Highborder Lodge

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

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.

This is the first assessment for this service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this

This service scored 63 (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. Some plans were more detailed than others’ and not all contained specific information relating to people’s needs. For example, some people lacked condition-specific care plans such as blood pressure monitoring, mood management, anticoagulation risk and epilepsy. We did not find anyone had come to harm as a result of this. Pain care plans were unclear on which analgesic to administer when prescribed more than 1.

However, people’s care was reviewed and sections developed within the care electronic system to reflect people’s needs.

People and their relatives told us they were involved in discussions about changes to their care.

One person told us, “Yes care plan, someone showed it to me to check, I agreed with it.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Care plans we viewed contained good information about people’s dietary needs and how people should be supported. Informed guidance was provided for staff on monitoring people for choking risk and weight loss. Staff we spoke with were knowledgeable about people’ dietary needs.

One staff member told us, “In the kitchen it is on a board, and we are told with the senior staff if there are any changes. We have handovers and there are copies on our handset devices.” Another staff member said: “In the kitchen there is a board with levels and we do get told. The chef is on it. Once it is handed to us, we know who it's for and told that is so and so. The residents are being assessed all the time.”

Staff made appropriate referrals to health professionals such as the speech and language therapist (SALT). A relative told us: “They have a pureed diet – I had a call; they noticed her coughing at meals and thought would be better.”

Staff worked with visiting professionals such as community nurses to manage people’s health needs. One visiting professional told us how people’s skin integrity had greatly improved over the past few months. Staff engaged in a more confident manner and acted on advice given by the community nurses.

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.

People’s care plans held clear records of health and social care professionals’ involvement. The service made referrals for people where additional support was required. The service met regularly with the local GP practice to share and review people’s health. Where people required medical appointments, the service liaised with family and other health professionals and ensured a multi-disciplinary approach was followed. New guidance provided by professionals was added to people’s care plans and shared with staff to ensure it was followed.

A relative told us, “They have registered with GP and before she saw them, they had a quick meeting with her and me to see whether any concerns to raise.” Another person told us: “If I want to see GP, I tell staff and go on list for Monday.”

The provider supported people to manage their health and wellbeing where able, so people could maximise their independence, choice and control. People told us they received support to access healthcare, inside and outside of the service which promoted their wellbeing. One person told us, “2 weeks ago wonderful sing song, last week 2 people one with a violin, this week one man singing, really enjoying.”

A relative told us: “They deal with dentist and they took her to hospital for an x-ray.”

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.

Whilst feedback from professionals we spoke with was supportive and positive in how people’s health needs were now being managed compared to before this provider took over; we found inconsistencies in record keeping for people who required repositioning in bed due to their skin integrity. Some of these people were cared for in bed and at a high risk of skin breakdown. Staff we spoke with were not always clear on people’s needs in this area. However, we did not find people had come to harm because of this. We raised this with the provider during the assessment who acted on our information promptly.

Staff monitored people’s food and fluid intakes appropriately where needed and interventions sought from health professionals to support the person. Where people needed fortified diets, staff communicated this clearly with the kitchen staff.

People’s consent was not always recorded correctly. Some people’s consent forms had been signed by staff, and some people had signed for consent when they had been assessed as lacking capacity to consent to their care`.

We found stair gates in situ across communal stair ways. We did not find any assessed consent documentation in place for this. Staff were unclear why these gates were in place.

The provider had recently extended the locked area of the secure dementia wing of the care home. This meant more people’s bedrooms were now behind a locked door. Some of the people who now lived behind the locked door did not require a locked door. It was not clear if the provider had consulted with people before this change was implemented. However, we were told following the assessment people had been asked about the new arrangement.