High Pines Residential Home Limited

High Pines Residential Home is a residential care home providing personal care to 23 older people who may be living with dementia at the time of the inspection. The service can support up to 27 people in one large adapted building.

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

People told us, they were happy and safe living at the service. Potential risks to people’s health, safety and welfare had been assessed. There was guidance in place to mitigate risks.

Accidents and incidents had been recorded, analysed to identify patterns and trends. The registered manager was open and transparent when things had gone wrong. Action had been taken to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received supervision and training to develop their skills to meet people’s needs. Staff monitored people’s health and referred them to health care professionals when their needs changed. Staff followed the guidance given by professionals to keep people as healthy as possible. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to eat a balanced diet. People had access to activities they enjoyed and keep them as active as possible. People were treated with dignity and respect.

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 support this practice.

People met with the registered manager before moving into the service to check staff could meet their needs. Each person had a care plan that contained details of their choices and preferences. People had been involved as much as possible in developing them. People’s end of life wishes were recorded. Staff worked with GP’s and district nurses to support people at the end of their lives.

People were supported to express their views on the service. Complaints had been recorded and investigated following the provider’s policy. The environment had been developed to support people living with dementia. People were given information in the way they can understand.

Checks and audits had been completed on the quality of the service and action had been taken when shortfalls were found. The registered manager attended local forums to keep up to date with developments to continuously improve the service.

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 February 2019) and there were two breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulation.

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.

High Pines Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

High Pines Residential Home provides accommodation for up to 27 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 25 single bedrooms and one double bedroom which people can choose to share. There were 23 people living at the service at the time of our inspection.

The service had last been inspected on 14 and 15 February 2017 and was rated Good.

At the time of our inspection, there was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 with the CQC.

Risks to people had been assessed, however, there was not always clear, detailed guidance for staff to follow to mitigate the risks to people. This did not impact on people, as staff knew people and took action to keep them as safe as possible.

Checks and audits on the quality of the service did not identify and address shortfalls found during our inspection. For example, care plans were not always consistent, and lacked relevant information and risk assessments. When new staff were recruited to work at the service the relevant checks were not completed to ensure staff were of good character to work with people.

Staff understood how to recognise potential safeguarding concerns. The manager had made appropriate safeguarding referrals to the local authority safeguarding team. Accidents and incidents had been logged by staff, and the manager had oversight to ensure action had been taken to reduce the chances of it re-occurring.

People and staff told us there were suitable numbers of staff to meet people’s needs and keep them safe. Staff completed regular training to keep them up to date with guidance and best practice. Staff received supervision and appraisal to discuss their performance and personal development. Staff had received training in medicines administration, and supported people to receive their medicines safely.

The service was clean, and the provider had a programme of improvement to ensure it continued to be suitable to support people, some of who were living with dementia.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People had been supported to access healthcare services when necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and respected people's privacy and dignity. We observed positive and caring interactions between the staff and people. People told us they were comfortable and at ease with the staff.

People were engaged in meaningful activities they enjoyed. There was a leisure therapist employed who supported people to follow their faith.

Complaints had been documented and actioned appropriately by the manager.

The manager notified CQC about important events that had occurred. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. The provider had displayed the rating in the service.

People were engaged and involved in improving the service. People were involved in regular meetings to give feedback on the service.

People, relatives and staff gave positive feedback about the culture of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities). You can see what action we told the provider to take at the back of the full version of this report.

High Pines Residential Home provides accommodation for up to 27 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 25 single bedrooms and one double bedroom which people can choose to share. There were 24 people living at the service at the time of our inspection.

We last inspected this service in January 2016. We found the service was in breach of several regulations and required the provider to make improvements. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that improvements had been made.

The registered manager was not working at the service and had applied to the Care Quality Commission to cancel their registration. The registered provider was leading the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had improved the way in which they gathered feedback from people, their relatives and staff about the service. They had employed two care consultants and had acted on their advice and the people’s views to improve the service. The provider had oversight of the service. Staff felt supported and were motivated by them. They shared the provider’s vision of a good quality service. We would recommend that the provider seek the views of a wider range of stakeholders, including visiting professionals and commissioners.

At our last inspection we found that action had not been taken to make sure people medicines, were managed safely at all times. Action had been taken to manage people’s medicines safely and people received their medicines in the ways their healthcare professional had prescribed.

Previously we found records about people’s care including some medicines records were not complete. At this inspection we found that the quality of records in respect of each person had improved. Records were now accurate and complete.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At our last inspection we found that the conditions of one person’s DoLS had not been complied with. No one was the subject of an authorisation at the time of this inspection. People were not restricted and applications had been made to the supervisory body for a DoLS authorisation when necessary.

The requirements of the Mental Capacity Act 2005 (MCA) had been met. Staff supported people to make decisions and respected the decisions they made. When people lacked capacity to make a specific decision, decisions were made in their best interests with people who knew them well.

