Archived: Highdell Nursing Home

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Is the service safe?

We found there were enough staff to meet people's needs. Although some staff were working long hours this was being monitored and reviewed by the registered manager.

Is the service effective?

This was not reviewed at this inspection.

Is the service caring?

People told us staff were kind and we observed some good interactions between people and staff. However, people's respect, independence and dignity were undermined by the poor quality environment and some staff practices.

Is the service responsive?

Staff responded to and respected people's choices about when to go to bed and when to get up. People's continence needs were met although continence assessments and care plans required more information.

Is the service well-led?

The registered manager had investigated concerns raised by one person but had not discussed the action they had taken with the person. Action had been taken in response to a smoking incident to prevent a reoccurrence, however the registered manager had not investigated the incident and was not aware of information recorded about the incident.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe-

Each person's care file had risk assessments in place which covered areas of potential risk such as managing behavioural problems, mobility, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

Effective -

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

The home had a good working relationship with other health care professionals and followed their guidance and advice. The input of other health care professionals involved in people's care and treatment was clearly recorded in their care plan.

Caring '

We found the staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We looked at the results of a recent survey completed by the relatives of people who used the service and saw the majority of the comments made were positive. Comments included 'My relative is more content now and seems to have relaxed into her life at Highdell which all the family are very pleased about.' and 'My relatives health has improved and in the main they are much calmer.'

Responsive '

People's needs were assessed and care and support was planned and delivered in line with their care plan.

Wherever possible people who used the service and/or their relatives were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

Well led '

Both the care staff we spoke with and people who used the service told us the manager and senior staff team were approachable and listened to them if they had any concerns.

However, we found the registered care provider still did not have effective quality assurance monitoring systems in place which highlighted any shortfalls in the service and non-compliance with the essential standards of quality and safety. In addition some records relating to the management of the service and people's care and welfare had either not been completed correctly or could not be produced promptly on request.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance and record keeping.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Safe '

All the people we spoke with who used the service told us they felt safe at Highdell. They said they could talk to the matron if they had any concerns. We saw one person was smoking in their bedroom and the manager confirmed a care plan and risk assessment were in place to manage the risk. A relative said the staff were 'very patient' in the way they interacted with people. They said the staff were always around and intervened quickly as soon as anyone started to show signs of anxiety or agitation.

The staff we spoke with confirmed they had completed safeguarding training and would report any safeguarding concerns directly to their line manager. They told us they were aware of how to detect signs of abuse and were aware of external agencies who they could contact if they had any concerns. With one exception the staff also told us they were aware of the whistle blowing policy and felt able to raise any concerns with the manager knowing that they would be taken seriously.

However, we found a person who used the service in 2013 had been the subject of Deprivation of Liberty Safeguards (DoLS) and the manager had not reported this to the Commission, as required by law, and were unaware they were required to. This legislation is used to protect people who might not be able to make informed decisions on their own.

Caring '

We spoke with the relatives of four people who were using or had recently used the service. One person's relatives said in the three years they had been involved with the service they never had any cause for concern. They said the home provided 'wonderful care'. Another person said the staff were 'marvellous and really caring' and added they 'would recommend the home to anyone' Two people's relatives said they liked the 'homely' atmosphere.

Responsive '

People's relatives told us they were kept well informed about any changes in their relatives care needs and/or condition. They said the staff never hesitated to get medical advice if they had any concerns about people's health. They said the manager and matron were very approachable and listened to them, they said they felt confident any concerns they had would be dealt with appropriately.

When we looked at people's care records we saw evidence people had access to other health care professionals such as GPs, psychiatrists, dieticians and speech and language therapists.

Effective -

People's files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before they moved into the home.However, the relatives of two people who used the service told us they had not been given the opportunity to read their care plans since admission and had not attended a review meeting to discuss their care and treatment.

When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Well led '

People told us they had confidence in the management team and the manager was approachable and listened to what they had to say.

However, we found the service did not have an effective quality assurance system in place and some records relating to the management of the service and people's care and welfare had either not been completed correctly or were not on the premises.

In addition, there was little documentary evidence to show the views and opinions of people who used the service, their relatives and staff were actively sought as part of the quality assurance process. This lack of documentary evidence made it difficult to establish if the service was being managed effectively and in people's best interest.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance and record keeping.

We looked at the personal care plans of people who used the service and observed how people were being cared for.

We spoke with people who used the service and their relatives. They told us they were very happy with the care provided at the home.

One person told us "I get the help I need when I need it."

One person's relative told us "The staff are fantastic and the care they provide is excellent."

People told us they were well cared for, one person who used the service for respite care said they looked forward to going to Highdell and 'wouldn't want to go anywhere else'. Another person told us the staff were kind. They said they liked living at Highdell because they could come and go as they pleased as long as they let staff know.

One person's relatives told us they were 'highly delighted' with the care provided and another said the staff were 'fantastic'. Relatives told us they were involved in decision making when people did not have capacity to make their own decisions. They told us they were kept informed about any changes to their relative's condition.

People told us the manager and matron were always available to listen to them and any concerns they had were dealt with.