Highcliffe Nursing Home

We found the following examples of good practice.

People, staff and visitors to Highcliffe Nursing Home were protected from risks of infection as policies and staff practices reflected best practice guidance. This included admissions to the home, staff deployment and people self-isolating when required.

Arrangements for visiting were by appointment only and overseen by trained staff. Visitors had their temperature and oxygen levels checked and a rapid Covid-19 test, which indicated a positive or negative test result within 30 minutes. Visitors used an external door directly into a designated visiting area avoiding access into the main areas of the home. Individual risk assessments had been completed to enable safe visiting when people were at end of life and included safe walking routes to the person’s room, additional PPE needed, and staff support arrangements.

Premises and equipment appeared clean and the correct cleaning products were being utilised. Weekly infection, prevention and control audits were carried out and effective in identifying actions where needed. PPE was used correctly, in good supply and available throughout the home.

Staff were up to date with infection, prevention and control training which had included safely putting on and taking off PPE. Competencies were regularly checked.

People and staff were participating in regular testing and the Covid-19 vaccination programme in line with government guidance. Legal requirements for obtaining consent for testing and vaccinating had been met. The provider had also arranged for a GP to hold individual reassurance meetings with staff enabling them to discuss any vaccination concerns or medical issues privately.

People’s wellbeing needs were understood, and staff assisted people to use technology to help keep in touch with family and friends. This had included a video link onto a large projector screen over Christmas so that families could join in with a carol service. Activities were held every day both in the communal areas and people’s own rooms.

Further information is in the detailed findings below.

Highcliffe nursing home is a residential care home providing personal and nursing care to 41 older people at the time of our inspection. The service can support up to 62 people. The service specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Staff were passionate and skilled in providing person centred care which respected people’s lifestyle choices and the things important to them. Knowledge of people’s past history, interests and hobbies provided staff with information to help people get the most out of their lives. Staff provided outstanding end of life care to people that was reflective of their lifestyle choices, culture and religion, and worked closely with other health professionals to ensure people were comfortable and pain free. Staff were excellent at recognising and pro-actively supporting the emotional needs of people and families who had experienced a bereavement.

People and their families described care as safe. Staff understood their role in recognising and reporting any concerns of abuse or poor practice. People were protected from discrimination as staff had completed equality and diversity training and we observed them respecting people’s lifestyle choices. Risks to people, including infection prevention, were regularly, assessed, reviewed and monitored. Staff understood the actions needed to minimise avoidable harm to people. People had their medicines administered safely by staff that regularly had their competencies checked. Accidents and incidents were used to reflect on practice and lessons learned were shared with the staff team.

Pre-admission assessments captured peoples care needs and choices and were used to create an initial care and support plan. People had their eating and drinking needs understood by both care and catering teams. Staff had received an induction, on-going training and support which enabled them to carry out their roles effectively and were provided with opportunities for professional development. 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. The environment provided private and social indoor and outdoor space and signage enabled people to access areas independently.

People and their families spoke positively about the care provided and the friendly nature of the staff team. Staff knew people well, including their past history and family and friends important to them which meant they could enjoy meaningful conversations. People had their communication skills understood which enabled staff to involve them in decisions about their day to day lives. Staff understood the importance, and we observed them, respecting people, ensuring dignity and finding ways to enable independence.

People, their families and the staff team spoke positively about the management of the home, describing the management team as visible, supportive and caring. Staff understood their roles and responsibilities, felt involved and able to share ideas. Quality assurance processes were multi-layered and robust, included the voice of people, families and staff and drove continuous improvement.

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 24 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Highcliffe provides nursing and residential care to older people, some of whom are living with a dementia. At the time of our inspection there were 37 people using the service. The home is in a residential area with good access to local amenities. The home has a registered 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.

Staff had been recruited safely. Employment and personal references had been obtained and checks had been made with the Disclosure and Barring Service to ensure applicants were suitable to work with vulnerable people. However employment references in some cases covered a short period of time. The service told us they would review their recruitment policy and introduce guidelines for the minimum length of time employment references needed to cover. People and their families felt the care was safe. Staff understood how to recognise abuse and the actions they needed to take if abuse was suspected. People were supported by enough staff to meet their needs in a timely way. Staff had received an induction, on-going training and support that provided them with the skills to carry out their roles effectively.

Staff understood the risks people lived with and the least restrictive actions needed to minimise risk ensuring people’s freedoms and choices were respected. People were supported with their individual eating and drinking requirements, were offered choices and supported to maintain their independence at mealtimes. Medicines were stored, administered and disposed of safely. People had access to health care when it was needed.

