Highborder Lodge

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

This service scored 71 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

All residents had a care plan that recorded information about their care needs, preferences and life history. People and their relatives we spoke with confirmed this was in place commenting, “Yes care plan, someone showed it to me to check, I agreed with it” and “[interim manager] did the care plan at our house and then later they assessed for stand aid hoist and a bedrail, discussed with me and her.”

We saw care plans were being reviewed and families could be part of this review if the person wished. The acting manager told us they followed a review plan saying, “We do resident of the day now, these things weren’t in place when we took over so we look at the holistic picture every 6 to 8 weeks and look at that care plan.”

The management team spoke about the work undertaken to ensure staff recorded information accurately. We saw written reminders were placed around the service drawing staff attention to the importance of accurately documenting and recording information.

Care plans were detailed and were written in a respectful and individual way. For example, 1 person’s emotional support care plan spoke about examples the person would draw on when feeling low and how to inform professionals upon noting any changes to ensure timely support was received.

However, 1 person’s care did not always follow a person-centred approach. Records showed staff did not always know how to engage with this person confidently meaning sometimes the person was not supported as well as they could be.

There were shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of people’s choice and continuity.

During our inspection, we identified some people supported at the service lived with a learning disability and autism. For 1 person at the service, this did impact on the support they received. The provider had a routine condition on their CQC registration that states they must not deliver specialist services for autistic people and people with a learning disability at this location. We fed this back to the service.

We found that the service was not meeting all the principles of ‘Right support, right care, right culture’ guidance (Right support, right care, right culture is statutory guidance that underpins our approach to regulating services for autistic people and people with a learning disability).

For example, 1 person who had a learning disability was living alone on the top floor. They were separated from the rest of the home by a stairgate leading to their room. Staff told us this was in place to stop a person on the ground floor from going up, however there was a stairgate on the ground floor that would have prevented this. When we spoke with this person and asked them how often they went downstairs they told us, “Not all that often, got to be taken.”

This person did not engage much with other people living in the home and was not regularly participating in daily activities. We saw they liked musical activities, but staff had only recorded twice in a week they had invited this person to join in. Since raising concerns during our inspection, we were informed that this person was now engaging with other’s more and attending activities on and off site.

The service did not have a structured approach to supporting this person with self-neglect around their personal care. We found this person to be living in a condition that was detrimental to their wellbeing. This person was not being supported in a way that enhanced or supported a fulfilling quality of life. Since raising our concerns, the local authority has started working with the home to review the person’s needs.

Staff and leaders did not demonstrate understanding or knowledge for supporting people with a learning disability and or autism, They had not heard of Right support, right care, right culture guidance and not all staff had undertaken mandatory training appropriate to support people with these needs. The provider expressed that when they took over the service, people’s needs had not been fully reviewed or shared. Following our feedback, the provider informed us they would adapt their service provision in future to ensure they were not in breach of this condition and can meet the needs of all service users.

We saw some residents had continuity of care in ensuring external professionals were involved in people’s care. This included the learning disability team nurses, occupational therapists and social workers.

People’s communication needs had been identified and recorded within their care plans. There was good information recorded about people’s preferred communication styles and how staff could support these.

Relatives told us they were provided with information about their family member as needed and kept informed when they were unwell. One relative commented, “[Relative] hasn’t been very well recently, and staff have kept me informed especially [staff member name], they keep me informed about the GP.”

However, information provided for people and their relatives in communal areas was not always accurate or up to date. We identified that the complaints policy and the safeguarding policy did not have the correct information about who to contact or who the manager or provider was. We raised this to the management team who confirmed this would be addressed. This had not had an impact on any of the people living there.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider had not yet undertaken formal feedback surveys with people and their relatives since taking over the service, however there had been opportunities for people to share any concerns or feedback about their experiences. This had included service leaders inviting feedback during face- to-face meetings, having an open door to people, families and staff and letters and email communication.

People and their relatives told us that communication was good, and the home newsletter was a welcome feature with 1 relative commenting, “The newsletter is much better than it used to be and really good to know about activities so we can talk with her about things and avoid times she is busy.”

One person told us, “I know the staff and they look after me” and another said, “I gave some feedback to the manager about something staff had done well and it was good to hear it had got to them at a staff meeting.” One relative told us, “Things have stepped up, it’s a very local home, we hoped they would stay local, not become corporate, they have reached out to the village” and another said “At Christmas they let the village know that if anyone was alone on Christmas day they could come in – about 4 – 5 people did.”

Relatives told us they were kept up to date with changes at the home and activities going on with news in the form of a newsletter.

We saw people had written cards to the staff thanking them for the care and kindness they had shown their relatives. The acting manager told us, “I meet with families and they see me and we had a big event. We did the same at Christmas, and some have booked in a private chat at these occasions, families working full time often come in the evening to see me.” One relative told us, “I gave some feedback to the manager about something staff had done well and it was good to hear it had got to them at a staff meeting.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access specialised help to meet their needs. We saw communication and visits recorded with other professionals. From a recent review, 1 person had been supported to have 1 -to-1 hours so they could participate in activities of their choosing. The acting manager described the positive impact this was having on the persons mental wellbeing.

Although staff described a previous struggle to access dental treatment, some people had now been visited by a community dentist so were able to receive this support.

The service had out of hours management support for staff should they need to seek advice about a person. The acting manager said they had seen an increase in calls at night from staff which they reported was a positive thing as staff were actively seeking guidance and showing confidence to do this.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

There was a commitment to ensuring people did not face discrimination and had equal opportunities within the home. This was evident in the service’s approach to attending activities outside of the home. The acting manager explained, “Everybody is asked to go out, we look at risk assessments, we would even have more staff on to enable more people to go out. We accommodate wheelchairs going out. We have our own minibus and use it actively. I noted that every week it was the same residents going out and we have made this more inclusive.”

People had care plans to recognise any protected characteristics and ensure people’s needs were met. We reviewed some people’s sexuality care plans which recorded how the person liked to identify and if they were open to discussing this area of their life. It recorded staff must respect the person’s privacy and personal boundaries.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People were given the opportunity to discuss any preferences around their future care wishes should they become unwell. Staff respected when people did not want to have these discussions at that time and recorded this in their care plan, stating a meeting, at a later date would be arranged.

People’s care plans contained information personal to the individual, such as if they wanted music played and who should be called to be with them.

Staff were also given access to support if they needed this as it was recognised the impact of caring for someone at the end of their life can have on them. One of the directors told us, “We check in, staff support each other really well in the home.” Staff had access to support when they come across emotionally difficult situations.