Background to this inspection
Updated
3 February 2024
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 3 inspectors including a medicines inspector. There was also a Specialist Advisor (SpA). A SpA is a person with specialist knowledge to support inspections. An Expert by Experience also supported the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Highfield Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Highfield Court is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We used all this information to plan our inspection.
During the inspection
We spoke with 13 people who lived at the home. We spoke with 9 members of staff including the registered manager, audit and compliance officer, 1 team leader, 4 care workers and 2 activity coordinators. We also spoke with 4 visiting health and social care professionals.
We reviewed 10 people's care plans, medicines records, accident and incident records and safeguarding records. We also reviewed records relating to training, 3 recruitment files, quality assurance and feedback and complaints. Following the site visits, we gained feedback from 1 health and social care professional. We also reviewed the training matrix, staff rotas and dependency tool sent to us by the registered manager.
Updated
3 February 2024
About the service
Highfield Court is a care home providing personal care to up to 59 people. The service provides support to people who have a learning disability and autistic people. Some people also have mental health needs. The accommodation is divided into 22 separate bungalows. Some people live alone, and others live in small groups. At the time of our inspection there were 39 people using the service.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of the service and what we found:
Right Support: People were not supported to receive their medicines in a safe way. People’s risks were not managed in a safe way. Systems and processes in place to safeguard people from the risk of abuse were not effective. People were not protected from the risk of infection. The provider did not ensure there were enough staff available. The provider had failed to ensure appropriate decision-specific mental capacity assessments were carried out. The service did not ensure staff had the skills, knowledge, and experience to deliver effective care and support. People’s needs were not always understood and supported. People were not always supported to develop and maintain relationships, follow their interests, or take part in activities that were relevant to them.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Right Care: People’s needs were not always assessed; care and support were not always delivered in line with current standards. The provider did not always support people to achieve effective outcomes. The provider did not always ensure the service worked effectively within and across organisations to deliver effective care, support, and treatment. People’s individual needs were not always met by the adaptation, design, and decoration of the premises. People were not always supported to eat and drink to maintain a balanced diet, although people told us they liked the food. People were not always supported to express their views and involved in decisions about their care. People were not always well supported and treated with respect by staff. People were not always supported as individuals or in line with their needs and preferences. People’s end of life care needs were not always assessed.
Right Culture: People were not always supported to express their views and involved in decisions about their care. People were supported by a service which was not safe. People were not routinely and consistently protected from risks and avoidable harm. While people were asked for feedback in resident meetings and through surveys, the provider’s response to feedback led to 1 person being excluded from communal activities. The registered manager understood when things went wrong it was their legal responsibility to be open and honest. However, we identified missed opportunities for learning by the provider and registered manager because quality checks were not always effective. People, and those important to them, could raise concerns and complaints.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 28 June 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the provider remained in breach of regulations.
Why we inspected
The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by the CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of people’s risks. This inspection examined those risks.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to managing people’s risks and environmental risks, assessing people’s mental capacity, safe recruitment of staff, delivering person centred care, and the governance of the care home.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow Up
The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.