Highview Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to safe care and treatment. Risks to people’s safety were not always identified and recorded or safe.

This service scored 59 (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 routinely have a proactive and positive culture of safety, based on openness and honesty. Although, staff reported safety events, lessons were not always learnt to continually identify and embed good practice.

Staff had not always followed the correct procedure, as detailed in the providers falls policy, following a falls incident of people using the service. A robust and detailed investigation had not been completed by the previous management team. The investigation report viewed at the time of our assessment failed to identify procedures had not been followed by staff and the actions required to ensure lessons were learned. Lessons learned were not always shared with staff, either individually or raised in handovers and staff meetings. Following our feedback the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed the actions to be taken, by the management team, to review and re-examine the service’s accidents and incidents, ensuring these were appropriately analysed, validated and lessons learned. A further updated Service Improvement Plan confirmed a full review of the service’s accident and incident records was now completed and action would be taken to ensure these were continually monitored and shared with staff. We will check on improvements the provider said they are making when we next visit the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and associated risk assessments. The peripatetic manager told us about the service’s assessment and admission process. They told us people’s care and support were planned where possible with the person, those acting on their behalf and other key partners to ensure continuity of care. A relative confirmed they had been actively involved with their family member’s admission to Highview Lodge, stating that the assessment undertaken by the service was thorough and they had been given the opportunity to view the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Improvements were required to ensure all safeguarding investigations were robust and detailed, demonstrating all elements of concern raised were investigated. There was a lack of evidence to demonstrate how some decisions, actions taken, and outcomes had been reached as not all supporting evidence was readily available.

People and their relatives considered themselves and their family member to be safe. A person using the service told us, “Yes, I feel safe, they [staff] all look after me here.” Relatives told us, “I am much more relaxed knowing [Name of person using the service] is safe here” and “[Name of person using the service] is safe, never seen or heard anything unpleasant.”

The provider and peripatetic manager were aware of their responsibility to notify us and the Local Authority of any allegations or incidents of abuse. Staff had completed appropriate safeguarding training. Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. Staff told us they would escalate any concerns to the provider, manager, Local Authority or Care Quality Commission. A member of staff told us “If I heard or saw any abuse, I would report it to my line manager.”

The provider did not ensure all risks to people’s safety and wellbeing were identified or provided enough detail as to how these should be mitigated.

We observed 2 separate incidents during the first day of our visit whereby staff, including a senior member of staff, performed unsafe moving and handling practices. This referred to staff putting a person using the service at potential risk of harm by placing their hands under the person’s underarms when assisting them with transfers from their comfortable chair to a wheelchair and vice versa. This practice is unsafe and can cause the person to experience discomfort and injury. Following our feedback, the provider immediately arranged for moving and handling competencies to be conducted with staff. This continued on the second day of our assessment.

Where people could become anxious, distressed and exhibited behaviours that could place themselves and others at risk of harm, their risks management plans did not provide enough details on how to support people safely. Where people were assessed to be at risk of dehydration and required their fluid intake to be monitored and recorded, records demonstrated their fluid targets were not always maintained and there was a lack of evidence to show what was being done to monitor and address this. A person’s care plan referred to them living with the medical condition of diabetes. A risk assessment detailing early intervention and management strategies to reduce the risk of complications with this medical condition were not recorded. The potential risks associated with catheter care were not routinely identified and recorded for 1 person who used the service. A catheter is a medical device used to empty the bladder and collect urine in a drainage bag. Prior to the inspection team concluding this assessment, the person’s care plan and risk assessment was reviewed and updated to accurately reflect their care needs.

Personal Emergency Evacuation Plans [PEEP] were evident for each person. However, not all plans viewed accurately reflected people’s needs, had considered and identified people’s physical and neurological needs which would affect their ability to evacuate, their ability to communicate and understand instructions and where they could be anxious and distressed. A PEEP is a bespoke ‘escape plan’ for individuals who may not be able to reach a place of safety unaided or within a satisfactory period in the event of a fire emergency.

Limited records were available to demonstrate regular fire drills for night staff were being conducted at Highview Lodge.

The Service Improvement Plan submitted to the Care Quality Commission confirmed staff’s competencies relating to moving and handling had been assessed and additional training provided. The plan also confirmed all care plans, including risk assessments would be evaluated, revised and updated. A further update was later provided confirming each person’s care plan and risk assessments had now been reviewed and updated. All PEEPs were reviewed and amended and fire drills completed. We will check on improvements the provider said they are making when we next visit the service.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and relatives did not express any concern in relation to the safety of the environment.The service was decorated and furnished to a satisfactory specification. People had personalised rooms which supported their individual needs and preferences. There were different areas available for people to use for their preferred activities, including a hairdressing salon and its own café. Each unit had its own communal lounge and dining area. People had access to an outside space that was safe and secure.

