High Mount

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. This is the first assessment for the provider of the service. The service under a previous provider was rated inadequate for this key question. At this assessment the rating has changed to Good.

This service scored 69 (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.

We saw evidence where the new provider had driven improvements since taking over the registration from the previous provider. For example, a new management team was in place, the provider had worked closely with the manager to develop their skills for the role. Staff were provided regular supervision and observation around meeting people’s eating and drinking needs. The manager built a good relationship with the speech and language team (SALT) to ensure people received a responsive action to keep them safe whilst eating and drinking. Accident and incidents were reviewed by the manager and any themes or reoccurring incidents would be identified. The manager would then investigate and act. Action plans were in place and the manager completed regular reviews to ensure actions were met in agreed times. For example, new floorings had set deadlines, and reviews were scheduled to be completed to check the progress. If there was a delay, a reason would be recorded.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Most of the people in the home had lived there for many years. However, there was a process in place to assess people’s needs when moving into or out of the home. We saw an example of the last person to move in, the assessment covered personal details, required needs and any information required to keep people safe and met their needs.

Staff ensured communication between agencies was maintained and any key information was shared when people were supported by different services.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Where a person displayed distressed behaviours and required ‘as required’ medication, monitoring and record charts were detailed and completed. Staff were aware of how to complete the charts and the appropriate action to take. Staff we spoke with understood people’s behavioural care plans and how best to support them. People had detailed care plans and risk assessments. These were reviewed regularly. People were supported to make informed decisions safely. Where people were prescribed flammable ointments, this was risk assessed, and guidelines were in place in their care plan on how to protect them from fire risks. A relative told us, “Staff know how to support [person] they know them really well”. A health professional told us, “Since the new provider and management we have seen great improvement in all areas of the service”.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Where a person displayed distressed behaviours and required ‘as required’ medication, monitoring and record charts were detailed and completed. Staff were aware of how to complete the charts and the appropriate action to take. Staff we spoke with understood people’s behavioural care plans and how best to support them. People had detailed care plans and risk assessments. These were reviewed regularly. People were supported to make informed decisions safely. Where people were prescribed flammable ointments, this was risk assessed, and guidelines were in place in their care plan on how to protect them from fire risks. A relative told us, “Staff know how to support [person] they know them really well”. A health professional told us, “Since the new provider and management we have seen great improvement in all areas of the service”.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, in one of the bungalows further developments was required to improve the standard of the environment.

The provider had an action plan to improve the physical environment of the two bungalows. We saw where action had been taken and evidence of some of the improvements already made. During this assessment we identified one bungalow was more developed and had received more work to improve the environment. The manager was receptive to our feedback and agreed there was a difference in decoration and the progression on the action plan.

The provider completed risk assessments of the environment to ensure it was safe for staff and people. This included a fire risk assessment and where actions were identified the provider had

addressed these. Where repairs were needed action plans were in place to address these.

We saw how people were involved in selecting the decoration of the home. People’s rooms were clean and person centred. One relative told us, “The bungalows are always clean, tidy and attractively decorated”.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff had undertaken training in how to support people with a learning disability and autistic people. Staff worked together well to provide safe care that met people’s individual needs. They worked together well to provide safe care that met people’s individual needs.

Recruitment procedures were safe and ensured only suitable staff were employed. All required recruitment checks were undertaken before staff worked with people. One staff member told us, “Before I started here, I had checks carried out and shadowed people’s care needs”.

There was a comprehensive induction staff completed, this included a starter checklist signed off by the manager. Meet and greet coffee mornings for new starters provided a chance to meet the registered manager and hold discussions around values of the provider and standards of care expected.

Training was regularly provided for staff. The manager sourced outside training from the local authority teams to help develop the skills of staff further. The Provider had a mandatory training programme in place to ensure staff had the skills to support people safely. This was overseen by the manager. Where people were diagnosed as having an additional need, the manager had a process in place to source the required training. For example, where a person was diagnosed with epilepsy, staff were provided this training. Staff we spoke with told us they felt they had the right amount of training and felt confident in their role.

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.

The two bungalows were clean and tidy. Staff supported people to maintain a clean environment. We saw when bathrooms had been used, staff would ensure these were mopped and disinfected to protect the spread of any infections.

Staff we spoke with told us they had enough personal protective equipment (PPE). Staff confirmed they had never gone without PPE and if they required more this would be provided.

The management team completed audits to check environments were clean and to check staff were using PPE and cleaning materials correctly.

The home had audits completed by local authority infection control teams and the food standards agency.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Systems were in place to ensure medication was safely checked and audited. For example, daily counts of mediation were recorded. Staff would sign to evidence they had counted the medication, and the quantity was correct. Medication audits were completed by the management team, these would be reviewed and signed off by the registered manager.

Care plans and risk assessments detailed how to administer medication for each person. People had detailed ‘as required’ PRN protocols. PRN protocols also detailed the action staff should take and the timescales within which action would be required. This detailed what the medication was for, when to administer and the expected outcome.

The provider shared during the inspection how they had supported a person to reduce the use of PRN medication at times of distress. The person used PRN medication daily and showed periods of distress daily. During the assessment we sawthe person had very little use of the PRN medication and behaviours of distress had decreased. This was also noticed by a health professional who told us, “We are so pleased to see [person’s] reduction in medication and times of been distressed. This has only happened since the new provider and manager came into place”. A further psychiatrist told us, “Over the last 6 months, under new management of the care home I note this [person] has only been administered the Lorazepam 4 times over the last 6 months reflecting much more settled behaviours and also other lesser restrictive measures being used to reassure or redirect this [person]”.

Staff received competency assessments and had to be signed off by a member of management before they administered medication. Staff received medication training and this was refreshed annually.

We observed medication been administered, this was completed safely and following the provider’s policy and procedure.

Creams and storage of medication followed NICE guidelines. Creams and medication were stored in a locked cupboard in people’s bedrooms.