Highfield Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent.
 

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some people’s assessments recorded conflicting information about their needs and risks. For example, a person’s nutritional assessment detailed they were on a normal diet. However, elsewhere in their care plans it was clear their needs had changed and due to swallowing concerns, they were now having a soft diet to prevent the risk of choking. The assessment recorded their BMI (body mass index used as an indicator of a healthy weight). The recorded BMI calculated they were obese, however, a malnutrition scoring tool recorded their BMI as normal, and they had in fact lost weight. These contradictions meant the person’s risks may not be assessed accurately to enable staff to provide care that met their needs. The person’s nutrition care plan was not accurate as it did not record information either in relation to the soft diet the person required, the risk of choking or the recent loss of weight.

Initial assessments were undertaken with people before they moved into the service to make sure their needs could be met by staff.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care and support plans and their risk assessments had not always been comprehensively reviewed and monitored to ensure information was accurate or contained important information and guidance.
Although staff had used nationally recognised tools to assess risks to people such as malnutrition and skin integrity, these were not always accurate and contain up to date information. Care records did not always provide clear guidance for staff on how to respond to identified risks, or how care should be delivered in line with best practice. There were inconsistencies across individual care records. For example, some people had an identified risk such as malnutrition and dehydration or changes in physical health such as a deterioration in their mobility. Care records did not always clearly describe what actions staff should take, when to escalate concerns or how frequently their needs should be reviewed.
Inconsistencies in care records meant there was not always a clear up-to-date view of people’s needs and the care required, particularly for staff who were not familiar with the person. The provider used agency staff and were in the process of recruiting new staff. This meant although permanent staff mainly knew people well, so care was often delivered appropriately, it relied on staff knowledge and experience rather than clear, evidence-based systems. As a result, the provider could not demonstrate that care and support was delivered consistently and in line with best practice across the service.
Most people thought staff knew them well, but there were mixed views, for example, “I would say they know me quite well now” and “Some of them know me very well, some not so much.”
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The registered manager worked well with other agencies to make sure people received the appropriate care and support. Referrals were made to relevant services, such as GPs and other health professionals, and people were supported to access care when required. They engaged with healthcare professionals and made referrals for additional advice. Although concerns had been raised early in 2026 by healthcare professionals in relation to people’s care and their working relationship, this had now improved and the feedback we received was good with improved communication.
The staff team worked well together. The registered manager held staff meetings 3 monthly and many subjects were discussed, relevant to the service, including recent safeguarding concerns and staff roles and responsibilities. However, many staff were not able to attend meetings, and although the minutes of meetings were shared with staff, many staff had not had the opportunity to attend to raise issues, good ideas, and be part of the team discussion. Observations during the inspection showed staff communicating effectively and working together to meet people’s needs.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff knew how to support people and encouraged healthy choices despite not always being up to date with their training and relying on inconsistent care records. Many people were mobilising independently and encouraged to do so, others who needed some assistance were supported to maintain and increase their mobility. Some people chose to stay in their rooms, and this was respected. Staff did encourage people to use the communal areas, for at least part of the day, to maintain their well-being and support socialisation.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and
consistent, or that they met both clinical expectations and the expectations of people themselves.

Monitoring systems were not always in place to improve care and drive improvement. Where they were, they were not always effective in assessing risk and improving outcomes. For example, staff completed records when a person experienced periods of anxiety and distress. However, the records were not complete and there was no evidence the records were monitored. This would enable changes in behaviour could be identified or where interventions had worked well or not worked well, to update the person’s care plan and strive for better outcomes.
Where people at risk of dehydration had their fluid intake recorded by staff, there was no evidence the records were monitored to check if interventions were working. This meant there was no assurance a reduction in fluid intake would be identified. If limited fluid intake was identified, close monitoring could determine if a person’s health was deteriorating or staff were not keeping accurate records. Ineffective monitoring could result in a risk to health and poor outcomes.

The provider did not always tell people about their rights around consent and did not respect their rights when delivering care and treatment.

The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and associated code of practice. The provider and staff’s lack of knowledge and understanding of MCA and what it means in practice meant people’s rights were not maintained and upheld.

Mental capacity assessments were not always completed for specific decisions that needed consent and a robust best interest decision making process had not always been followed. Mental capacity assessments had been undertaken with people who were deemed to lack capacity, however some of these were not decision specific. Some people had a capacity assessment with a list of 8 specific decisions included in 1 assessment, not in keeping with the basic principles of MCA 2005. These included consent to care, locked premises, restriction to access community, all personal care needs including continence care, dietary, hydration and medication management and the use of safety bed rails when in bed. This meant people’s rights were not appropriately considered when assessing their understanding of the decision in question, to enable their ability and right to consent to specific decisions. Best interest decision making did not appropriately record why decisions were made in a person’s best interest. They did not include who was involved in the decision making nor how the person may have considered the decision before they lost capacity to consent. Where people had a lasting power of attorney in place to support health and welfare decisions, this was not always evidenced or accurate. This placed people at risk of decisions being made that were not lawful.

A capacity assessment was completed for a person with a safety gate placed across the door to their room. This assessment also included the decision to have an alarm mat in their room, to support their safety. However, the 2 decisions were different, with differing impacts on the person’s life and restriction. The best interest decision making record did not make any reference to the safety gate, which was a clear restriction. Best interest decision making was undertaken by only 1 person, a staff member, and therefore potentially restricted the person’s fundamental basic rights.

People had not always signed consent forms. Those that were in place were often signed some years ago. For example, a person had signed consent to have their photograph taken to be used in social media content, however this was dated 2021 and had not been reviewed to check if the person had changed their mind since.