The Care Quality Commission
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Highwood Mill Extra Care Scheme

Overall: Requires improvement read more about inspection ratings

The Office, Highwood Mill, The Boulevard, Horsham, RH12 1GF

Provided and run by:
Care Outlook Ltd

All Inspections

During an assessment under our new approach

Date of assessment: 27 November to 5 December 2024.

Highwood Mill is an extra care housing scheme providing personal care to older people and adults with a range of needs, including dementia, physical disabilities, and sensory impairments. Although the service was not supporting any autistic people or people with a learning disability at the time of inspection, we still assessed the service against the principles of Right Support, Right Care, Right Culture. This is because the provider is registered to support people with these needs, and must be able to demonstrate that its culture, model of care and governance would enable safe, person‑centred, rights‑based support should someone with these needs move into the service.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented or owned and is the occupant's own home.

At the time of our inspection there were 41 people receiving personal care using the service.

This was a risk-based assessment following concerns raised with us about medication management, staffing levels, and governance.

The provider was previously in breach of regulations relating to safe care and treatment (medicines management and risk oversight) and governance. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

The provider did not always ensure safe care. We found repeated medication errors, incomplete records, and gaps in oversight. Systems for monitoring medicines and risks were not robust, creating potential harm.

Staffing levels were not always sufficient, particularly at night when one care worker was responsible for everyone in receipt of personal care. Reliance on agency staff affected continuity and oversight.

Governance arrangements were not robust. Audits and care records were inconsistent, limiting the provider’s ability to identify and act on risks.

Care planning was not always comprehensive or up to date to enable staff to provide safe consistent support. Some plans lacked detail about preferences and end-of-life wishes.

Improvements had been made since our last inspection, including introducing shift leads and competency checks, but these were recent and not fully established

People were generally positive about staff being kind and respectful, and we saw examples of care that promoted independence and choice. Adaptations such as adjustable kitchen units provided by the housing provider and not Highwood Mill supported people to live more independently.

We have asked the provider for an action plan in response to the concerns found at this assessment.

 

1 November 2022

During a routine inspection

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.