Haighfield Care Home

Haighfield is a care home located in Standish, Wigan and can accommodate up to 45 older people. The home is operated by Mr Naveed Hussain & Mr Mohammad Hussain & Mrs Anwar Hussain, a partnership. At the time of this inspection, there were 34 people living at the home.

People’s experience of using this service and what we found

Our inspection was carried out following an incident where a person had fallen down some stairs and suffered a serious injury. We carried out checks of the home environment and found it was not always safe. Items such as topical creams, drink thickeners and cleaning products were not stored securely. Corridor areas were cluttered and presented a trip hazard when people were mobilising.

The fire risk assessment had not reviewed since September 2020. This was despite the five-year electrical installation report expiring in February 2022, which could present a fire risk. There had been an incident earlier in the year where the electrics had ‘blown’ in part of the home. The provider made arrangements for these to be completed during the inspection, with work planned for September 2022. We have made a recommendation regarding staffing levels within the home due to the feedback we received.

Governance systems at the home needed to be improved. A high number of staff had not received regular supervision, or an annual appraisal. The matrix used by the service to monitor this showed these were overdue. The last full team meeting was in February 2022 and the last residents’ meeting was in August 2021. These were not in line with the expected frequency. The policy and procedure regarding service user satisfaction surveys said these would be sent each year. However, this had not been done. People living at the home and their relatives told us they were not regularly asked for their views.

The current home manager completed daily walkarounds to check the environment and safety within the home. However, these were not documented. Provider audits were completed. However, these did not always provide a focus on the areas of concern we had found during the inspection. Confidential information was not stored securely, with documents such as staff personnel files and personal care records openly accessible. Some staff said that although they enjoyed their roles, staffing levels could often impact their morale and the culture in the home.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This last rating for the service was good (2 March 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service sustained a serious injury. The injury is currently being reviewed as a ‘Specific incident’. As a result, this inspection did not examine the specific circumstances of the incident. The information CQC received about the incident indicated concerns about the safety of the environment. This inspection examined those risks and the wider safety of people living at the home.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements with regards to safety and leadership of the service. Please see the safe and well-led sections of this full report.

The overall rating for the service is requires improvement. This is based on the findings at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home. The provider ensured they checked the vaccination status of relevant visitors.

Staff were ensuring they arrived at the home in their own clothes and changed into their uniforms in a designated room. PPE was worn and disposed of appropriately throughout the home. The provider had assessed the impact on people of staff using PPE.

All staff had a test without delay if they became symptomatic. Staff who had been exposed to COVID-19 also had a test where recommended by guidance. The frequency of testing followed current guidance.

Domestic staff were completing cleaning schedules for general cleaning and deep cleaning of high touch areas, which took place regularly.

We found the following examples of good practice.

The home was accessing the government testing scheme, which had helped in identifying the outbreak quickly and allowed action to be taken to minimise the spread. Clear protocols were in place for any professionals visiting the home, including temperature checks, risk assessments and wearing of PPE.

Detailed guidance and plans had been introduced to support visits by relatives and friends, when these were permitted. This included a booking system, to ensure only one visit at a time, use of a separate access point, to prevent visitors having to walk through the home and use of track and trace protocols, risk assessment and temperature checks, along with the wearing of PPE.

In the absence of physical visits taking place, the home had been using technology to support people to maintain contact with family and friends, through both voice and video calls. Window visits had also been supported.

The home had clear guidance, polices and processes to help minimise the risk of an outbreak and manage any which occurred. Consideration had been given to the governments winter plan and how this would be facilitated within the home. Information on contingency planning had been shared with staff and relatives via email. The home had a detailed action plan in place to ensure infection prevention and control practices were robust and where necessary improved.

Further information is in the detailed findings below.

Haighfield Care Home provides personal and nursing care for up to forty-five people. It is a purpose built home spread over four floors. At the time of inspection 28 people were living at the home.

People’s experience of using this service:

People and their relatives spoke positively about the home and standard of care provided, telling us they would, “Recommend the home to anyone, it is excellent.”

