Highview Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Relatives confirmed initial discussions were held with the provider and with a representative from the local authority where appropriate. Staff completed an assessment of their family member’s care and support needs. Visits to Highview Lodge were conducted to enable the prospective person and/or their relative to view the premises, to meet staff and others living at the service.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People’s and relatives’ comments about the quality of the meals provided were positive. Comments included, “The food is very good”, “The food has got a lot better. There is always plenty of vegetables and fruit” and “I like the food; staff are aware of my likes and dislikes. There is plenty of choice.”

The dining experience across all units was positive. Staff showcased food choices through ‘show plates’ by allowing people to choose their meals at the point of service. Meals were well presented, considering people’s individual food and dining preferences. For example, if they favoured a big or small plate of food, specific favourite food items and if they required specialist equipment, such as adapted cutlery, crockery and plate guards. Where people required staff assistance this was provided in a respectful and dignified manner. People were not rushed to eat their meal and received verbal encouragement and prompting from staff where they experienced a reduced appetite or difficulties with swallowing.

Where people were at risk of poor nutrition, their weight was monitored at regular intervals and appropriate healthcare professionals, such as dietician and Speech and Language Therapy Team [SALT], were consulted for ongoing advice and support.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Information demonstrated the service worked with others, for example, the Local Authority, healthcare professionals and services to support people’s ongoing care provision. Staff told us they had the information they needed to support people. The manager and staff confirmed daily handovers took place. Effective staff handovers ensure continuity of care, facilitate the transfer of essential information, details staff responsibilities and accountability between shifts, allowing staff to be well-informed about each person’s needs and any relevant updates.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to healthcare services when they needed it and confirmed their healthcare needs were met. A person who used the service told us they had had a recent blood test following advice by their GP. People also confirmed a weekly GP surgery was held at Highview Lodge, and they had access to a chiropodist. Relatives confirmed staff were responsive to people’s healthcare needs and were kept up to date about their family members needs and the outcome of health-related appointments.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

An electronic software system was being used for care planning. Staff used handheld devices to access people’s care records and record the day-to-day support people received. People’s care needs were reviewed regularly each month as a minimum and in between if a person’s needs had changed. However, we found that information relating to a person’s mobility needs following their readmission to the service from hospital was incorrect and not accurately recorded. This can be confusing for staff and affect the overall quality of the care provided including inappropriate management of the person’s mobility needs. Following our feedback, the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed all people’s mobility needs had been reviewed and reassessed to ensure the information was accurate. We will check on improvements the provider said they are making when we next visit the service.

Although there were arrangements in place to monitor people’s weight, food and fluid intake, records relating to the latter were not always consistent with targets set within their individual care plan. The fluid intake for some people were below recommended quantities, either because people had not received sufficient fluids or because the monitoring system was not accurately reflective of what had been given by staff. Following our feedback, the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed a full review of people’s weight, Malnutrition Universal Screening Tool [MUST] to identify people who were at risk of malnutrition, and food and fluid intake records had been undertaken.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The Mental Capacity Act 2005 [MCA] provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards [DoLS].

Staff did not demonstrate sufficient knowledge and understanding of the key requirements of the MCA and how this affected people using the service. We found the service was not fully working within the principles of the MCA. Assessments relating to people’s capacity were not routinely completed and recorded. Capacity assessments are important so as to understand a person’s ability to make decisions, whether these are day-to-day or more complex. Legal authorisations were in place to deprive a person of their liberty but had not always been applied for in a timely manner. Where people had an authorised DoLS order in place with conditions imposed, there was no evidence to demonstrate these had been reviewed and actioned to ensure compliance with the Mental Capacity Act. Following our feedback, the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed a full review of MCA’s and DoLS would be undertaken. A further update from the provider confirmed an MCA and DoLS tracker had been implemented, DoLS completed and forwarded to the local authority, with care plans updated accordingly. We will check on improvements the provider said they are making when we next visit the service.

However, staff understood the need to gain consent from people for care and to encourage people to make decisions for themselves wherever possible. For example, enabling people to make choices involving the times they got up in the morning and the time they went to bed, whether to participate in social activities, and where to have their meals.