Archived: Highfield House

Updated 15 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced inspection on 8 and 9 August 2016. This inspection was to check the provider had taken action to address breaches we had previously identified and enforcement action we had taken. We had also received information of concern from local professionals who were visiting the home.

The inspection team consisted of one inspector.

As this was an inspection to follow up previous breaches of regulations we did not request provider information return (PIR). Before the inspection we reviewed the information we held about the home.

We spoke with two people who used the service to obtain their views on the care and support they received. We talked with the acting manager, the provider, one nurse, two care workers, a domestic worker and the cook. We also spoke with a health professional who was visiting the home during the inspection. Subsequent to the inspection we met with the provider and the provider’s nominated individual.

We observed care and support being delivered in communal areas, including lounges and dining rooms, looked in the kitchen areas, the laundry, clinic rooms, bath/shower rooms and toilet areas. We checked people’s individual accommodation. We reviewed a range of documents and records including; five care records for people who used the service, five medicine administration records; four records of people employed at the home, duty rotas, complaints records, accidents and incident records and a range of other management and care records.

Updated 15 October 2016

We carried out an unannounced comprehensive inspection of this service on 7 and 13 April 2016, at which we found a breach of legal requirements related to the governance and management of the home. In particular we found issues related to the checking and auditing of the care and environment at home and the oversight of the service by the provider. We took enforcement action against the provider and issued a warning notice.

We undertook a further inspection on 8 and 9 August 2016 to check that they had acted on the requirement of the warning notice and to confirm that they now met legal requirements. We had also received information of concern from other professionals who had visited the home and so spent time looking at other areas of care and service provision. We again visited the home on 20 September to further review actions taken by the provider. We also wrote to the provider seeking clarification on actions taken and documentation related to the running of the home.

This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Highfield House' on our website at www.cqc.org.uk'

Highfield House is a nursing home located in Bedlington, Northumberland. It is registered to provide accommodation with personal care for up to a maximum of 27 people. At the time of the inspection there were 16 people living at the home.

A registered manager was not in post at the home at the time of the inspection. 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. An acting manager was in charge of the home during the inspection and he supported us on both days. We were also supported by the provider on the second day of the inspection.

At the previous inspection we noted that no fire drill had been undertaken at the home in recent months. At the inspection on the 8 and 9 August 2016 we could find no formal record that a drill had been completed, although the acting manager and staff said there had been a drill, but it had not been recorded. At our visit on 20 September 2016 we saw a drill had been undertaken, but had not occurred until 15 September 2016. We also found that risk assessments for individuals related to fire safety had not been updated in line with the set review date.

At the inspection in April 2016 we found that accidents and incidents at the home were not being regularly reviewed, to identify any patterns or concerns. At this inspection we found that, whilst accident records were being completed there continued to be no review of the events to help improve safety at the home.

We had also previously found issues with the safe management of medicines at the home. In particular we found records to ensure safe recognition of people when giving medicines were not well maintained, care plans for “as required” medicines were not appropriate and temperatures in the room where medicines were stored was not regularly monitored. At this inspection we found new identification sheets had been developed and revised “as required” medicine care plans had been rewritten. Whilst room temperatures were being monitored we noted that the temperature in the clinic area was regularly above recommended levels and only limited action had been taken to address this. At the inspection on 20 September action had been taken to address the temperature issues in the clinical room.

Safety certificates to show that equipment used at the home was well maintained and safe to use had not been previously available. At this inspection these certificates were in place and available to view. At the previous inspection we had highlighted concerns about the cleanliness of certain areas of the home, including the laundry area. At this inspection we saw significant improvements had been made to the laundry area and the sluice areas. The home had been working with the local infection control service to improve overall cleanliness. However, on our return on 20 September 2016 we found that three of the four laundry machines were broken and washing had been hung in empty rooms to dry and air.

A number of new nursing staff had been employed at the home. However, it was not always possible to determine from records whether appropriate Disclosure and Barring Service checks had been undertaken.

We had raised concerns at the previous inspection in April 2016 that consent was not always sought in line with the provision of the Mental Capacity Act (2005). At this inspection we found there were still inconsistencies about how consent was gathered or how decisions about people care were made when they were unable to give consent.

The acting manager had reviewed staff training needs and was developing a training strategy. Staff had been formally signed up with the local learning development unit to access training. People continued to be supported to access health services and sufficient food and fluids were available.

People told us that they continued to feel supported and care for by the staff at the home and we witnessed good relationships and interactions. We highlighted with the acting manager some practices that could be improved to support people’s privacy and dignity.

At the previous inspection we found that care plans were in the format of the previous provider. We were told these were in the process of being reviewed. At this inspection we found there had been limited reviews of people’s care and the majority of plans had not been updated, although monthly reviews of care records were being undertaken. Where plans were updated they did not always reflect people’s full needs. The provider had dealt with a number of complaints and concerns since the last inspection and where necessary made alerted the local safeguarding adults team.

At the inspection in April 2016 we had found that there were no consistent checks and audits being undertaken at the home to ensure that the care and the environment were safe. At this inspection we found there remained very limited audits in place, although the acting manager told us he regularly walked around the home to carry out visual checks. The provider told us they had not been overseeing the home as closely as they would have liked, but had plans to improve their monitoring visits in the coming months. We had also previously found that records were not effectively maintained or stored securely. At this inspection we noted this had improved and older records had been archived appropriately.

We found five breaches of regulations. These related to person centred care, need for consent, safe care and treatment, good governance and fit and proper persons employed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.