People received safe care which met their needs. Staff had received training in safeguarding and knew how to identify and report any concerns. Sufficient staff had been deployed to care for people with procedures in place to cover any shortfall due to holidays or sickness absence. Medicines were managed safely by staff who had been trained and assessed as competent to do so. The home was clean, odour free with effective cleaning and infection control processes in place.

People received effective care from a staff team who had received appropriate training, ongoing supervision and support. An admission assessment had been completed for each person, to ensure the home could meet their needs and for people to discuss the care and supported they wanted. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People spoke positively about the meals provided and we found people requiring a modified diet received these in line with professional guidance.

People told us staff were kind, caring and treated them with dignity and respect. People had developed positive relationships with the staff, who had taken the time to get to know people, their likes dislikes and interests. People were encouraged and supported to express their views and have involvement in the running of the home.

Staff supported people in a responsive way. Care plans were in place which explained how people wanted to be cared for. These had been reviewed regularly to reflect people’s changing needs and wishes. The home had an effective complaints procedure, which people were aware of, though very few had needed to use. Where people had chosen to discuss their end of life wishes, these had been captured. The home actively supported people to remain at the home at the end of their life and ensured staff had received the necessary training to facilitate this.

The home was well-led and managed. People, their relatives and staff spoke positively about the manager and deputy manager, who were reported to be friendly, approachable and willing to listen. A range of audits and quality monitoring were completed to ensure the standard of care was maintained and any issues identified and addressed. Action plans had been generated and completed to promote continuous employment.

The home met the characteristics for a rating of ‘good’ in all key questions. More information is in the full report.

Rating at last inspection:

At our last inspection the home was rated as ‘requires improvement’. The last report was published on 26 January 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected. As the home was rated as ‘requires improvement’ following our last inspection, we returned within 12 months to check the necessary improvements had been made.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure care remains safe and of good quality. Due to the improvement in rating, we will return to re-inspect in line with our inspection timescales for good services, however if any information of concern is received, we may inspect sooner.

Haighfield Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Haighfield Care Home is a purpose built, four storey home located in Standish, Wigan. Haighfield Care Home can accommodate a maximum of 45 people. The care home has 39 bedrooms; 14 bedrooms have en-suite facilities and there are four companion rooms. Haighfield Care Home offers residential, nursing, continuing care, day care and respite care services. At the time of the inspection there were 28 people living at the home.

The home was last inspected on 27 June 2016 when we rated the home as requires improvement overall and identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment and good governance. We also made a recommendation regarding the environment. At this inspection we found the registered manager had addressed our concerns and was now compliant with these regulations.

However, during this inspection we identified one breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to protecting service users from abuse and improper treatment. You can see what action we told the provider to take at the end of the full version of this report.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People, relatives and visitors told us Haighfield Care Home was a safe place to live. We saw comprehensive risk assessments in place and care plans had been developed taking in to account people’s wishes and preferences.

We found systems required strengthening regarding both the identification of safeguarding concerns and reporting procedures to the local authority. We acknowledged the registered manager had put in measures to address the concerns and there had been a misinterpretation of the local protocols. Management informed us they would attend the local authority safeguarding training to address this deficit in knowledge and understanding.

We received mixed views on whether there was enough staff on duty to meet people’s needs. At the time of the inspection, a dependency tool was not used to determine care hours needed to meet people’s needs. However, following the inspection, the registered manager introduced this and told us it had deemed there was sufficient staff deployed at the time of inspection.

Medicines were managed safely but we found discrepancies with the administration and recording of creams. This had been identified on an internal audit prior to our inspection and the deputy manager was in the process of addressing this with staff at the time of our inspection.

There was an appropriate recruitment process in place. Steps were taken to verify new employee's

character and fitness to work. Following successful appointment to the role, the provider ensured staff received an induction and this was in the process of being aligned with the care certificate.

Staff expressed feeling supported by management. We saw staff developed and maintained their skills and knowledge through ongoing support and regular training. The staff liaised with a range of health care professionals to ensure that care and support to people was well coordinated and appropriate.

All staff spoken with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the provider had submitted applications were required and had an effective system in place for monitoring and tracking applications.

We saw the mealtime experience was positive, people’s dietary needs were met and people were complimentary of the food choices and quality of the food provided.

During the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner and the home had a calm and warm atmosphere. We observed people enjoying each other’s company, conversing and laughing with each other.