The service was working within the principles of the Mental Capacity Act 2005. Staff understood a person’s level of ability to make decisions and used different ways to communicate additional information in order to help people make informed choices. When people had been assessed as unable to make a specific decision a best interest decisions had been made involving all the relevant family and professionals. When power of attorney legal arrangements were in place staff understood the scope of decisions that could be made on persons’ behalf.

People and their families consistently described the staff as caring and felt they genuinely had an interest in their wellbeing. Care was provided professionally, with kindness and with good humour. Staff understood people’s individual ways of communicating. This enabled them to recognise and understand people’s care needs and involve the person in day to day decisions. People’s interests were understood which enabled staff to have meaningful conversations about things that were important to them. People had their dignity, privacy and independence respected

People had clear, accessible, individual care and support plans that provided information which provided staff with information on how the person needed to be supported. Plans were understood by staff and reviewed regularly with people and their families. Activities reflected people’s abilities and individual interests and took place both within the home and the local community.

The service was well led. People, their families and staff all spoke positively about the service. They felt able to share ideas, views and comments with the registered manager and were confident they would be listened too. There was an open and positive culture that empowered staff to feel included in the quality of the service. Staff understood their roles and responsibilities and the scope of their decision making. The registered manager shared information with CQC and other regulatory bodies appropriately. Audits had been regularly carried out which provided a good insight into quality standards and when actions had been identified they were acted upon appropriately and in a timely manner. Processes were in place to gather feedback from people including a complaints procedure. Feedback was used to continually improve service quality and used to promote learning within the staff team.

Following our inspection of May 2015 the service was placed into special measures as the overall rating of the service was inadequate. People had not received safe or high quality care and the provider had not met a number of the fundamental standards. Improvement were needed in a variety of areas including staffing, management of medicines, management of risk, management of health and safety, staff training, management of people’s legal rights, treating people as individuals, management of complaints, having a registered manager and notifying CQC of significant events.. During this inspection we found that significant changes had been made. However, further improvements were needed in staffing, management of risk, treating people as individuals, meeting CQC’s requirements for a registered manager and reporting responsibilities to CQC.

The service is registered to provide accommodation and residential or nursing care for up to 46 people. During the inspection there were 33 people living at the service many whom were living with a dementia.

The service comprised of a ground and first floor providing accommodation. There were 46 bedrooms, 28 were single rooms of which 13 had en-suite facilities. Nine were double rooms of which four had en-suite facilities. The ground floor had two lounge areas one of which gave access into a secure garden area, a dining room and a conservatory. On the first floor there was a small dining room, which could accommodate four people, and a small lounge that could accommodate five people. There was a lift and staircases to the first floor. The service had specialist bathrooms, a kitchen, sluice and laundry facilities.

The service did not have a registered 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. The manager had submitted an application to become the registered manager.

We found that the service was not always safe. We found that staffing levels at some times of the day were not sufficient. This meant that people could not always have staff support them at times they needed. The service had not reviewed people’s levels of dependency since July 2015 to determine the staff hours needed to support people with their assessed care needs.

The manager monitored accident and incident records monthly to check that risks to people were being managed. Staff had not consistently followed the reporting process. This meant that potential risks of harm to people had not been identified and any necessary actions taken to minimise them. People’s risks were assessed and reviewed regularly for malnutrition, skin integrity and moving and handling. Plans had been written that detailed the actions needed to minimise identified risks.

Medicines were stored and administered safely. Daily fridge and room temperatures were recorded to check the temperatures were within safe medicine storage limits.

Staff had completed safeguarding training and were able to tell us how they would recognise potential abuse and what actions they would take.

Staff had completed fire training and had been involved in fire drills. Fire equipment was regularly checked and maintained.

Staff were recruited safely and there were policies and procedures in place to manage unsafe practice.

People had the equipment they needed to support them.

We found the service was not always effective. The swallowing specialist had written a safe swallowing plan for a person. This provided detailed information for staff to follow to minimise the risk of the person choking. We observed the person being supported with their lunch and the safe swallowing plan was not followed which resulted in the person coughing. We observed staff supporting another person as their swallowing plan directed. We discussed this with the manager who told us that they would look at the reasons why staff had not been aware of the new swallowing plan and if necessary review the communication process.

People had their weight taken monthly. Any changes in a persons’ weight were investigated and referrals to GP’s and specialist professionals had been actioned. Food and fluid charts for people had been completed and monitored. People were offered a choice of meals.

On the ground floor people had a choice of where they wanted to take their meal. We observed people enjoying their lunch in the dining room, the lounge and in their rooms. Upstairs had more limited options for people as the lounge and dining room had limited space.

