Archived: Highfield Residential Home

Highfield Residential is a residential care home providing accommodation and personal care to up to 26 people. The service provides support to people aged 65 and over, and people living with dementia. At the time of our inspection there were 9 people using the service. The service currently accommodates 9 people in 1 building, across 3 floors. There is a communal lounge, a dining area, and a large garden area.

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

People were not always supported safely. Systems and processes were not always in place and effective in managing risks to people. We found that allegations of abuse were not always responded to appropriately, leading to a poor culture within the service. There was a lack of training for staff.

People were not always supported in a person-centred way. We observed interactions where staff did not respect people’s equality and diversity. People were not always offered choices. Relatives gave mostly positive feedback, although some raised concerns around lack of engagement and activities for people.

We identified concerns around the culture of the service during our inspection, in terms of the way staff supported people and the way the service was run. There was a lack of quality monitoring and support for staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We saw that many people living at Highfield had sensor mats, to alert staff when a person stood up and to reduce the risk of falls. There was no evidence of any mental capacity assessment or best interest decisions relating to these at the time of inspection.

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

Rating at last inspection

The last rating for this service was good (published 1 April 2019).

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

Why we inspected

The inspection was prompted in part due to concerns received about the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

The overall rating has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety of people using the service, managing risks, good governance, personalised care, and consent for people. We have issued two warning notices to ensure the provider makes improvements.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review.

If the provider has not made enough improvement when we re-inspect and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

People were supported to have friends and relatives visit them safely. There were clear systems in place to support people’s relatives and friends to visit as safely as possible. This included social distancing, appropriate PPE, hand hygiene and temperature checks. The provider had plans to introduce a specific visiting area in line with national visiting guidance.

Staff changed into uniforms on site and had been provided with ‘kit bags’ to transport their uniform safely to and from work.

Staff were tested weekly and people living at the home were tested monthly. The registered manager had a good understanding of safe isolation processes and these had been implemented effectively where a positive test had previously been identified.

The registered manager kept up to date with national guidance updates which were communicated effectively to staff, people and their relatives. This was done through meetings, regular telephone calls and letters.

Staff supported people with activities in communal areas that had been re-arranged in line with social distancing guidance. Where people were isolating or unable to access communal areas, people were supported with one to one activities in their rooms.

The home was clean, and we observed staff wearing PPE and regularly handwashing or using hand gel. The service used a traffic light system to support staff to know what level of PPE was required for each area of the home. Staff had received training in infection control and the use of PPE.

Further information is in the detailed findings below.

Highfield Residential Home provides accommodation and personal care for up to 26 people over 65.

At the time of our inspection, there were 23 people living at the service.

People’s experience of using this service:

• People enjoyed the atmosphere at the service, they told us it felt homely and staff were caring and helpful.

• People enjoyed their mealtimes, they told us the food was good quality and they always had choice. People’s dietary requirements were recorded clearly and consistently met.

• People were cared for by staff who knew their life history and what was important to them.

• People were supported to access healthcare services when needed. Staff identified concerns and referred people promptly.

• People had access to a range of activities, further work was being completed by the registered manager to personalise the activities available.

• The registered manager had a visible presence in the home, staff felt well supported by management and people knew how to raise concerns if needed.

• We made recommendations about the management of some risks to people and the storage of medicines.

More information is in the full report.

Rating at last inspection:

At the last inspection, the service was rated Good (Previous report published 29 November 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection

Follow up:

We will continue to monitor this service to ensure people receive high quality care.

The inspection took place on the 28 September and 3 October 2016. The first day of the inspection was unannounced. This was the first comprehensive inspection since the Home registered under a new provider in September 2014.

The service had a registered manager in post at the home. 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 and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection, with people using the service not hesitating to seek assistance where required and sharing jokes with staff.

People spoke positively about the food choices and were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available.

People’s medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People told us they were regularly consulted about their care and they had monthly meetings with their keyworker. People also had an opportunity to share their views and make suggestions at the monthly residents’ meeting.

Risk assessments were in place to support people to be as independent as possible. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place. There were enough staff on duty to meet people’s care and support needs safely.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role. Staff received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Training was regularly refreshed, with staff attending a range of core training as well as training specific to the needs of people using the service, for example dementia awareness.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly undertaken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence. The management operated an on call system to enable staff to seek advice in an emergency. This showed leadership advice was present 24 hours a day to manage and address any concerns raised.