Highfield Care Home

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• 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.

This is the first assessment for this service. This key question has been rated 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.

Safeguarding incidents were not always reported to the local authority in a timely manner and lessons. There was mixed feedback about staffing levels and staff had not always been safely recruited. Risks to people were not always well managed including risks from health conditions and risks to people from the environment. People’s medicines were adequately managed, the service was clean, and people were referred to healthcare services as needed.

The service was in breach of legal regulation in relation to safe care and treatment, good governance and safe staff recruitment.

This service scored 44 (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 have a proactive and positive culture of safety. The registered manager did not always report safety events to the local authority in a timely way. How incidents and accidents were recorded could be improved to ensure there was clear oversight. Incidents and accidents were recorded in two places in the IT system and there was no clear distinction on what was recorded where. This impacted on the oversight of incidents.

When incidents had occurred, action had been taken to reduce risks to people. Incidents were analysed to identify where there were lessons to be learnt. However, staff raised concerns about communication within the service and it was not clear how lessons learnt were shared with staff as there were no regular staff meetings prior to the inspection. There were some areas where staff were not always clear. For example, we received mixed feedback from staff about how to support one person with anxiety and the person was recorded as being anxious.

Staff worked with people and healthcare partners to establish and maintain systems of care, in which safety was managed. Staff from the local GP practice visited the service weekly. They told us staff were always well prepared for their visit and the nurses shared information as needed to enable them to provide support to people. When people moved into the service, they were greeted by staff who supported them to settle into the service. One person told us they were happy with the support they received when they moved to the service. A relative said, “[My relative] settled quickly and said to me ‘staff keep popping in to see if I am okay’".

The registered manager and provider did not always share concerns quickly with the local safeguarding authority which increased the potential risk people would not be protected from the risk of abuse in a timely way. Systems to report concerns were not operated effectively to ensure concerns were reported in a timely manner. We reviewed a concern were there had been an altercation between 2 people. Staff witnessed a second incident occur where one person threatened another person. However, this second incident was not shared with the local authority for almost a month whilst the registered manager conducted their own investigation. This increased the risk of potential harm to service users.

However, staff knew how to identify safeguarding concerns when they arose. Where people were restricted from their liberty appropriate legal authority had been applied for.

Risks for people were not always mitigated as far as reasonably practicable. For example, where people had pressure injuries or were at high risk of developing pressure injuries, they had not always been supported in line with their care plan, which increased the risks of potential harm. There were protocols in place to support people who were at risk of diabetes. However, the service was not able to evidence these were followed when people’s blood sugar had been identified as high. Where people were at increased risk from dehydration there was a lack of oversight to monitor how much they had drunk, increasing the risk the person could become de-hydrated.

Where people had risks to their mental health and wellbeing, support needed to be improved. People’s care plans did not always effectively plan their support and included information on support which was not available to them. Plans were not always clearly in place to manage triggers to people’s anxiety and ensure new staff or agency staff knew how to support people.

The provider and registered manager did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care. Planning and preparation for the event of an emergency evacuation needed to be improved. There were no records of any night-time fire drill. The registered manager told us this had taken place but there was no information on how this went, or which staff had been involved so they could ensure all staff were included in drills regularly. Fire drills had taken place during the day. However, there had been delays in staff getting to the assembly point at both the last two drills.

Some people living at the service had risks associated with dementia and acquired brain injuries and care was not always taken to ensure risks from access to unsafe items were well managed. For example, during the inspection cleaning materials were left unattended, the maintenance cupboard was left open and accessible to people. Medicines used to thicken liquids were left in unlocked drawers, people were at risk of choking if these medicines were swallowed without being appropriately prepared. There were an increased risks people could access these items which were potential safety hazards.

Checks on environmental risks such as gas and electric had been undertaken as required.

Staff were not always recruited safely. We reviewed staff recruitment files. There were no records of some staff having provided any references and one staff file did not include their full employment history as required.

Feedback from people and relatives was mixed about staffing levels. For example, one person told us, “The staff are lovely but there is not enough of them.”. A relative said, “There are always staff around who respond to call bells appropriately.” Staff views were also mixed. Following the inspection the provider met with staff and discussed concerns which resulted in a reorganisation of responsibilities. A new activity coordinator had started in post a couple of weeks prior to the inspection. They were still in the process of settling into the role and working with people to establish what group and one to one activity they wanted to undertake. Staff had undertaken training to complete their role. However, we observed staff’s understanding of supporting people with diabetes needed to be improved so staff knew more about supporting diabetics with healthy eating. Some staff still needed to complete training in learning disability and autism as staff working in care are required to undertake this learning.

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. Cleaning was undertaken by domestic staff who followed cleaning schedules to ensure the service was kept clean. People and their relatives told us they were happy with the cleanliness of the service. Comments included, “The kitchen is always spotless.” And “The service is clean when I go in.” One staff said, “It’s a very clean place to work.”

Red bags were used to indicate where laundry should be kept separate to reduce infection risks. Staff had access to personal protective equipment (PPE) which was available throughout the service. There were suitable bins to dispose of PPE. Staff were aware of how to support people if there was an infectious illness and the principles of barrier nursing.

People’s medicine was, for the most part, administered safely as prescribed and people told us they were happy with the support they received with their medicines. However, there were some issues which needed to be addressed. Most medicines were stored safely. However, medicine used to thicken people’s drinks were not. We raised this during the inspection and the medicine was moved to the medicine room.

Staff were not always recording the time when time critical medicines were administered. Staff were aware of the importance of giving some medicines on time. This is an area for improvement. Prior to the inspection the service was not able to evidence their blood glucose machine had been calibrated to ensure it was accurate. People’s pain patch placement had not been rotated as regularly as they should have to reduce the risk of skin irritation. We raised these concerns during the inspection and action was taken to reduce the risk of the concerns re-occurring.

Medicines were disposed of safely. People’s medicines administration records were completed. Where people needed as and when medicines, for example, to manage constipation, there were protocols in place for staff to follow and medicines had been administered as required. Medicines were in date. There were sufficient stock levels. Bottles were dated when they were opened to ensure staff know how long the medicine could be used for.