Routine environmental and equipment checks were completed to ensure the premises were safe. For example, safety checks were completed relating to the service’s electrical and gas installation system, electric portable appliances throughout the service and fire safety equipment checks. Specialist or adaptive equipment was made available for people’s use to ensure their needs were met.

The provider ensured there were enough qualified, skilled and experienced staff that were deployed to meet people’s needs. They did not always make sure staff received effective formal supervision and development.

People’s and relatives’ comments relating to staffing levels were variable. Where comments from people using the service and relatives were positive these included, “Generally, there are enough staff”, “If I use the call bell, they [staff] come quite quickly” and “There are always staff around.” However, where less variable comments were made these included, “When it gets busy, we [People using the service] have to wait”, “Staff are always rushing about and at night, sometimes I have to wait 15 to 20 minutes for staff to come.”

The provider used a formal tool to assess people’s dependency needs and this was used to inform the service’s staffing levels. Observations during our assessment demonstrated there were enough staff deployed during the day in line with staffing levels stated by the peripatetic manager. Throughout our visits, call alarms to summon staff assistance were responded to in a timely manner with staff presence evident within communal lounge areas. However, we expressed concerns regarding the lack of social activities promoted for people using the service during our visit and queried if there were enough staff at night as the numbers of staff rostered suggested these may not be suitable to meet peoples needs.

Following our feedback, the provider wrote to us confirming a review of people’s dependency and staffing levels had been conducted with no areas of concern highlighted. The provider stated this would be regularly monitored to ensure existing staffing levels remained appropriate and safe.

Not all staff had received regular formal supervision. The absence of formal supervision can negatively impact staff wellbeing, the quality of care provided and outcomes of people using the service. Where staff supervisions were happening and an issue raised about a member of staff’s performance and conduct, there was a lack of information recorded as to how these matters were to be addressed and monitored. Following our feedback, the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed supervisions for all staff would be conducted and a supervision tracker implemented with improved managerial oversight.

Staff recruitment records demonstrated relevant checks were completed before a new member of staff started working at the service. This included an application form, written references, proof of identification and Disclosure and Barring Service [DBS] checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Newly employed staff received an induction and were given the opportunity to ‘shadow’ more experienced staff to ensure they understood the routines of the service and their roles and responsibilities.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Peoples and relatives’ comments about the cleanliness of the environment were positive. Comments included, “The cleaners are good, even my friends mention the cleanliness of the place”, “The environment is very pleasant, my room is cleaned every day” and “I have complained about the cleanliness of [Name of person using the service] room as there were cobwebs. Staff apologised and cleaned the room. It has not been too bad since then.”

Observations during our visit demonstrated the service was clean, hygienic and odour free. Staff were clear about their roles and responsibilities to ensure people were protected by the prevention and control of infection arrangements at Highview Lodge. Staff had access to policies and procedures on infection control and had sufficient Personal Protective Equipment [PPE]. Staff were observed using PPE appropriately and when required.

Audits relating to the service’s infection, prevention and control arrangements were being conducted at regular intervals and demonstrated there was a good level of compliance. Staff had received appropriate infection, prevention and control training.

The provider made sure that medicines management was safe and met people’s needs. A person using the service told us, “I get my medicines as regular as clockwork.” A relative told us they had no concerns relating to the management of medicines for their family member.

Staff were observed to administer people’s medicines appropriately and in line with current guidance. The medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together or too late. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported.

Medicine records were maintained to a good standard, and Medication Administration Records [MAR] demonstrated people received their medicines as they should and in line with the prescriber’s instructions. The service ensured people's behaviour when anxious and distressed was not controlled by excessive and inappropriate use of medicines. PRN [as needed] protocols were in place for all prescribed medicines administered in this manner. However, improvements relating to PRN protocols were required to include the actions to be taken by staff to alleviate people’s distress prior to this medicine being administered. Following our feedback, the provider forwarded a Service Improvement Plan to the Care Quality Commission. This confirmed all PRN protocols had been reviewed and updated. We will check on improvements the provider said they had made when we next visit the service.

Staff who administered medication were trained and had their competency assessed to ensure they remained competent to undertake this task safely.