Highfield House

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 good. At this assessment the rating has change to 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.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Relatives told us they were informed when things went wrong or there were any incidents and accidents. Staff were able to describe the actions taken if there were accidents or incidents. A staff member said, “If someone had an accident in the home, I would inform the team leader or manager and assess the seriousness of it, for emergency service intervention and inform the family.” The manager told us there was a process in place to monitor any incidents. There was a policy in place which ensured any significant events and incidents were shared with the provider to ensure these were investigated and actions taken including lessons learned. We saw incidents were documented and shared and any learning was cascaded to staff and through governance meetings with the provider.

The provider had worked with people and healthcare partners to establish safe systems of care, in which safety was managed or monitored; however these had not been maintained effectively. The provider had systems in place which required staff to receive training to manage these systems safely. For example, managing medicines, first aid and safeguarding. Training for staff, in these areas had not been maintained, therefore we could not be assured staff were adequately operating these systems and maintaining people’s safety.However, the manager told us there were systems in place to manage safe transitions into the home. The manager said, “Referrals are from social services, we have a specific role within [the] company to manage this and check [the] suitability of the placement.” There were systems in place to assess needs, identify and manage risks and create and review support plans. Staff confirmed they had access to information about people’s needs, and this guided how they supported people. Where needed other agencies engaged in this process.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. DoLS were in place for people when required, and the manager had a system in place to check when reviews were needed. However, some staff were unable to describe who had a DoLS in place and what this meant, despite having received training. This meant improvements were needed to ensure staff had the appropriate knowledge to ensure the legal requirements around DoLS were consistently followed.

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. The provider shared safeguarding concerns quickly and appropriately. People were observed to be happy and engaging with staff. Relatives told us they felt people were safe living at the service. Staff were able to describe the signs of abuse and tell us how they would report any concerns. The manager was able to describe how safeguarding procedures worked and share how any incidents were reviewed and reported to the appropriate body.

The provider worked with people to understand and manage risks to their safety. People were observed receiving care from staff who followed their individual risk assessments to ensure safety. Relatives told us staff understood how to support people safely and they had no concerns about how risks were managed. Staff could describe in detail how they supported people to manage risks to their safety. This included describing how they minimised risks from specific health conditions such as Epilepsy, managed risks relating to food and drink and accessing the community. The manager told us risk assessments were updated monthly or more frequently if things changed and staff would update these immediately if needed and this would be checked at the monthly review. We saw risk assessments were in place to manage risks relating to Epilepsy, distressed behaviours, skin integrity and nutrition and were reviewed regularly. Staff confirmed they were made aware of any changes.

Relatives had mixed views about the environment with 1 relative having no concerns, but another shared they had some concerns over their relative breaking things and felt their bedroom needed internal decoration and a bathroom needed a new toilet. The provider was aware of this, however the work had not yet been completed. The provider detected and controlled potential risks in the care environment. People were observed to be able to safely move around the home and the garden area. The manager told us they assessed risks relating to people’s environment and made adjustments to ensure people were safe. There were systems in place to check the safety of the building and equipment in place.

The provider did not have a consistent staff team available. There were some vacancies at the home and whilst there were enough qualified, skilled and experienced staff, the staffing was not consistent. This meant people were at risk of receiving care and support from staff who did not always know their needs and preferences well. The manager told us the home had experienced some staffing issues with vacancies and sickness and whilst cover had been arranged, they planned to recruit staff. Staff told us there was a lot of staff on sick leave, however they confirmed they were never short of staff as cover from other services or agencies was used to ensure there were enough staff to meet people’s needs. People were observed being supported by staff to meet their needs and relatives raised no concerns about staffing at the home. Staff were recruited safely. Checks were in place to ensure suitability for the role and there was a policy to guide safe recruitment.

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. People were supported in a clean environment and protected from the risk of cross infection. Relatives raised no concerns about infection prevention control. The manger told us there were polices and processes in place to manage the risk of cross infection. The manager said, “Cleaning schedules are in place, and these are followed by staff. There is a schedule of jobs to make sure everything gets done. [Person’s name] likes to participate, and they love to load the dishwasher.” We saw the home was clean and well maintained. Staff had received training in infection prevention control and were observed using protective equipment such as gloves and aprons.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider’s medicines administration systems were not consistently followed. Where people needed ‘as required’ medicines, the guidance for staff on when to administer these was not consistently in place. We spoke to staff about this and they could describe when these would be given and confirmed the documentation had been updated following our inspection. Some medicines had been prescribed and there was no medicines administration record available for staff to record if the ‘as required’ medicine was administered. Staff told us they would address this and confirmed after the inspection this had been completed. Staff received training in administering medicines and checks were carried out to ensure there was enough medicine available and people had received their medicines as prescribed. People were observed receiving their medicines and relatives raised no concerns with us about medicines administration. The manager told us there was a companywide approach to stopping over medication of people with a learning disability and autistic people (STOMP). The manager told us clear protocols were in place to ensure people only received medicines to reduce anxiety driven behaviours at the most appropriate moment and only when other interventions had not worked.