Background to this inspection
Updated
10 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.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. 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
This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
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 manager registered with the service, the registered manager had resigned. A new manager had been in post for two months and had submitted an application to register with us. We are currently assessing this application.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 1 November 2022 and ended on 9 November 2022. We visited the location’s office on 1 November 2022 and 4 November 2022.
What we did before the inspection
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 reviewed information we had received about the service since their registration. We used all this information to plan our inspection.
During the inspection
During the inspection we observed interactions with people and staff throughout the day. We spoke with five people who used the service about their experience of the care provided and five relatives of people who use the service. We spoke with three health and social care professionals who regularly visited the service. We spoke with nine members of staff including the regional manager, manager, deputy manager and care staff.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.
Updated
10 December 2022
About the service
Highwood Mill is an extra care housing setting where staff provide personal care and support to people living in their own flats within one large purpose-built building. People are supported with a range of needs including learning disabilities, age related frailties, physical disabilities, dementia, and Parkinson's disease. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 46 people who were using the service received a regulated activity.
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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection one person was living at the service who had a learning disability. We spoke with the person, who told us they were pleased with the care and support they received.
People’s experience of using this service and what we found
Right Support
Known risks associated with people's care were not always well-managed. Some people's risk assessments did not provide staff with the information they needed to keep people safe. Some people’s medicines were not always managed safely.
The model of care and settings maximised people's choice and independence, people had their own apartments which were adapted to suit their needs and taste. People were supported by staff to pursue interests and hobbies, staff supported people to achieve their aspirations and goals.
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.
Right Care
People received kind and compassionate care by staff who knew them well. Staff respected people's privacy and dignity and, promoted their independence. There were enough skilled and trained staff to meet people's needs. People received consistent care as understood their individual communication needs.
Right Culture
Systems to monitor the quality and safety of the service and to drive improvement were not always effective. The service had a registered manager who had recently resigned, a new manager was overseeing the management of the service with the support of the regional manager. The management team recognised improvements were needed at the service and showed a willingness to improve. People and staff told us there had been an improvement in communication and morale since the appointment of the new manager.
People led inclusive lives and felt in control of their support. Staff knew and understood people well and supported their aspirations to live a quality life. Staff and management encouraged, listened to and acted upon people's views and wishes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 5 April 2022 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about medicine management and the management of risks. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
The provider responded to our concerns throughout the inspection and immediately put measures in place to improve medicine management, the management of risks and quality assurance processes.
You can see what action we have asked the provider to take at the end of this full report.
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.