Highmead House

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

People felt safe with the staff and the care provided. Systems were in place to ensure staff were trained and understood how to protect people from poor care and abuse.

People’s individual care and support needs and any known risks had been assessed, managed and monitored. Care plans were comprehensive and provided guidance for staff to follow to mitigate risks. Staff understood people’s individual care needs and associated risks. People were supported with their medicines safely.

Since the last inspection the provider had invested in the service. Improvements had been made to the premises and infection prevention and control practices and continued refurbishment. People lived in a homely, clean and hygienic environment which promoted their health, safety and wellbeing.

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.

Recruitment procedures needed to be strengthened to ensure suitable staff were employed to support people. There were enough staff to meet people’s needs and keep them safe. Staff were supported through ongoing training and supervisions.

The registered manager understood their legal responsibility and duties. The provider’s quality assurance systems and processes had been fully embedded to monitor all aspects of the service provision and to drive improvements. This included systems to identify trends from incidents and accidents and learning opportunities.

People were involved in the review of their care and their equality and diversity needs were considered and respected. The registered manager was responsive to feedback regarding monitoring records. Feedback about the quality of service was sought from people, their relatives and staff and used to make improvements. The management team worked collaboratively with external agencies. Feedback from the local authority was positive in relation to the improvement made at the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 August 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highmead House on our website at www.cqc.org.uk.

Follow up

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

Highmead House is a residential care home providing accommodation and personal care for up to 32 people. The service provides support to older and younger people, people living with dementia and people with physical disabilities. At the time of our inspection there were 26 people using the service.

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

People’s health and safety was put at risk from lack of adequate bathing facilities, maintenance of the premises and infection control risks. Some action was taken to reduce immediate risks but further action was needed.

Risks associated to people’s needs had been assessed and care plans had guidance for staff to follow. However, risks to people were not always managed and monitored effectively.

The provider did not have effective oversight systems and process in place to monitor all aspects of the service provision to drive improvements.

People and their relatives felt the service was safe, and people were cared for by staff who understood safeguarding procedures. People were supported with their medicines well.

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.

People lived in a clean environment. There was ongoing decorating within the service.

Staff had been safely recruited. There were enough staff working at the service to keep people safe. Staff were trained for their role, supported by management and received feedback on their performance.

People, their relatives and staff had confidence in the management team. People were involved in the review of their care. Feedback about the quality of service was sought from people, their relatives and staff and used to make improvements.

The service worked in partnership with external professionals. The registered manager shared information and any lessons learnt with the staff team.

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

Rating at last inspection and update

The last rating for this service was good (published 29 January 2018). At this inspection we found breaches of regulation in relation to premises and equipment, risks to people’s safety and wellbeing and governance oversight and monitoring.

Why we inspected

This focused inspection was prompted in part by a review of the information we held about this service and concerns received about staff working whilst they had tested positive for Covid-19 and the lack of bathing facilities. A decision was made for us to inspect and examine those risks.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highmead House on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to premises and equipment, infection prevention and control, people receiving safe care and treatment and governance arrangements.

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.

We found the following examples of good practice.

¿ Sufficient stocks of Personal Protective Equipment (PPE) were in place including masks, gloves, aprons, hand sanitiser and visors. Staff were wearing this appropriately on the day of the inspection. Portable handwashing stations were in use.

¿ Infection control polices reflected the current national guidance and had been reviewed regularly. Cleaning schedules had been increased to ensure touch surfaces were cleaned regularly and additional cleaning to maintain good hygiene standards.

¿ People living in the service and staff were being tested regularly. This was to ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

¿ There was a clear process for visitors, which included a risk assessment, temperature check and the wearing of PPE. The environment for visitors was COVID-19 secure and followed national guidance for visitors to care homes.

¿ Staff had received training in the use of personal protective equipment (PPE), and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance.

¿ There was a clear procedure in place, in line with national guidance to ensure people were admitted to the service safely.

Further information is in the detailed findings below.

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

Highmead House provides care for up to thirty two older people. At the time of inspection, thirty one people were receiving a service.

At the last inspection in January 2016, the service was rated Good. At this inspection we found that the service remained Good.

People and their family were able to contribute to the way in which they were supported. The service was proactive and innovative in planning people's care so that they felt listened to and empowered. People were supported in a creative and innovative way that identified their wishes and supported them to take part in meaningful activity.

People's needs were identified and responded to in a creative way, so that people felt cared for and had maximum opportunities to pursue interests that were important to their history, culture or religion.

Strong links and activities were created with the community to enable people to feel a sense of

belonging and develop positive relationships.

People received end of life care that was personalised and dignified. The service excelled at creating a caring, comfortable and empathetic environment for people and their families through end of life care.

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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and risk assessments were in place to manage risk within a person’s life.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions.

People's consent was gained before any care was provided.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns.

Highmead house provides accommodation and personal care for up to 32 older people and people with dementia care needs. At the time of our inspection, the service was providing support to 32 people.

The service had a registered manager. 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 felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible.

Effective recruitment processes were in place and followed by the service and there were sufficient numbers of staff available to meet people’s care and support needs

Medicines were stored, handled and administered safely within the service.

Staff members had induction training when joining the service, as well as regular on going training.

Staff were well supported by the registered manager and had regular one to one supervisions.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People were able to choose the food and drink they wanted and staff supported people with this.

People were supported to access health appointments when necessary.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

People’s privacy and dignity was maintained at all times.

People were encouraged to take part in a range of activities and social interests of their choice.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.

We found Highmead House to be compliant against the judgements we inspected against.