Highwood Mill Extra Care Scheme

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant people’s needs were not always met.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider aimed to deliver person-centred care, but this was not always consistent. Some people told us their preferences were respected, such as choosing female carers for personal care, but others reported repeated failures to honour these choices. One person said, “I kept telling the office I wanted female carers. They said they’ll sort it out.” At the time of the assessment this had been addressed.

However, care plans were not always up to date, and some lacked detail about preferences, which increased the risk of care not being delivered in line with people’s wishes. For example, there was evidence of ineffective reviews. People still had information about how they should socialise during the COVID pandemic. This was neither person centred or up to date information.

Staff demonstrated good knowledge of individual needs and life histories, and we saw examples of personalised support. For instance, a staff member described supporting a person by encouraging independence during showering and dressing, while respecting their preferences for clothing choices.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People experienced variable continuity of care. Some praised regular carers and said, “They know me well and never rush.” Others reported frequent use of agency staff, which affected consistency and trust. The provider acknowledged staffing shortages and reliance on agencies, although steps were being taken to use regular agency workers and improve oversight.

Care plans were generally detailed, but some were not updated promptly when needs changed. The provider had introduced medication trackers and competency checks to improve safety and continuity.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were not always given timely information about changes to their care. Several people told us carers arrived outside agreed times without explanation, which impacted their routines and independence.

The provider had systems to share information, including care logs and communication books, but these were not always used effectively. For example, information in care logs was sometimes not detailed enough and were too generic. Improvements were underway, including better documentation and staff training on communication standards.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

While some people felt listened to, others said concerns were not acted on promptly. One person told us, “I keep asking for a timetable so I know who’s coming, but they don’t do it.”
Staff described encouraging independence and involving families in care planning. For example, relatives were consulted for people lacking capacity, and staff used accessible tools such as picture boards where appropriate, for those with communication needs.

The provider told us they had a complaints process in place, and we saw evidence where complaints had been logged and the outcome recorded.

We saw evidence of feedback surveys being sent out to people and their relatives. These surveys were collated and an action plan was created. This showed the feedback and actions required and by what date.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. People generally accessed care when needed, but delays and missed calls were reported, particularly at weekends when management presence was limited. The provider had implemented support if needed and on call member of staff was available at short notice.

People were supported by staff to attend medical appointments where required.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Other people told us that they didn’t always receive care at a time that suited them, often without explanation or agreement. Some people couldn’t get on with their day until care had been provided.

However, some people did experience positive outcomes through using the service. We found evidence of a person who required consistency, to be receiving the same carer, at the same time each day, and the carers followed a predictable routine.

Staff had completed training in equality and diversity.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

None of the care plans we reviewed contained information about people’s goal or aspirations for the future. This meant people were at risk of not leading fulfilling lives and choosing how they would like to be treated at the end of their lives.

Some plans we reviewed did not contain clear or detailed information about how people wish to be cared for at the end of their life or if discussions had taken place. This meant people’s wishes may not be met at the end of their life and may end up being less dignified.

Care plans did indicate if a DNACPR (Do Not Attempt CPR) was in place but with no supporting documentation about how this decision was made. Some people had ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms in place, but some did not.