Archived: High Hilden

There was a registered manager in post who was registered with the CQC. 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.

At our previous inspection on 11 and 12 August 2016, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to medicine management and safely recording the amount of medicines in stock. At this inspection, improvements had been made and the service was compliant with the regulation. Medicines were stored securely and safely administered by staff who had received appropriate training to do so.

The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered managers had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. When appropriate, risk assessments were updated when people’s needs changed. The registered provider had effective policies and procedures in place to ensure that the environment was kept safe and well maintained for the people living there.

There was sufficient staff to provide care to people throughout the day and night. The provider used a dependency tool to identify the amount of care hours each person required. When additional staff were required due to staff sickness or leave the registered manager had an approved agency list. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff spoke positively about the training supplied by the registered provider and the encouragement to progress their careers. Staff met together regularly and felt supported by the manager.

Mental capacity assessments were carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were supported to have a nutritious diet that met their needs. People were supported to eat by suitably trained staff. Staff completed fluid and eating charts for those that needed it. People were referred to health care professionals when needed. People's records showed that appropriate referrals were made to GP's, physiotherapists, speech and language therapists, dieticians, dentists and chiropodists.

People told us they were very satisfied with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. Staff communicated with people in ways that was understood when giving support. Staff and the registered manager had to know people well. People and their relatives told us they were involved in the planning of their care. Care plans were reviewed on a monthly basis by staff. Staff respected people's privacy and dignity at all the times. The provider had ensured that people's personal information was stored securely and access only given to those that needed it.

People at the service had access to a wide range of activities that were designed for their individual needs. People told us they were very happy with the amount of activities on offer at the service. People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people's decisions.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people.

The registered manager was seen to be open, transparent and responded positively to any concerns or suggestions made about the service. The registered manager carried out audits to identify shortfalls with the service and took action as a result. People’s records were updated by staff on a regular basis and in circumstances when required such as changes in health.

There was a registered manager in post who was registered with the CQC. 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.

At our last inspection on 12 and 13 May 2015, we asked the provider to take action and make improvements on staff training and guidance on safeguarding, and this action has been completed.

People were protected against abuse and harm. Staff were trained to identify the types of abuse and knew who to report to if they had any concerns. Staff were aware of the policies and procedures regarding abuse.

Staff were not correctly managing medicines. We found discrepancies between the records and stocks of medicine being stored by the service. No protocols or guidance was available to staff for homely remedies. Staff were administering medicines to people in a safe way.

The service appeared clean and tidy. The provider had ensured that the premises were safe for use by having up to date certificates of safety.

There was sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

People’s needs had been assessed and detailed care plans developed. Care plans contained appropriate risk assessments that were specific to the person’s need.

At our last inspection on 12 and 13 May 2015, we asked the provider to take action and make improvements on management and staff understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and this action had been completed.

People were being appropriately referred to health professionals when needed. Care plans showed referrals to GP’s and nurses and these were done in a timely manner. People were also supported to attend routine appointments such as health checks with a GP, chiropodist and opticians.

People were supported to have a healthy and nutritious diet. People could choose what they wanted to eat from a set menu or ask for an alternative meal. The snack trolley did not offer those who had diabetes low sugar options on all rounds. We have made a recommendation regarding this in our report.

People and their relatives told us they were involved in the planning of their care. Care plans and risk assessments were being reviewed by staff on a monthly basis or when a person’s needs changed.

People told us they were very happy with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. Staff communicated with people in ways they were able to understand when giving support.

Staff respected people’s privacy and dignity at all the times. The provider had ensured that people’s personal information was stored securely and access only given to those that needed it.

At our last inspection on 12 and 13 May 2015, we asked the provider to take action and make improvements on activities that are on offer to people living at the service, and this action had been completed.

People told us they were happy with the activities on offer at High Hilden. Activities included quizzes and games run by staff, visits by external entertainers and days out. The service also had garden parties and staff would actively encourage people’s relatives and friends to get involved.

People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.

The provider had ensured that there were effective processes in place to fully investigate any complaints. The registered manager communicated outcomes of the investigations to relevant people.

At our last inspection on 12 and 13 May 2015, we asked the provider to take action and make improvements on the quality monitoring processes and improvements had been made. However, we found that the information was not being collected together to identify potential trends at a service level. We have made a recommendation about this in our report.

The registered manager had not ensured that all records were accurately showing where good practice was taking place. We have made a recommendation about this in our report.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with the registered manager at any time and had confidence appropriate action would be taken. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service.

On this inspection, we found one breach in the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We found that staff actively sought consent when providing care and support. We observed that staff were respectful and proactive in their support of people. We found that the care and welfare of people living at High Hilden was completed to an excellent standard. We found that medication management was good and that we could be sure that the administration of medication was completed well, this included the administration of controlled medication. We found that staff were sufficiently trained, supported and had good inductions, which meant we found staff to be competent in carrying out their duties. Our observations of staff supported this. Strong management meant that there were policies and procedures in place which were relevant and up to date.