Archived: Highdell Nursing Home

Updated 12 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We also checked whether the provider had made improvements following regulatory breaches identified at the August 2014 and March 2015 inspections.

The inspection took place on 30 September 2015 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case experiences of services for older people.

We used a number of different methods to help us understand the experiences of people who used the service. We observed care and support in the lounge and communal areas of the home. We spoke with three people who used the service, five relatives, three care workers, the cook, the registered manager and the acting manager. We looked at a number of people’s care records and other records which related to the management of the service such as training records and policies and procedures.

On this occasion, we did not asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However we reviewed all information we held about the provider.

Before the inspection with spoke with the local authority to get their views on the service .

Updated 12 November 2015

Highdell Nursing Home provides personal and nursing care for up to 22 people living with dementia and long term mental health care needs. The home is situated in the village of Idle on the outskirts of Bradford. The accommodation is provided in single rooms, some with ensuite facilities.

This was an unannounced inspection which took place on 30 September 2015. On the date of the inspection there were 17 people living in the home.

A registered manager was 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.

The registered manager was not in day to day charge of the service. In the registered manager’s absence, an acting manager had been employed however they were not given adequate time allocated to the running of the service. We found the lack of management support had a significant impact on the quality of the service.

At the previous inspections in August 2014 and March 2015 we found a number of breaches of regulation. We found most of the issues we raised at these inspections had not been adequately addressed. These risks should have been addressed through strong leadership and management of the service. There was a lack of auditing systems in place to ensure robust documentation was maintained, medication safely administered and to ensure recruitment and training was done correctly. The acting manager told us they had not the time to ensure quality checks were undertaken in these areas. Following the inspection, the registered manager confirmed they had increased the acting managers management hours to help address these issues.

People and their relatives all spoke positively about the home. They said the care was good and staff were kind and friendly. Relatives commented how an established staff team provided care which meant they were all familiar with their relatives and their individual needs.

Medicines were not managed safely. We saw the nurse who was also the acting manager was constantly interrupted during the medication round to attend to other tasks. This increased the risk mistakes would be made. Medicines were not always given as prescribed and all medicines could not be robustly accounted for. Covert medicines were not given in line with existing legal frameworks meaning people’s rights were not protected.

There was a lack of documentation available to demonstrate that staff had been recruited safely and that the required checks on their character and background had been undertaken.

Although some risks to people’s health and safety were well managed this was not universally so. For example we found adequate preventative measures had not been put in place to control risks associated with poor nutrition and skin integrity. People were missing assessments detailing how they would be safely handled or evacuated in the event of a fire.

People and their relatives told us people were safe and said they had no concern over the conduct of staff that worked in the home. However following a previous safeguarding incident, we found an appropriate protection plan had not been put in place to protect people from the risk of harm.

Overall, we found the premises to be safely managed. However a programme of maintenance was required to address shabby and tired décor. Work was needed to ensure the home’s environment was suited to people living with dementia.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had not managed DoLS appropriately, as they had let one authorisation expire and were not meeting the conditions on another. This meant legislation designed to protect people’s rights was not being adhered to.

People and their relatives spoke positively about the food at the home. However appropriate plans of care were not always in place to support people to maintain good nutrition.

Staff had not been provided with timely training and were overdue training updates in a number of areas. The acting manager had recognised this and was in the process of addressing through the provision of additional training sections.

We saw some good interactions between staff and people that used the service with staff demonstrating a kind and caring approach. However, we found mealtimes were chaotic with people not receiving timely care and support.

The home utilised an electronic care record system. However we found it was poorly completed with many care plans and risk assessments incomplete or missing key information. Care plans were also not accessible for staff which meant there was a risk staff would not be aware of people’s agreed plan of care. This was of particular risk when agency were on duty.

A detailed daily handover took place between staff to help ensure staff were aware of any changes in people’s needs.

Complaints were appropriately managed by the home and people and their relatives told us they were satisfied with the service and had no need to complain.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe."