Archived: The Highgrove

There was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, we saw evidence the manager at the Highgrove was in the process of registering.

At the last inspection on 24 and 25 January 2018, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

The Highgrove 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, both of which we looked at during this inspection.

During this inspection, people told us they received their medication on time and staff managed this safely. Staff completed with each person, or their representative, a medication care plan and risk assessment. Staff responsible for administering medicines completed regular audits to assess the safety of related procedures.

We observed staff supported people with a safe approach. For example, we saw they attended very quickly to one person who was choking. Staff were calm and soothing in their tone, which helped to reassure the individual and resolve the incident. Care records included risk assessments to assist staff to understand how best to support those who lived at the home. Staff we talked with demonstrated a good understanding of safeguarding people from unsafe or poor care.

Staff files included required recruitment documents. The manager was implementing a new system to review each candidate’s employment history to confirm their suitability to work with vulnerable adults. We noted there were sufficient staffing numbers and staff skills mixes to support those who lived at The Highgrove. A staff member stated, “I feel there’s enough staff on.” Staff accessed a range of courses to support them in their designated roles.

Care planning focused upon people’s nutritional support, including the management of potential risks, such as malnutrition and dehydration. We observed a ‘hydration station’ was provided in the lounge so that those who lived at the home could access drinks whenever they wished. People commented positively about the meals they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The manager had considered people’s rights and implemented innovative practices to improve the lives of those who lived at the home. For example, the manager trained staff to better support Lesbian, Gay, Bisexual and Transgender (LGBT) older couples. We observed staff had a friendly, caring approach and used humour appropriately. One person who lived at The Highgrove told us, “I have been here [a long time]. The staff are brilliant.”

Care records we looked at had the person at the heart of their support planning. For example, the manager documented people’s backgrounds, life histories and preferences. There was clear evidence those who lived at the home or their representatives were involved in their care planning.

People, staff and visitors had a variety of opportunities to feedback their experiences of living and working at the home. The manager had a detailed system to retain clear oversight of everyone’s safety and the quality of the service provided. They produced for people and visitors a regular newsletter about the service and any recent events. This included a poem written by someone who lived at The Highgrove, the Christmas party and a note thanking staff for their hard work.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were comfortable and relaxed during our inspection. One person told us, 'I have discussed my support with staff. For example, we agreed they would look after and give me my medication. I feel safer that way and glad they do it'.

Our discussions with staff demonstrated they understood the needs of people they supported. Information we found in people's care records was in-depth and regularly updated. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

People told us they felt safe and secure whilst living at the home. Records we reviewed demonstrated people were protected against unsafe premises because the manager had systems to monitor this.

Is the service effective?

The Highgrove did not have recorded evidence of formal consent. The manager assured us this would be addressed as a priority. We observed people were consistently supported to make basic day-to-day decisions. We noted staff had a good understanding of consent and related principals. One staff member told us, "Every task I undertake with residents I always check how they want to be supported. I don't assume this just because I know that person".

One person who lived at the home confirmed, 'I feel in control of my life. I make my own decisions and I can come and go as I please. The staff never take over or force me to do anything'. This meant care provision was effective and based on individual choice because the service gained people's consent prior to giving support.

One person told us the home was efficient in meeting their needs. They explained, 'I'm independent and being helped to make decisions is very important to me. I'm never forced to do anything'.

Care records we looked at contained support plans and risk assessments. These were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

The Highgrove met people's nutritional needs in an effective manner. People had been consulted about menus and meal options. Care records we reviewed held information about the regular monitoring and assessment of people's needs. This meant the provider had ensured people's nutritional requirements were properly managed.

Is the service caring?

We observed staff interacting with people in a respectful and compassionate manner. One person told us, 'I've lived here a long time. This is my home and I would be very unhappy if I had to go somewhere else. The staff are very caring'.

People were comfortable and relaxed during our inspection. Staff engaged with people in a friendly manner and had a good understanding of quality care. One staff member told us, 'Good care is about being caring and having the time to spend with people to build relationships with them'.

Is the service responsive?

Care files we reviewed recorded where people's health needs had changed. Documents included reports and outcomes of visits by external professionals, such as GPs, district nurses and social workers.