Detailed assessments of people’s needs had been completed since our last inspection and care had been planned with people to meet their needs and preferences. Staff followed the guidance in people’s care plans to provide consistent care.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People were offered a balanced diet and food they liked. People had enough to do during the day.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the provider. Complaints were investigated and responded to.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Checks had been completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff had completed the training and development they needed to provide safe and effective care to people and held recognised qualifications in care. Staff met regularly with a member of the management team to discuss their role and practice and were supported to provide good quality care.

High Pines Residential Home provides accommodation for up to 27 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 25 single bedrooms and one double bedroom which people can choose to share. There were 22 people living at the service at the time of our inspection.

A registered manager was in post and leading the service on a day to day basis. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager did not provide strong leadership to the staff and did not have oversight of all areas of the service. The registered provider was helping them to develop these skills. Staff were clear about their roles and responsibilities but checks were not completed to make sure they fulfilled these.

People were treated with dignity and respect. For example, staff explained the care and support people would receive before they received it and asked them what they would like staff to do and when.

The provider took action during our inspection to make sure there were enough staff, who knew people well, to meet their needs at all times. The needs of the people and skills of staff were considered when deciding how many staff were required on each shift.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were not consistently supported to provide good quality care and support. Staff met regularly with the manager to discuss their role and practice and any concerns they had; however, these meeting were not planned and staff did not have time to prepare for them. Staff did not get the maximum benefit from these meeting. A plan was in place to keep staff skills up to date. Some staff held recognised qualifications in care.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the provider or the local authority safeguarding team. Plans to keep people safe in an emergency were in place.

People’s needs had not been consistently assessed to identify the care they required, especially when their needs changed. Care and support was not planned with people and reviewed to keep them safe. Detailed guidance had not been provided to staff about how to provide people’s care. This had a limited impact on the care people received because people’s needs were generally known by staff.

People received the medicines they needed to keep them safe and well. Action had not been taken to make sure people received all their ‘when required’ medicines when they needed them. The side effects of medicines were not managed to minimise their impact on people. People were supported to attend health care appointments and to have regular health checks.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The conditions of DoLS authorisations had not always been complied with and there was a risk that people were not supported to go out when they wanted to. Applications had been made to the supervisory body where they were necessary.

Consent to care had been obtained from people. People who had capacity were supported to make decisions and choices. Processes were not in operation to assess if people were able to make decisions. Decisions were made in people’s best interests when they were not able to make the decision themselves. The requirements of the Mental Capacity Act 2005 (MCA) had not been fully met.

The activities offered at the service did not meet everyone’s preferences and most people were not involved in planning the activities on offer. The provider was looking to recruit a new activities coordinator to work at the service.

The provider had recognised that possible risks to people had not been consistently identified and was putting new processes in place to assess and manage the risks to people. This included a new process to look for accident patterns and trends.

People told us they liked the food at High Pines. They were offered a balanced diet that met their individual needs, including low sugar diets for people who wanted them. A range of foods were on offer to people each day and people were provided with regular drinks to make sure they were hydrated.

People and their representatives were confident to raise concerns and complaints they had about the service with staff and had received a satisfactory response.

Regular checks on the quality of the service people received had not been completed to make sure that it was to the required standard. Shortfalls had not been identified so they could be addressed to prevent them from happening again. People, their representatives and staff had been asked about their experiences of the care but this had not been used to improve the service. Views shared with the manager had not been consistently acted on and not everyone had received feedback about the action taken to address the issues they had raised.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place. Appropriate equipment was provided to support people to remain independent and keep them safe. Safety checks were completed regularly.

Records kept about the care and support people received were not always accurate and up to date.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We made some recommendations to improve practice including that the provider seek advice and guidance from a reputable source about effective systems to assess people’s capacity to make decisions and review the application of their staff supervision and support processes.

We met with four relatives of people that used the service and spoke with one relative on the phone. All the relatives we met offered us their views about aspects of the service provided. Relatives told us that the manager and staff cared about their relative. They told us they thought their relative was safe and looked after well. One relative made the comment that they, "...could not have picked a better place".

We spoke with two visiting health care professionals. Both of these people said that the service worked well with them and that the service had provided good quality care. One of these people said that staff were, "Kind and thoughtful" and that they were managed very well.

Care and support that we observed respected the individuality, wishes and dignity of those to whom it was provided. We saw staff delivering care and support in a timely way and which met the needs of people who used the service.

We saw that there has been investment in improving the standard of accommodation and that these works had been managed safely.

The atmosphere in the home was relaxed and calm and people were chatting with staff and other people using the service.

People told us they were very happy living at High Pines and there was always enough staff on duty and they responded quickly when they needed them.

Relatives were satisfied with the service and would recommend the home. They said that the staff were polite, respectful and caring and there was always enough staff on duty.

Relatives told us that they were involved with the care of their relative and had visited the home before decisions were made to move in.

Staff said they felt supported by the Registered Manager who often worked alongside them providing care to the people