Highfield Hall

About the service

Highfield Hall is a residential home. They were providing personal care to 18 people at the time of the inspection. The service supports adults with learning disabilities and autism.

The home is divided into three units, the Hall, Abbey View and Kingston each providing bedrooms, a lounge/dining area, kitchen and a bathroom. People had access to a large garden area and an allotment.

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

Right support

People were not always supported by staff to pursue their interests.

People did not always receive care and support in a safe, clean, and well-maintained environment.

Staff enabled people to access specialist health and social care support in the community.

Right Care

The service did not always have enough appropriately skilled staff to meet people’s needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People did not always lead inclusive and empowered lives because there was not always enough staff on duty to support them.

Staff did not ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 requires improvement published 15 April 2020. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to regulation 12, Safe care and treatment and regulation 17, Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

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

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

Highfield Hall is a residential care home providing personal and nursing care to 20 people with a learning disability at the time of the inspection. The service accommodates up to 21 people.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people. 20 people were using the service. This is larger than current best practice guidance of Registering the Right Support. People lived across three separate units and a semi-independent cottage, each of which had separate adapted facilities, with no more than eight people living in each unit. The provider had started to work towards meeting best practice guidance and were looking at ways to support people to access the community more often. Staff understood the importance of supporting people when they needed it, whilst prompting people to make their own choices.

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

Improvements were needed to ensure the systems in place were always effective in monitoring and mitigating risks to people. Records did not always reflect people’s needs and preferences.

Improvements were needed to ensure people were consistently safeguarded from the risk of harm when unexplained injuries had occurred.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support because there was limited inclusion within the community. People accessed activities within the grounds of the service. However, relatives and staff told us people were not consistently supported to access the community. The provider had recognised this and there were plans to increase social opportunities for people.

Improvements were needed to ensure there was guidance available for staff when they supported people with their topical medicines. There was a system in place to assess staffing levels in line with people’s needs. However, improvements were needed to ensure there were enough staff available to support people at busy periods such as mealtimes.

The provider used safe recruitment practices and people were supported by staff who knew how to support them to lower their risks, whilst promoting their independence. People were supported with their nutritional needs, and advice was sought from healthcare professionals to maintain people’s health and wellbeing.

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. Staff understood people’s individual ways of communicating and information was available to people in an accessible format.

People were supported by caring staff that supported people with patience. People’s choices were respected and their right to privacy was up held. Relatives understood how to make a complaint and there was a system in place to investigate and respond to complaints received.

People, relatives and staff found the registered manager was approachable and supportive. The registered manager worked with other professionals to ensure people’s needs were met. The provider had a system in place to gain feedback from people, which was acted on to make improvements to the care received.

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 requires improvement (published 14 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection visit took place on the 27 and 28 June 2017 and was unannounced. At the last inspection on 24 August 2016, the service was rated as requires improvement. We made a recommendation that the provider should review their staffing levels against people’s individual needs to ensure there are sufficient staff at all times. Improvements were also needed to ensure the staff followed legislation when they supported people with decision making and to ensure the systems used to monitor the quality of the service were consistently effective. At this inspection visit we found the provider had made improvements however some further action was still needed.

Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities. The service is provided in three units which comprise Abbey, Kingston and the main Hall. One the day of our inspection visit, 20 people were living at the home.

There had not been a registered manager at the service since February 2016. However, the acting manager had recently applied to register with us. 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.

People received their medicines when they needed them. However, some improvements were required to ensure the systems used to monitor the recording of medicines were effective in identifying and correcting inaccuracies. People and their relatives were asked for their views on the service but there were no systems in place to demonstrate how this feedback was used to make improvements in the service.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and acting manager. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. The provider ensured there were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed. Staff felt supported and valued by the acting manager.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Staff acted in accordance with the legal requirements where people were unable to make their own decisions.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People had sufficient amounts to eat and drink to maintain a healthy diet. People were supported to access the support of other health professionals to maintain their day to day health needs.

People received personalised care from staff who knew their preferences and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

This inspection visit took place on the 24 August 2016 and was unannounced. At the last inspection on 19 October 2015, the service was rated as Requires Improvement. We asked the provider to make improvements to ensure that where people lacked capacity, any decisions made on their behalf were made in their best interest and in accordance with the legal requirements. Improvements were also needed to ensure the systems used to monitor the quality and safety of the service were effective in identifying shortfalls and driving improvements. The provider sent us an action plan which said that the legal requirements would be met by 31 January 2016. At this inspection visit we found that some progress had been made, but further improvements were still required. We also found improvements were needed in the systems used to calculate staffing levels and the management of medicines.

Highfield Hall provides accommodation and personal care for up to 21 people with learning disabilities. The service is provided in three units which comprise Abbey, Kingston and the main Hall. One the day of our inspection visit, 20 people were living at the home.

There had not been a registered manager at the service since February 2016. There was an acting manager who had been covering the registered manager’s absence but they had not yet registered with us. 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 provider had made some improvements to show that where people lacked the capacity to make certain decisions and where people were being restricted to keep them safe, this was in their best interests and followed the legal requirements. However, further work was needed to demonstrate that people’s rights were consistently being upheld.

The provider had made some improvements in the systems used to assess and monitor the quality and safety of the service, but further action was needed to ensure shortfalls were consistently identified to bring about the required changes.

At times, we saw that staff were busy with housekeeping tasks and did not always have time to interact with people. We have made a recommendation about the way staffing levels are calculated and deployed by the provider. Staff received training to gain the skills and knowledge to meet people’s needs but did not always feel supported in their role because the acting manager was not always accessible to them.

People received their medicines as needed but improvements were needed to ensure that the administration of topical creams was accurately recorded.

Staff had caring relationships with people, respected their individuality and promoted their privacy and dignity. People were encouraged to be as independent as they wanted to be and had opportunities to follow their hobbies and interests and engage in activities both inside and outside of the home. People were supported to have food and drink which met their individual needs and preferences. Staff supported people to access other health professionals to maintain good health.

People and their relatives were asked for their feedback on the service and the provider made improvements where needed. There was an accessible complaints procedure and people were supported to raise any concerns or complaints.

People had individual care records which informed staff of how people wanted to be supported and were written in a style that people could understand.

We saw that some people using the service were encouraged to be independent and helped with cooking, making drinks, and looking after their home. We saw other people were not given the same opportunities and their independence was not always promoted.

We saw people were comfortable in the presence of staff and people told us they were happy with the care and support. Some people were not asked how they would like to be supported and people were not always treated with dignity and their care did not reflect their diversity.

We found that people were able to choose how to spend their time and what activities to be involved with. People could choose to socialise with other people or spend time alone.

There were systems were in place to identify and report any concerns about people's safety.

We saw that staff treated people with respect and choices were offered and people's views had been taken into consideration. We saw personal care was not always addressed promptly to ensure people remained clean.

The routines and daily activities were flexible and staff responded to people's needs. The staffing was provided to ensure people were able to carry out planned activities. We saw people chose what to do and where to go and were provided with support from staff to keep safe.

People said if they had any concerns they would discuss them with members of staff or the manager and they were happy with the support they received.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

We found that medication systems were safe and that medication had been given to people as it had been prescribed by their doctor.

The care records were being reviewed to ensure they contained all the information about how people wanted to be supported.