Highfield Residential Care Home

The risk of infection from visitors was minimised. People living in the service could select a named relative who could visit them in a dedicated room if they tested negative for Covid-19 infection. Arrangements could be for a person’s relative to be an essential care-giver if this was necessary for their wellbeing.

There was a video portal enabling people living in the service to see and speak with their family members. Relatives also received email updates from the registered manager about developments in the service particularly relating to keeping people safe from Covid-19.

New people were able to safely move into the service. A negative test for Covid-19 and a 14-day isolation period were in place. Health monitoring was completed both during the isolation period and afterwards to make sure people remained free from symptoms of infection.

The service was part of the government’s whole-of-service testing programme with people living in the service and staff regularly being screened to check they were free from Covid-19 infection.

There was enough personal protective equipment (PPE) including disposable gloves and aprons for staff and visitors. This equipment was being used in the right way.

The registered manager knew about government guidance for managing risks associated with Covid-19. There were up-to-date infection control policies including those specific to Covid-19 and infection outbreaks.

There were cleaning schedules in place. The service was neat and clean. Regular infection control audits were done by the infection control lead with actions followed up when necessary.

People living in the service had consultations with their doctor when necessary. The service received advice from specialist infection control nurses.

Further information is in the detailed findings below.

Highfield Private Rest Home accommodates up to 31 older people who may be living with dementia. At the time of the inspection 22 people were living at the service.

People’s experience of using this service:

The registered manager had made improvements to the way staff were recruited, fire safety and records at the service.

New staff were recruited safely and had the skills they needed to meet people’s needs. There were enough staff to care for people.

Records were accurate and held securely.

People were supported to remain as independent as possible. Assessments of their needs and any risks to them had been assessed. Care had been planned to support people in the way they preferred and to keep them as safe as possible.

People were supported to live healthy lives. Changes in people’s health had been identified and people were supported to see health care professionals when they needed. People received their medicines as prescribed. Medicines were managed safely by staff. People were offered a balanced diet which meet their needs and preferences.

Staff were kind and caring and treated people with dignity and respect. People were not discriminated against and received care tailored to them. Staff knew the signs of abuse and how to raise any concerns they had with the management team and the local safeguarding authority.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when people were at risk of being deprived of their liberty.

People told us the management team acted on what they told them to address any concerns and improve the service. Staff told us they felt supported by the management team and were motivated. Checks and audits were completed, and any shortfalls were addressed.

Rating at last inspection:

The service was rated Requires improvement at the last inspection on 20 December 2017 (report published 19/04/2018).

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 and plan to inspect in line with our re-inspection schedule for those services rated Good.

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

Highfield Private Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Highfield Private Rest Home is a large detached house. Accommodation is provided over three floors, with a passenger lift and stair lifts allowing stair free access. There are communal sitting and dining rooms together with a sun lounge. Large enclosed gardens are accessed at the rear of the property.

At the last comprehensive inspection in June 2016 the overall rating for the service was Requires Improvement. Five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to ensure that medicines were managed safely and that equipment was fit for purpose. Recruitment processes were incomplete. They did not ensure people were not unlawfully deprived of their liberty. People’s individual needs and preferences had not been established. The provider also failed to ensure systems and processes used to improve the service were effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good.

At this inspection we found some improvements had been made and some breaches in regulation had been met. However, there were still improvements to be made and embedded to ensure improvements were sustained. We found two continued breaches and one new breach.

A registered manager worked at the service each day. 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.

Shortfalls had been identified by a specialist consultant regarding the fire safety arrangements at the service. Action had not been taken to remedy these and there was a risk that people may not be evacuated from the service quickly in the event of an emergency.

When new staff were being employed the registered manager had not consistently recorded their decisions to employ people.

People’s medicines were stored, managed and disposed of safely. There was guidance for staff to follow about how to keep people’s skin healthy. Staff understood their responsibilities in relation to infection control. The service was clean and tidy.

Risks to people, including the risks of abuse and discrimination, were assessed, monitored, managed and reviewed. Accidents and incidents were recorded and analysed by the registered manager to check for any patterns and to ensure that referrals to health professionals had been made when required. Incidents were used as a learning opportunity to drive improvements at the service.

There were enough staff on duty to keep people safe. Staff completed an induction and regular training to keep their skills and knowledge up to date. They met with a senior member of staff on a one to one basis to discuss their performance and personal development.

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. People’s physical, mental, emotional and cultural needs were assessed and reviewed. They were encouraged to eat a healthy and balanced diet and to drink well. Staff supported people to stay as healthy as possible and worked with health and social care professionals; following any advice they were given.

Areas of the service had been refurbished since the last inspection, including people’s bedrooms. People were encouraged to bring small items of furniture in to the service with them to personalise their bedrooms.

People and their relatives told us they were treated with kindness and compassion. Their privacy and dignity were promoted and their independence encouraged. People were involved in making decisions about their care and support. Staff knew people well and made sure people and their relatives had information about external bodies that could provide independent advice.

People were encouraged to remain as active as possible and keep busy. They told us there was always plenty to do and that they did not feel bored or isolated. People and their relatives knew how to raise a complaint and felt the registered manager would listen to them if they had a concern. Staff knew about whistle-blowing and how to take concerns to outside agencies if they needed to.