Staff had received induction training and on-going training that gave them the skills to carry out their role. They had individual supervision quarterly and also group supervision where practice was discussed.

We found that the service was working within the principles of the MCA. Care plans included details of a person’s ability to consent and where they were unable to best interest decisions had been made. The manager was aware of which people had a power of attorney in place and the decisions they could be involved in on behalf of their relative.

People had good access to healthcare.

We found the service was caring. Staff had a good knowledge of the people they were supporting. Staff were described as approachable, kind and patient. We observed staff having good positive interactions with people, laughing together and sharing friendly banter. People were supported to keep in touch with their families. Staff used picture cards and visual prompts to communicate with people who were not able to verbalise their needs or feelings.

People and their relatives felt involved in decisions and had access to an advocacy service. People had their dignity and privacy respected.

We found that the service was not always responsive. Assessments had been completed prior to people moving into the service and included information gathered from the person, their families and other professionals. People had care plans that were individual and clearly explained how people wanted to receive their care and support.

Staff demonstrated a good knowledge of the practical care needs of people and what they needed to do to support them. We found they did not always have an understanding of people’s likes and preferences.

Care plans described how people liked to spend their time. We saw that people living downstairs had the opportunity to be involved in socialising with staff and visitors in the communal lounge area. Some people who were less able to communicate were awake and alert and watched what was happening around them. People living upstairs did not have the same opportunities to sit amongst other people in a social setting. This meant that some people were not being protected from the risk of social isolation and loneliness.

Some people needed staff to support them with daily exercises for stiff limbs. Exercise programmes were in people’s rooms with diagrams demonstrating how staff needed to support people. Staff were carrying out the exercise plans and working with the occupational therapists.

An activities programme was in place that covered seven days of the week and required care staff to organise as part of their day. We were told that the service was in the process of recruiting a person to work full time as an activities co-ordinator. Some links with the community had been established.

Care plans were reviewed monthly or if changes were identified. Risks were understood by staff, discussed at handovers and actions agreed.

People and their families told us that they felt staff listened to them and took actions to put things right. A complaints process was in place and complaints were logged, investigated and the outcome fed back to the complainant including information on who to contact if they were unhappy with the outcome.

We found the service was not always well led. The service had not had a registered manager since 24 January 2011. A manager had been in post since May 2015. Their application for registration had not been submitted to CQC until November 2015.

Notifications were not always being sent to CQC. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them.

We observed senior staff communicating with each other and organising care staff to move to other parts of the service to provide support when it had been needed.

Staff meetings had been held monthly. Minutes included an action plan that was shared with the staff team. A staff survey had been completed in January 2016.

Relatives and staff told us the service was well managed. We observed a professional but relaxed relationship between the manager and staff team.

Audits had been completed by the manager which provided information on the quality of the service. They had highlighted any shortfalls, actions required and the person who needed to take the action, date action needed to be taken and notes on progress. A quality assurance survey had been sent to people and their families, other professionals and staff in June 2015. They had found the returns difficult to interpret and had made a decision to redesign the survey form so that it was easier to complete. The new form had been used in January 2016 to gather feedback from staff. We were told there was no confirmed date for the survey to be sent to people and their families and other professionals.

We found that staff sought various ways to gain consent to their care and treatment from people and they treated them with respect and dignity. Where people had difficulties in making decisions the correct procedures for acting in people's best interests were put in place. We looked at care records relating to people and found that people's wishes had been taken into account in planning their care, with the help of relatives if necessary. Care was delivered in a way that promoted people's independence.

Although staffing levels were generally adequate there was no member of staff responsible for co-ordinating activities for people which meant that this was left to staff to organise and we found that as such, there were few activities for people to do. Whilst most staff were experienced we found that some had little formal knowledge about the terms "safeguarding" and "whistleblowing", although we saw that they had received training in this.

We spoke with three people who were able to tell about their experiences of living in the home. We also spoke with two relatives and three members of staff. Several people had complex health needs and were unable to talk to us. One person told us they had "nothing but praise for the staff" and another said "they do their best".

We used the Short Observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed that people were in positive or neutral moods and frequently smiled with each other and staff. People freely approached staff and had good relationships with them. Staff gently redirected, reassured and supported people when they became unsettled.

People living at Highcliffe Nursing Home were very positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed.

People told us that they had good relationships with the staff, who were described as 'very caring'. They told us that the home was kept clean and warm. People said that the standard of food was good and there were activities to keep them occupied.

People who lived at Highcliffe Nursing Home benefited from thorough processes and procedures being followed when new staff are recruited, which meant they were protected from harm.

We saw the home had a robust quality assurance system in place to ensure standards were maintained.