team and we get good support from the manager'.

We looked at the records of four people living at Highfield Manor Care Home. These all contained risk assessments and care plans required so staff knew what support and care was necessary. They were updated on a regular basis. When a risk of malnutrition or dehydration had been identified a record of food or fluid intake was kept, and people were given extra calories as part of their meals or in drinks.

Robust recruitment procedures were in place and staff did not start work until all the appropriate checks were completed.

The manager had recently updated the home's policies in relation to the Mental Capacity Act 2005. Staff were aware of the law and knew who was able to give consent to any form of care and support.