The Light House

The Light House is a residential service providing personal care for up to 9 people with mental health support needs. The service consists of an adapted building, which includes individual bedrooms, communal spaces and an accessible outdoor space. At the time of our inspection there were 6 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people with their medicines in a way that promoted their independence. People had a choice about their living environment and were able to personalise their rooms. The service gave people care and support in a safe, clean and well-maintained environment.

Right Care:

The service did not always have plans and guidance in place for staff to support people with their individual risks. We received mixed feedback as to whether people always felt safe within the service. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe. People told us they had good relationships with permanent staff. However, we received mixed feedback about support provided by agency staff.

Right Culture:

Systems were in place to monitor the quality of the service to people. However, quality assurance systems were not always effective at resolving issues within the service promptly. The service enabled people to work with staff to develop the service. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published November 2021) and there was a breach of Regulation 18 (Registration) Regulations 2009. At this inspection we found the service was no longer in breach of Regulation 18 (Registration), however we identified a breach of Regulation 12 (safe care and treatment). This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 21 and 24 September 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to ensure notifications were submitted to CQC as required.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a breach of Regulation 12 (Safe care and treatment) at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Highbridge Court is a care home providing accommodation and personal care for up to nine people with mental health needs. At the time of the inspection, eight people were living there. Each person has a self-contained flat with their own cooking and en-suite facilities. There is a communal space with a kitchen, dining and lounge area. There is a secure, accessible garden area with seating and plants.

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

Notifications had not always been submitted to the Care Quality Commission as required. Some shortfalls were identified in medicines administration and some areas of infection control. Audits were completed but not had always identified these areas.

Permanent staffing levels were low at the service. However, measures were being taken to improve this and ensure consistency for people. A service improvement plan was in place and regularly reviewed with the provider.

People were individually supported in their goals and aspirations by caring staff. People’s healthcare needs were monitored and support was given around food and drink. People enjoyed their living space.

There was an open culture. People and staff were positive about how the service was led and managed. People were listened to and involved in making decisions about how they spent their time and the service. People’s choices were respected.

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

Rating at last inspection and update

The last rating for this service was good (published 17 December 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbridge Court is a care home providing accommodation and personal care for up to nine people with mental health needs. At the time of the inspection, six people were living there. Each person has a self contained flat with their own cooking facilities. Each flat has an en-suite shower room. There is also a small communal area with a dining table and a sofa, and a communal kitchen and garden for people to use

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

Previous issues around permanent staffing levels had been addressed. A consistent staff team was being developed and trained to support people. The organisation of staff rotas and shifts were being reviewed to ensure support was in place at the times people required it. We received positive feedback about the planned management arrangements.

Infection prevention control systems were in place. Staff had received training and knew the correct use of personal protective equipment (PPE). Infection control policies and procedures were adhered to. People were being supported to access the community safely.

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 10 October 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing. We also reviewed the infection control procedures as part of our current methodology. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highbridge Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbridge Court is a care home providing accommodation and personal care for up to nine people with mental health needs. At the time of the inspection, nine people were living there. Each person has a self-contained flat with their own cooking facilities. Each flat has an en-suite shower room. There is also a small communal area with a dining table and a sofa, and a communal kitchen and garden for people to use.

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

People told us they felt safe living at Highbridge Court. Staff felt confident to raise concerns with the registered manager and were aware of external agencies where they could report concerns.

Staff supported people to manage their medicines safety.

People told us there were enough staff available to support them. Staff were recruited safely. Risks to people were identified and guidance was in place for staff to reduce the level of risk to people.

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

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. Staff received regular one to one supervision and told us they felt supported.

Support plans were detailed and reviewed regularly with the person. People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.

People were supported by caring staff who worked towards promoting their dignity, privacy and independence.

There were systems to ensure care was responsive. People's concerns and complaints were listened to and responded to. People has escalation plans relating to end of life care decisions where required.

People gave us positive feedback about the quality of care they received. The feedback on the leadership of the service and the registered manager was positive.

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 (February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Highbridge Court is a care home providing accommodation for up to nine people with mental health needs. At the time of the inspection, four people were living there. Each person had a self-contained flat with their own cooking facilities, table and comfortable seating. Each flat has an en-suite shower room. There is a small communal area with a dining table and a sofa, and a communal kitchen area where staff prepare meals at the weekend.

The registered manager left in December 2016 and a temporary manager was in post. The service was actively seeking to recruit a new registered manager. 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 told us they were safe. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staffing levels were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. People were involved in the recruitment process.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. People’s legal rights were protected because the correct procedures were followed where people lacked the capacity to make specific decisions for themselves.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. The risk assessments included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to make healthy choices around their meals. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the manager was accessible and approachable. People told us they were able to speak with the manager and provided feedback on the service.

People told us staff were caring and supported them with the activities they wanted to do. The manager and provider undertook checks to review the quality of the service provided and made the necessary improvements to the service.

Highbridge Court is a care home providing accommodation for up to nine people with mental health needs. At the time of the inspection, four people were living there. Each person had a self-contained flat with their own cooking facilities, table and comfortable seating. Each flat has an en-suite shower room. There is a small communal area with a dining table and a sofa, and a communal kitchen area where staff prepare meals at the weekend.

There is a registered manager in post. 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.

Staff promoted people’s privacy and dignity by asking people if they wanted to return to their rooms to have their medicines in private. We observed staff giving medicines to people and saw people consented to this.

Medicines were stored in a secure, locked room which was protected from heat and damp to ensure the medicines did not lose their effectiveness. Medicines waiting to be returned to the pharmacy were kept separately. Staff sent unused or wasted medicines back at the end of the month, so there were no excess stocks of medicines.

Staff did not record accurately when one person had received the correct number of medicines they should have, in one day. Although staff were counting medicines every day, the audits had not picked this up.

Staff did not record dates when creams were opened and when creams expired on the box, which meant there was a risk creams could be applied after they had expired. There was no written guidance for staff where to apply creams, or how much to apply.

Not all staff had undergone checks to ensure they were competent to give people their medicines as stated in the provider’s policy. Of the five staff files we looked at, two staff did not have the required checks in place.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.