We saw people visiting throughout our inspection. Visitors told us they were always welcomed and said that communication from the staff and management was good.

People spoke highly of their experiences and that they wouldn’t hesitate to recommend the home to other people that were considering a care home.

People had care plans relating to end of life care in their files. People’s wishes in relation to end of life care had been recorded where they had been willing and able to discuss this aspect of care provision. We saw families had also been consulted in relation to end of life care.

The management had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis and covered a wide range of areas including medication, care files, infection control, health needs and the overall provision of care. We saw evidence of action being taken to address any issues found.

We last inspected Haighfield care home on 30 January 2014, when we found the service to be compliant with all the regulations we assessed at that time.

Haighfield care home is a purpose built, four storey home located on the A49 in Standish, Wigan. Haighfield care home can accommodate a maximum of 45 people. The care home has 39 bedrooms, there are 14 bedrooms with en-suite facilities and four companion rooms. Haighfield care home offers residential, nursing, continuing care, day care and respite care services. Car parking is available at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014in relation to safe care and treatment and good governance. We also made a recommendation regarding the environment.

People told us they felt safe living at the home. However, we found some practices in the home were not safe. Sluice room doors, which contained various cleaning products, were left unlocked and unattended by staff. We also saw the supplement ‘Thick and Easy’ left unattended on the medication trolley and in the lounge.

Medicines were not managed safely as we found occasions when prescribed medicines had not been available to people when they needed them.

People had comprehensive risk assessments which were reviewed and updated timely to meet people’s changing needs. People and their relatives told us they were involved in assessments and planning of the care and support received.

The home had suitable safeguarding procedures in place and staff were able to demonstrate that they knew how to safeguard people and follow the alert process. Appropriate employment checks had been conducted before new staff commenced employment in the home.

Staff told us they felt supported and received regular supervision and an appraisal of their work. Appropriate training was undertaken but this was in staff’s own time and there was some confusion as to the provider support to staff to ensure they were sufficiently trained to meet the requirements of their role.

We saw the meal time experience was not rushed and people were appropriately supported. Everyone we spoke with was happy with the food provided and people were given sufficient amounts to eat and drink to meet their nutritional and hydration needs.

People were supported in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We observed people living at the home were living with sensory impairment, memory issues or living with dementia. We saw no evidence of dementia friendly resources or adaptations to support people’s orientation in any of the communal lounges, dining room or corridors. We have made a recommendation in relation to environments.

People’s relatives and visitors we spoke with were also complimentary about the care provided. Staff treated people with kindness and respect. There were two identified dignity champions and people’s privacy and dignity was maintained.

We saw staff had attended end of life training and the home was equipped to support people nearing the end of life. There was a dedicated memorial area of the home which contained cards and a memories book.

People were encouraged to maintain their relationships with friends, family and their pets. There were no prescriptive visiting times and friends and family were invited to activities when entertainers where scheduled. People were provided individual and group activities. Everybody’s needs were considered and catered for.

People and their relatives knew how to make a complaint. They told us they were confident in the manager and we saw complaints had been resolved in the required timeframes. People were asked for their input in how the home was run through resident meetings and there were suggestions books and boxes in the foyer of the home.

On arrival at the home, we found confidential information and records were not safely secured.

The registered manager was visible throughout the inspection; people, their relatives and staff spoke highly of the home and the management team. Management audits were undertaken but the provider had not implemented an audit system to maintain oversight of the home.

Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

During the inspection we looked at respect and involvement, care and welfare, safeguarding, support for workers and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking to professional visitors and looking at records:

Is the service caring?

During the visit we saw staff offering care and support in a friendly, polite and respectful manner. Staff were patient and ensured people were not rushed, preserved people's dignity and privacy and respected people's choices.

There were a number of activities on offer, such as trips out, entertainment, games and parties. Other activities, such as pet therapy, were planned for the near future.

We spoke with four people who used the service and six visitors. All were positive about their involvement in the home and the care given by the staff. One person said, 'It's wonderful. The carers are superb, they are proficient, efficient, kind and helpful, but there aren't enough of them'. Another commented, 'They (the staff) are kind and caring', whilst a third told us, 'If I don't like something I complain, I go and tell them, then it gets sorted out. The food is very good; menus are changed as a response to residents' likes and dislikes'. A visitor told us, 'Staff are all lovely and seem to know what they are doing'.

