The Highgate Care Home

Updated 16 December 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

The Highgate Care Home 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. The Highgate Care Home is a care home with 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

This 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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with three people who live at the home and one visiting relative about their experience of the care provided. We spoke with 12 members of staff including the registered manager, deputy manager, four nurses, three care workers, the administration officer, the housekeeper and the chef. We also observed staff engaging with people who live at the home. We spoke with two health and social care professionals who support people living at the home.

We reviewed a range of records. These included five people’s care records. We looked at nine staff files in relation to recruitment, staff supervision and training. A variety of records relating to the management of the service including policies and procedures and quality monitoring audits were also reviewed.

Updated 16 December 2022

About the service

The Highgate Care home is a residential care home providing personal and nursing care to people with complex physical and cognitive support needs at the time of the inspection. The service can support up to 52 people in four separate units with their own communal areas and facilities. At the time of our inspection 41 people were living at the home.

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

At our last inspection people with complex physical needs were using a lift situated in a service adjoining the home as the lift at the home could not accommodate stretchers and some specialist wheelchairs. The provider had taken action to address this and work on installing a new lift has now commenced.

People had person centred care plans and risk assessments. These were up to date and included information about their needs and preferences along with detailed guidance for staff on how to provide effective and responsive support. Where people’s needs had changed, their care plans and risk assessments had been reviewed and updated immediately.

Improvements had been made to the food provided to people on soft or pureed diets due to choking risks. Staff had received training on modified diets and were required to taste food and check if the texture is suitable before offering it to people. People told us they enjoyed the food and were offered choices.

People’s medicines were stored and administered safely. Medicines were administered by nurses and senior care workers. The records of medicines administration had been completed appropriately and guidance was in place for medicines that were provided on an ‘as required’ basis. Some people who were unable to swallow received medicines via a feeding tube. Their records showed that such medicines were administered following professional guidance. Staff administering medicines via a tube feed had received training.

People were protected from the risk of harm or abuse. Staff members had received safeguarding training and knew what to do if they had concerns about a person’s safety. The home’s records of safeguarding concerns showed that appropriate actions had been taken to reduce the possibility of similar concerns arising in the future. Safeguarding concerns had been reported to the local authority and the Care Quality Commission (CQC).

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 were recruited safely and received the training and support they needed to do their job well and to effectively meet people's needs.

The home’s quality monitoring systems showed regular audits had been carried out. These included audits of care plans and risk assessments, medicines, infection control, and safety at the home. Actions had been taken to address any concerns identified by these audits. The provider made unannounced monitoring visits to the home. The registered manager and deputy manager undertook unannounced monitoring visits at night. This ensured the provider and the registered manager were able to maintain safe practice at the home.

Infection prevention and control measures and practices were in place to keep people safe and prevent people, staff and visitors catching and spreading infection.

The registered manager was supported by a deputy manager and a team of nurses and senior care workers. Staff, people and their family members told us they were satisfied with the management of the home.

Staff engaged with external health and social care professionals to ensure people’s needs were met. They held regular meetings with a multi-disciplinary team of professionals to discuss and address people’s immediate and ongoing needs. A local GP visited the home twice weekly.

People and relatives spoke positively about the care and support provided by staff.

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 7 May 2021).

Why we inspected

The inspection was prompted in part by notification of an incident two years ago, following which a person using the service died. This incident is subject to further investigation by 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 risk of death or injury caused by choking. This inspection examined those risks.

This report only covers our findings in relation to the Key Questions Safe, Effective, and Well-led.

The rating from the previous comprehensive inspection for the key questions not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Highgate Care Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.