One person told us, 'The staff are very caring. When times are hard for me they are always there to talk to and are very supportive'. This meant people were safeguarded against inappropriate care because their changing health needs were assessed and responded to.

Is the service well-led?

There were a range of quality audits in place to monitor service delivery. Appropriate policies and other regular processes underpinned this, such as staff and resident meetings. This meant people were protected against inappropriate support because the manager had systems to check the quality of care.

Care delivery was well-led and there were clear lines of responsibility. Care planning was in-depth and personalised. This was reflected in our observations during our inspection. One person who lived at The Highgrove told us, 'The home is well managed. I like the manager as he's very approachable and you can have a laugh'. This meant care delivery was appropriate and safe because the home was well-led.

Additionally, the service was non-compliant with outcome 20 at a previous inspection. This was because the home was failing to tell the Care Quality Commission about information that serious injuries to people had occurred. This meant we were unable to fully undertake our regulatory duties in monitoring the service properly.

We have reviewed The Highgrove's submitted evidence. This included a Provider Compliance Assessment and updated procedures related to statutory notification. Records showed that new equipment had been purchased. This further highlighted staff were trained in equipment use and risk assessments were completed to minimise potential risk.

Other records we received were updated policies and procedures in relation to the service's obligation to complete statutory notification. These outlined to the service's staff about responsibilities related to reporting notifiable incidents to the Care Quality Commission. This meant we were able to fully undertake our regulatory duties in monitoring The Highgrove properly.

Outcome 1 ' Respecting and involving people who use services

Outcome 4 ' Care and welfare of people who use services

Outcome 7 ' Safeguarding people who use services from abuse

Outcome 8 ' Cleanliness and infection control

Outcome 9 ' Management of medicines

Outcome 14 ' Supporting workers

Outcome 16 ' Assessing and monitoring the quality of service provision

This was because the home was not compliant at previous inspections.

We spoke with a range of people about the home. They included the provider, manager and staff. We also spoke with people who lived at the home. We additionally had responses from external agencies including the local authority contracts and safeguarding teams.

We observed staff delivering support in a respectful and dignified manner. We found evidence that people were involved in their care. We found the home to be clean and there was a programme of renovation and re-decoration underway. Systems to protect people from abuse had been developed. Medication was being managed in a safe and appropriate way. We checked that improvements had been made to care planning and risk assessments. Staff had received appropriate training and supervision.

The home was now compliant because the provider had introduced new measures to monitor the quality of its service. We were told by the provider that they will continue to progress with these improvements.

When we undertook this inspection the provider was still in the process of responding to concerns identified during our last inspection on 14th June 2013. During that inspection we had found delivery of care had not been appropriately planned. Medication issues needed addressing and safeguarding arrangements were not robust. We also found procedures in place to monitor the quality of the service provided were not effective.

During this inspection we could see that the service provider had started to address the issues from the last inspection as improvements had started to be made. The provider was working within time scales provided by the Commission to produce a report on actions he planned to take to meet requirements. We did not assess all the outstanding compliance actions from the inspection undertaken on 14th June 2013.

We started this inspection at 6.30am to enable us to speak to the homes night staff. We did this so we could identify what routines they had undertaken during the night and discuss the care they had provided. We spoke with staff, the manager and provider, a number of residents, undertook a tour of the building and observed care practices.

We found people were receiving appropriate care which was meeting their needs.

However, we found the homes policy and current good practice guidance were not consistency followed when handling medication. Medicines audits were completed but these had not been effective in identifying some of the shortfalls we saw during our visit.

We spoke with one person, and they told us they had met with the manager before they had moved in. They said that alot of information about the home had been given to them prior to moving in. When asked if they felt they had been able to contribute to their assessment, this person said they had, and that the manager and staff had really listened to them. They said they felt valued.

We found that this service had quality and safety issues regarding the financial systems operated by the home, staff training and supervision, and regarding cleanliness. These were seen to be of concern, as they had a direct impact on people's health and well being. As a result, Compliance Actions had been made, and must be acted upon in order to comply with the Regulations governing this care setting.