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Archived: Highgrove Good

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Inspection carried out on 08 June 2015

During a routine inspection

We carried out this inspection on 8 June 2015 and it was an unannounced inspection. This means the provider did not know we were going to carry out the inspection. The last full inspection at Highgrove was in May 2013. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2008. A follow up inspection was carried out in August 2013 and we found the home was fully compliant with the regulations inspected at that time.

Highgrove is a care home registered to provide accommodation and nursing care for up to 67 people, who may have dementia care needs. The home was built in 2009, is purpose built and provides all single bedrooms with en-suite facilities. On the day of our inspection, there were 47 people living at the home.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The home had a new manager in post on the day of our inspection, who had sent their application to CQC to become the ‘registered manager’.

People and their relatives told us they felt the service was safe, effective, caring, responsive and well led. Comments included; “I feel very safe here, thank you”, “[The service] always asks what I want to do and how I want to do it”, “The staff are brilliant, so patient and caring. They go the extra mile for you” and “I give feedback about [the home]. If I don’t like something, then I say. It’s no bother to [staff], they just sort it if they can.”

People were protected from abuse and the service followed adequate and effective safeguarding procedures. Care records were personalised and contained relevant information for staff to provide person-centred care and support.

There were issues with staff support, where some staff had not received supervisions for a number of years. We also found some staff were out of date with training in several areas, including safeguarding and infection control. The home manager and regional manager told us they had training and supervision plans in place to ensure all staff were up to date with supervisions, appraisals and training. We saw evidence that training had already been planned in some areas and the home manager told us what they were doing to source other, required training programmes.

We found good practice in relation to decision making processes at the service, in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

There were good, regular quality-monitoring systems carried out at the service. We saw that, where issues had been identified, the manager and regional manager had taken (or were taking) steps to address and resolve them.

During our inspection, we found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection carried out on 27 August 2013

During an inspection looking at part of the service

During our inspection we found people looked reasonably clean, tidy and we saw their personal care needs had been met. We talked with eight people who used the service. The people who used the service told us they were happy living at the home, happy with the care they received, liked the staff who looked after them, and enjoyed their food. Some comments captured included, �it�s very nice here�, �I think the home is lovely� and �everyone (the staff) have been very good to me.�

We found care plans had been completely re-written since our last inspection to ensure they reflected people�s individual care needs. The provider was in the process of introducing a new electronic care records system.

We found accurate and appropriate records had been maintained. We found people�s confidential personal information had been adequately protected.

Inspection carried out on 17 June 2013

During a routine inspection

We found people who used the service and their relatives were able to influence and be involved in aspects of their care and welfare.

We talked with seven people who used the service. Some comments captured included, �all staff very nice, very caring � can�t do enough for you� and �one or two staff not as good as others � but generally are okay�. We talked with five relatives of people who used the service and said �staff very visible � swift to attend to people�s needs�, �staff really helpful� and �basic care is hit and miss � dependent on staff�.

The assessment and planning of care did not always meet people�s needs.

We found the home had systems and processes in place to ensure the safe administration of medications.

We found there were effective recruitment and retention processes in place.

Care records for people who used the service were not always reviewed adequately and people�s confidential personal information was not protected.

Inspection carried out on 17 January 2013

During an inspection looking at part of the service

We carried out an inspection of Highgrove in July 2012. At that time we found that people had not always experienced care, treatment and support that met their needs and protected their rights. We also found that staff had not always been supported because insufficient numbers of staff had received training, supervision or appraisal. We made compliance actions, which required the provider to make improvements in these areas.

We undertook this inspection to review the provider's compliance with the compliance actions made at the last inspection. At this inspection we found that improvements had been made. We found that people experienced care, treatment and support that met their needs and protected their rights and that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Additionally, in early January 2013 we received some concerns, from a number of sources that insufficient staff were available to meet people�s needs in the unit for people with dementia. We reviewed the staffing levels in the unit at this inspection. We found that there were enough qualified, skilled and experienced staff to meet people�s needs.

We spoke with several people who used the service in the unit for people with dementia and in the general nursing unit. They said they thought the home was good. They were happy with the standard of care and liked the care staff.

Inspection carried out on 16 July 2012

During a routine inspection

People with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the �Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who used services for a period of at least one hour and recording their experiences at regular intervals. This included people�s mood, and how they interacted with staff members, other people who use services, and the environment.

The SOFI observation was conducted within the lounge area of the middle floor which provides nursing care for people diagnosed with dementia. During the observation we saw that staff generally treated people with dignity and respect. We examples of good communication skills by some staff that utilised eye contact and touch to engage people who used the service.

It was noted that two people were asleep for long periods. Clearly during this time the people had no contact with staff or other people, which can have a negative affect on their mood. When one person was woken by visiting relatives they became alert, smiled and enjoyed the company. This showed that contact with other people increased their engagement with the world around them.

The majority of people who used the service appeared to have their care and welfare needs met. However, during our observation we saw that one person�s personal care needs had not been met. Their relative told us they were �very upset as he is unshaven, nails dirty and trousers are stained�. They explained that he received �inconsistent care� and his care �was becoming worse� because he was more regularly found unshaven with dirty nails and clothes when visiting.

