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Highfield Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 23 November 2018

This unannounced inspection took place on 19 September 2018 and 08 October 2018. During our last comprehensive inspection on 02 August 2017 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to keeping people safe, personalised care and support, dignity and governance. We rated the service requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions, Safe, Effective, Caring, Responsive and Well-led to good. At this inspection we found that not all the areas we previously found not meeting the required standards were improved.

Highfield Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Highfield Care Home is a purpose-built care home and is registered to provide accommodation and personal care for up 54 older people some of whom are living with dementia. At the time of our inspection 42 people were living at Highfield Care Home.

There was a recently employed manager in post, however they were not registered at the time of the inspection. 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.

People we spoke with told us they felt safe in the home. Relatives told us they felt that the care people received was safe. However, we observed, during the inspection that staff did not always follow guidance given by health professionals for people who needed assistance with their meals because they were at risk of choking.

Risk assessments had been completed and were regularly reviewed. However, when staff completed risk assessment tools to ascertain the level of risk presented to people the scores were not added up correctly and were not consistently reflected in assessment of need care documents or care plans. This meant that there was a risk people did not have the appropriate measures in place to mitigate the identified risks.

People told us that there were less staff over weekends and on occasions they had to wait long period of times for staff to answer their call bells. This was confirmed by relatives who told us that at the weekends there was always a shortage of staff. Staff members we spoke with told us there were not enough staff deployed to meet people`s needs in a timely way. Our observations confirmed that staff were stretched and busy which led to some people`s support being carried out in a rush.

People told us staff were kind and caring and protected their dignity and privacy. Care plans were developed and were reflective of people`s likes, dislikes and preferences, however not all care plans we reviewed had been updated following a change in people`s needs. Care plans contained a high level of information that was not helpful for staff and it did not give sufficient guidance in how staff should meet people`s needs in a personalised way.

Where people were identified at risk of malnutrition or dehydration and required their food and fluid intake monitored, this had not been done effectively. Where people used their own mobility equipment risk assessments were not developed and assessments were not carried out by the provider to ensure the equipment was suitable and in good working order as well as used correctly by people.

Safe and effective recruitment practices were followed to ensure that staff working at the home were of good character and suitable for the roles they performed.

People received their medicines safely and had access to healthcare prof

Inspection areas

Safe

Requires improvement

Updated 23 November 2018

The service was not always safe.

People told us they felt safe, however we observed that at times the care and support people received had not promoted their safety.

People told us on occasion they had to wait a long period of time for their call bells to be answered and mainly over weekends there was a shortage of staff.

Risk assessments were developed following the completion of a risk assessment tool, however scores were not added up correctly and this could have affected the measures put in place to mitigate risks for people.

Risks involved in people using their own electric wheelchairs was not assessed and there were no processes in place for the provider to assure themselves that these were regularly serviced and safe to use in the home.

Staff were knowledgeable about the risks of abuse; however, some staff were not aware of the whistleblowing policy and external safeguarding authorities they could report concerns to.

Recruitment procedures were robust and ensured there were suitable staff working at the home.

Medicines were administered safely by appropriately trained staff. There were infection control procedures in place to prevent the spread of infections.

Effective

Requires improvement

Updated 23 November 2018

The service was not always effective.

Staff told us that the last few months were unsettling for them with all the management changes and they did not feel supported by the provider.

Staff received induction training when they started working, however annual refresher training considered mandatory by the provider had lapsed for a considerable number of staff.

Mental capacity assessments were carried out to establish if people had capacity to understand and take decisions regarding the care and support they received, however best interest processes were not always followed.

People told us they were happy with the quality of the meals provided.

People had access to health care professionals when there was a need for it.

Caring

Requires improvement

Updated 23 November 2018

The service was not always caring.

Care was provided in a way that promoted people’s dignity and respected their privacy, however some systems used supported institutional practice.

People were looked after in a kind and compassionate way by staff who knew them well and understood their individual needs.

People told us they did not know about their care plan and they were not involved in any reviews of their care.

Responsive

Requires improvement

Updated 23 November 2018

The service was not always responsive.

People`s care plans were detailed about their likes, dislikes and preferences regarding their care, however some systems and daily routine staff followed restricted them to provide personalised care.

People who were more independent were supported to pursue their hobbies and interest however activities for people who needed staff`s support to help them engage were limited.

People`s end of life care needs were assessed.

People and their relatives felt confident to raise concerns with staff.

Well-led

Requires improvement

Updated 23 November 2018

The service was not always well-led.

A manager was recruited and started at the service a few weeks prior to this inspection, however they were not registered with the Care Quality Commission (CQC).

Quality assurance systems in place were used by the staff and provider to carry out audits, however little improvements were seen since the previous inspection.

There were regular meetings organised for people and staff. Staff found these helpful, however people told us that often they could see no improvement on issues they reported in these meetings.

People, their relatives told us that overall, they were happy with the service, however they did not know who the manager was currently.