Is the service responsive?

We observed staff being responsive to people's needs and witnessed them offering care to those within the home who were unable to express their needs verbally, anticipating their needs and demonstrating a good understanding of the people who used the service.

Assessments were carried out prior to people moving in to the home and care plans were regularly reviewed, in conjunction with people who used the service and their relatives, to ensure their continuing care needs were being met appropriately.

There was evidence that people's wishes and suggestions had been responded to via residents' meeting minutes, questionnaire analysis and within the care plans. We attended a residents' meeting and witnessed people being very involved in every aspect of their care, activities, environment and lifestyle. One person who used the service commented, 'Whenever I have said anything it is resolved immediately'.

There were also six monthly visitors' surveys used as a way of gaining insight into the visitors' perspective on the home, suggestions and concerns.

Is the service safe?

There were adequate numbers of staff on duty at the home on the day of the visit, but we were told the home had been short staffed recently due to a number of workers having left. This was being addressed via a recruitment drive and some new staff had already commenced work at the home, whilst others were part way through the recruitment process.

Although no one was currently subject to Deprivation of Liberty Safeguards (DoLS), the senior staff demonstrated a good knowledge of the subject which would help ensure people were deprived of their liberty only in their own best interests and with the least possible restrictions.

Staff training was up to date and on-going and staff had undertaken training in areas where a lack of knowledge was identified at the previous inspection.

Appropriate risk assessments, such as falls, nutrition and moving and handling were in place in the care records and were reviewed and updated regularly to ensure people's needs were met safely.

Staff demonstrated a good knowledge and understanding of safeguarding procedures and were aware of how to report any concerns. Policies, procedures and guidance were in place at the home.

People who used the service told us they felt safe. One person told us, 'I feel safe living here', another said, 'I feel very safe and secure'.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities. Care plans we looked at included factual and up to date information about people's health and support needs.

The four people who used the service with whom we spoke felt the care provided was effective and appropriate. We spoke with six visitors who agreed that their relatives were cared for appropriately and well.

The professional visitor with whom we spoke was positive about the care and support provided at the home.

Is the service well-led?

The home had a manager in place at the home, who was appropriately registered with the Care Quality Commission.

A significant number of audits and checks were in place to help ensure consistent standards of care within the home.

Monthly service user questionnaires were completed on a different theme each time to ensure all aspects of care and daily life were addressed. The monthly residents' meetings appeared to be very successful, demonstrating a wide range of decisions reached in conjunction with the people who used the service.

Complaints were dealt with in a timely and appropriate manner according to the home's policy.

"I'm ok, I like to stay in the lounge and have a cup of tea, they look after me here" and "I've no complaints it's all good."

People living at the service were happy with the standard of care received. However we noted some areas of privacy and dignity that were compromised whilst some people were being cared for in their bedroom, in bed. Staff left bedroom doors open to help them to monitor each person. However we noted some people in a state of undress due to their care needs. Staff did attend to people's needs when they noticed these issues however visitors and people walking past bedrooms could openly see into each person's room.

Staff were positive about working for the service and felt they were well supported with their training needs to be able to meet people's individual needs. However we found areas of training that needed improving to ensure that staff could always meet the needs of people admitted to Haighfield care home.

We found that steps were taken to ensure that people were protected from the risks of poor nutrition and fluid intake. People said they liked the food and had no concerns about its quality or amount.

We saw that medicines were managed safely and there were appropriate systems in place for ordering, storing, administering and disposing of medicines.

The home had effective recruitment procedures in place that were followed by staff. This ensured that the staff employed to work in the service were suitable to work with vulnerable adults and were appropriately qualified for their post.

There were appropriate systems in place to monitor the quality of care that people received the home and that the manager responded to comments and suggestions made by people and their relatives.

'It's nice here, I really like it'.

'I'm being really well looked after'.

'The staff here are very good. I have never regretted choosing this home for my husband'.

'The home has a relaxed and friendly atmosphere. The staff are very helpful'.