Highborder Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. There was evidence of learning taken from incidents, accidents and unexpected events.

Since out last inspection the provider had improved their system to review accidents and incidents. This was a more robust way for the manager to review and analyse trends in falls management and monitor people who were at risk of weight loss. Where learning was identified this was shared with the team through meetings, supervisions and further training.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider openly engaged with external agencies and professionals. We observed relatives and professionals visiting the service during the onsite assessment. People appeared relaxed and calm in their environment. Staff had a good rapport with people and understood people well.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes], this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found applications for Deprivation of Liberty Safeguards (DoLS) had been made to the local authority. Some service users had authorisations within their care records, we were told by the provider no one had any conditions attached to their DoLS authorisation. However, not all people who required a DoLS had been assessed by the supervisory body. The provider had reviewed referrals that had been made for people in recent months and was in the process of updating information at the time of the assessment. Whilst mental capacity assessments and best interest decisions were being made, not all information regarding 1 person’s capacity to consent to their care was consistently recorded throughout their care plan, this meant there was conflicting information for staff to follow when supporting the person to make decisions about their care. The provider told us all care plans would be reviewed following our assessment.

The provider did not always work well with people to understand and manage risks.

At our last assessment people were exposed to risks because the provider did not always operate an effective system or process to record, recognise or act on risks. This included risks around people’s individual needs, medicines administration and environmental risks.

At this assessment, risk assessments were missing in some people’s care plans including for example 1 person who was self-administering their own medicine and another person who was prescribed a mood stabilizer. The provider took steps to rectify this during the assessment however; we did not see a risk assessment for the person who self-administered their medicine to ensure they were safe to do this.

We found paper records of people’s personal emergency evacuation plans (PEEP’s) had not been updated. The provider acknowledged this during the assessment, and they told us this would be corrected. Accurate information in the paper folder is important because it is used to guide staff to assist service users to leave the building in emergency situations.

Overall, risk assessments had been developed using a more person-centred approach and reflected risks to people on a daily basis. These were reviewed as part of ‘resident of the day’ and manager monthly meetings. At this assessment, we found the provider had made improvements. However, further time was required to ensure improved practices were embedded and formed an on-going part of the providers risk assessment and management processes.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We observed improvements had been made to the environment since the last inspection.

The provider continued with the planned refurbishment of the building and steps had been taking to improve the storing of cleaning products, some areas were visibly improved. However, during our assessment some areas of the home did not look well kept for example loose cables in one room, some stained carpet areas, and a cracked window in one bedroom and walked in food on the floor in one bedroom. Whilst the provider had a plan to support improvements, we noticed some areas that would benefit from more oversight of these areas. The provider told us they had recently received a positive score from the Local Authority Infection Prevention Control team during their visit.

The provider had processes for reporting maintenance and safety issues, supported by regular audits and health and safety governance meetings. Recent safety improvement work included the upgrading of a storage facility outside the main building. This meant that potentially hazardous products were now stored securely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the last assessment we found not all staff were suitably skilled and trained to safely support people and identify potential risks for people.

At this assessment we found staff training had improved. Staff received a mixture of e-learning and in-person practical training. The deputy manager worked with staff to improve their knowledge and competency around medicines. Newly employed staff were subject to a probationary period and induction. The provider had introduced 360-degree appraisals to support staff. Staff received individual and group supervision, giving an opportunity to share good practice and learning.

The provider worked with the local authority to enhance their face-to-face training, staff had undertaken opportunities to attend Dementia and Parkinson’s disease training, and staff training was planned for positive behaviour to support people who could become distressed.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Since our last inspection improvements had been made to how medicines were managed. Staff were proud to share the actions they had taken and told us they felt these changes had improved care for people living at the home. However, they recognised further improvements were required.

Overall, there were suitable arrangements for ordering, storage and disposal of medicines, including for items needing cold storage and those needing extra security. Storage temperatures were monitored to ensure medicines would be safe and effective. However, we found prescribed topical creams were not stored according to the providers policy. The policy stated these creams should be locked in cabinets in people’s rooms. However, we found these cabinets to be unlocked, which meant there was a risk people living in the home, or others, could access them.

When medicines were administered, they were recorded on electronic Medicines Administration Records (MAR). Improvements had been made to these records and the process of medicines administration since our previous inspection; we did not observe any medicines delays or omissions. Specific changes to the way time-critical medicines, such as those to treat Parkinson’s, had been made to ensure medicines were administered in a safe, consistent, timely and clinically appropriate way.

Staff worked closely with the GP to resolve issues with medicines in the home. We observed staff working with the GP to amend 1 person’s medicines schedule to ensure it suited their personal schedule and preferences. This was being done according to an agreed plan with the person and the GP.

The provider had taken action to implement medicines risk assessments since our previous inspection. Risk assessments had been implemented for people prescribed medicines with associated risks of bleeding and bruising. Fire risk assessments for people who were prescribed paraffin-based flammable emollients had been implemented; however, these were not person centred. For example, all risk assessments we reviewed mentioned the individuals use of oxygen and smoking which were not always applicable to the people concerned. There was no risk assessment in place for a person prescribed a medicine which required regular therapeutic drug monitoring and staff could not tell us how they would recognise signs of toxicity. Following our inspection, this risk assessment has been implemented.

The provider had made improvements to the oxygen concentrator positioning and oxygen cylinders were now securely stored. Records reviewed demonstrated the management team had assessed staff competency to use these medical devices. However, there was no documented evidence to indicate staff had received initial training to provide them with the necessary knowledge prior to these competency assessments. In addition, there was no evidence the management team had received relevant training; therefore, we could not be assured the management team had the knowledge and skills to effectively assess the competency of other staff members.

Staff were not following good practice in relation to prescribed topical patches for the management of pain. Daily checks to ensure patches remained in place between weekly applications was not being documented, this meant we could not be assured patches remained in place and people’s pain was appropriately managed. There were no records of the removal and disposal of these patches which were controlled drugs (medicines which require additional controls and safeguards according to the law) this meant we could not be assured the provider was compliant with legislation. The provider started to address this during the assessment.

Personalised protocols were in place to support staff with the administration of medicines prescribed be administered ‘when required’/PRN, such as medicines for pain relief and constipation. These protocols considered each person’s individual preferences and needs; this had improved since our previous visit.