People’s choices for their end of life care were discussed and recorded to make sure staff could follow their wishes. The registered manager and staff spoke passionately about the end of life care and support they provided. Extra staff were available when needed to ensure people were not alone.

Regular checks and audits were carried out by the registered manager and action was taken to remedy any identified shortfalls. People, relatives, staff and health professionals were encouraged to provide feedback on the day to day running of the service.

There was an open and inclusive atmosphere at the service. Staff spoke with people and each other in a kind and respectful way and valued each other’s views.

All services that provide health and social care to people are required to inform CQC of events that happen, such as a serious accident, so CQC can check that appropriate action was taken to prevent people from harm. The registered manager notified CQC and the local authority in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the service.

You can see what action we told the provider to take at the back of the full version of the report.

This is the second consecutive time the service has been rated requires improvement .

Highfield Private Rest Home is a care home providing care and support for up to 31 older people. There were 28 people living at the service at the time of our inspection. People cared for were all older people and were living with a range of care needs, including diabetes and epilepsy. Some people needed support with all of their personal care, and some with eating, drinking and their mobility needs. Other people were more independent and needed less support from staff.

Highfield Private Rest Home is a large proportioned detached house. Accommodation is provided over three floors, with a passenger lift and stair lifts allowing stair free access. There are communal sitting and dining rooms together with a sun lounge. Large enclosed gardens are accessed at the rear of the property.

The service had a registered manager in post. A registered manager is a person who is 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.

Highfield Private Rest Home was last inspected on 29 August 2014 and no concerns were identified. At this inspection we identified shortfalls where some regulations were not being met.

Medicines were not managed, administered or stored safely; the service could not account for some missing controlled medicine.

Service and safety certificates could not be located for some equipment used at the service.

No system was in place providing an oversight of incidents and accidents; not all incidents and accidents were recorded and reviews following an incident did not always link back to risk assessments and care planning.

Recruitment checks were incomplete because they did not ensure all staff employed were suitable to work at the service.

Deprivation of Liberty Safeguarding authorisations had not been applied for where people were unable to consent to restrictions in place; and mental capacity assessments had not been completed in line with the requirements of the Mental Capacity Act 2005.

Elements of some care plans were not tailored to individual preferences and clear links were not always made between some conditions and other associated care needs. This did not provide the service with the best and earliest opportunity to be responsive to changes in people’s needs.

Auditing carried out for the purpose of identifying shortfalls in the quality and safety of the service provided had not been wholly effective.

People were supported by enthusiastic staff who received regular training and appropriate supervision. There were enough staff to meet people’s needs.

Staff were caring, compassionate and responsive to people’s needs and interactions between staff and people were warm, friendly and respectful. Staff spent time engaging people in communication and activities suitable for their current needs.

Referrals to outside healthcare professionals were made in a timely way.

People enjoyed their meals, they were supported to eat when needed and risks of choking, malnutrition and dehydration had been adequately addressed.

People commented positively about the openness of the management structure and were complimentary of the staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This responsive follow up inspection was carried out by one Inspector, who visited unannounced on the 29 August 2014. During the visit we met and talked with people that used the service and their relatives/representatives, the manager, senior care staff and care staff. They helped answer our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

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 who used the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Staff training records showed that staff had completed essential training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as dementia awareness.

Equipment at the home had been maintained and serviced regularly.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This was to make sure that people had the care and treatment that they needed.

Is the service caring?

The service was caring. People were treated with respect and dignity by staff. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as 'The staff are kind and the food is good, I have nothing to complain about'.

Is the service responsive?

The service was responsive. Staff listened to people, and took appropriate action to deal with any concerns.

Action had been taken to address issues of non-compliance raised at the last inspection visit in October 2013, and improvements had been made to the environment.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people.

Is the service well-led?

The service was well-led. The manager had an open door policy and staff worked as a team. The manager was in the process of applying to become the registered manager of the service.

There were systems in place to provide on-going monitoring of the home. This included checks of the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

We spoke with six people who used the service, and two visitors. People we spoke with who used the service told us that they were happy with the care and support they received and their comments were positive. One person told us 'it's the best home I've been in' and another person said 'they look after me excellently; so caring and helpful'.

We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that people were happy with their accommodation. However, we had some concerns about the on-going works to the home's hot water and heating system, and some other concerns about the premises.

We found that there were enough staff on duty and people we spoke with told us that the staff had a good understanding of their needs. We found that staff had undertaken relevant training to keep their skills and knowledge up to date. A visitor told us 'staff are fantastic; very on the ball'.

We found that the home kept accurate records and stored them safely and appropriately, to ensure people's details and information was protected.

We saw that when there were concerns about people's health, the relevant healthcare professionals were contacted.

The service had appropriate arrangements in place in relation to the ordering, management, administration and disposal of medication.

The care records included some evidence of assessments, care plans, and daily records of care. However, these were not consistently completed in all records, and when they were completed they were difficult to find. We saw that many of the care records were physically falling apart and were not in a clear order. This may put people at risk because their records did not contain easily accessible and accurate information about their care.