We were able to talk to two people who used the service on the middle floor who showed they possessed some insight of the world around them. They said �It�s nice here, good job there are such places� and �the people (staff) are nice here�very friendly�. Both these people appeared clean and well dressed showing their personal care needs had been met.

We talked to three people who used the service along with a relative on the top floor. One person told us they thought �staff [were] alright�. Another person who spent most of their time in bed explained that they were always �kept clean and turned regularly (to prevent pressure sores)�. We talked to a further person who used the service along with their spouse who was visiting during our interview. This person thought �staff are very good�very helpful and try their best� and explained they were able to have a bath regularly and see the doctor when required. The spouse who visited daily confirmed their husband was kept clean and thought �staff were lovely�.

Inspection carried out on 4 November 2011

During an inspection looking at part of the service

People said they had good care. They were confident that staff had considered any risks and that these were well managed. One person said: �It's nice, I don't have any complaints or problems.� Other people said: �I need two staff to help me to walk, they always come in pairs to do it. I don�t have to wait long.� and �We are alright here, we are all well looked after.� A relative said: �They look after my wife well and they are easy to talk to if there�s anything I need to say.� Another person said: �I am very satisfied, my relative can be �awkward' at times but the staff treat her with care and attention at all times.�

One person said: �It�s lovely here, the carers are lovely and they make sure I am alright with my clothes, my food and my medicines.� Another person said: �I am happy to let the staff look after my tablets.� A relative said: �They bring the tablets to her and watch while she takes them. They never rush her and she seems very comfortable taking them.�

Inspection carried out on 13 July 2011

During an inspection looking at part of the service

Since our last inspection people and or their representatives had been more involved in devising their care plans, and in decision making processes to ensure they were consenting to the care, treatment and support they received.

Overall, care plans had improved, but we found some anomalies in the health records which indicated people�s health may not have been monitored effectively.

People had access to food and drinks as required and overall, we found the systems in place to monitor people�s nutrition and hydration needs were effective in protecting their health and welfare.

Overall, people were safeguarded from abuse by the systems in place at the service. However, due to a recent safeguarding alert made by a Community Matron we could not be satisfied that people were safe from the risk of abuse as the safeguarding procedures had not concluded.

People living at Highgrove were living in a safe, clean, comfortable and homely environment.

Most people were receiving medication as prescribed. But the records of the administration of medication showed gaps in Nurses recording this accurately.

We found evidence that two people�s medication was not in stock. A compliance action was made for the home to address this on the day of our inspection. The provider told us the day after our inspection that this issue had been addressed and that people had medication supplied and administered as prescribed.

The staffing levels had improved to ensure there were adequate numbers of staff to meet people�s needs.

Staff had received supervision and training in a variety of subjects to ensure they were adequately trained to meet people�s needs. Some senior staff required supervision training to ensure they could provide quality supervision to staff.

Regular quality monitoring systems were in place to identify areas of service deficiency. But the senior staff told us the number of audits carried out in each unit was too onerous and this may need to be reviewed.

Inspection carried out on 21 February 2011

During a routine inspection

When we visited the home we found that the `call bells� system was not working properly. The volume of the bells was very high, and a fault on the system meant that if a call bell rang on one floor it rang on all three floors. This meant that bells were constantly ringing night and day. This impacted on people�s ability to sleep comfortably and we observed this to cause people distress.

Two people who lived at the home told us the staff respected their dignity and privacy. Two relatives told us, staff treated people with dignity and respect.

Some people living at Highgrove had complex needs and required Dementia care and were not able to verbally communicate their views and experiences to us. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the �Short Observational Framework for Inspection (SOFI). Overall, throughout our SOFI observation, we found that people�s needs were not being met, as the staff did not have the necessary skills to support people appropriately.

We also found that people living on the Dementia care unit had their rights restricted in many areas including; they did not have access to their bedrooms during the day. They also did not have access to make drinks and snacks at all times.

Two people, who lived on the residential care unit told us, �I like it here�. And �Yes, they are looking after me o.k.�. They went on to say, �But some carers are more empathetic, than others towards people�.

There were no activities for people on the day of our visit as the activities co-ordinator was off sick. People were observed to have no real meaningful activities on the Dementia care unit

We asked people about the food provided at the home, they told us,

�The food is good, plenty of it and we can choose what we get�.

�Meals are fine, they put a drink at the side for me all the time�.

Two people we spoke to told us the staff administered their medication to them and at the correct times and were satisfied with this.

During our SOFI observation we saw that there were, insufficient staff on duty, to meet people�s assessed needs, on the Dementia care unit. One person who lived on the residential unit, said they had enough support from staff, �They come as soon as you call them�. A relative of a person on the residential unit told us, �Yes, there always seems to be enough staff, I have a chat with them�. �They seem friendly and know what there doing�.

People who were able to give us their views, told us they knew how to make complaints if necessary.