Highgrove

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 good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (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. The management team were open, transparent, and committed to improving the service. They analysed accidents and incidents to identify trends and took action to prevent recurrence. Lessons learned were shared across the service and, where relevant, with the wider organisation.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Pre‑admission assessments were completed to determine whether the service could safely and effectively meet each person’s needs and to support a smooth transition. The provider shared relevant information with health and care professionals in a timely manner to promote continuity of care and ensure people received consistent support.

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. People and their relatives told us they were satisfied with the quality of care and said they felt safe living at Highgrove. One relative told us, “It’s a great weight off our minds that we know [person] is safe here.” Staff received safeguarding training and understood how to recognise and report poor care and abuse. Staff told us they knew how to raise a concern and were confident their concerns would be listened to and acted upon. One staff member told us, “If I suspected abuse I would report to my line manager, then home manager. If this was brushed to one side, I would report to CQC.” Another staff member commented, “If I saw abuse then I would report straight away and know this would be followed up. If it didn’t, I would ring CQC.” We saw evidence the provider followed the principles of the Mental Capacity Act 2005 (MCA) to review people’s capacity and understanding around receiving care and support. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Care plans were person‑centred and generally provided clear information about individuals’ needs and the support required to meet them. However, some documentation relating to allergies and modified diets was not always recorded or communicated sufficiently to ensure risks were consistently mitigated. In addition, some moving and handling plans lacked the required detail, particularly regarding the correct loop configuration for hoist slings. The senior leadership team took prompt action to address these shortfalls once identified. Staff had completed a range of training to support with managing risk. Staff knew people well and understood when people required support to reduce the risk of avoidable harm. One staff member told us, “Follow care plan to reduce risk.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home was clean, tidy and overall, well maintained. However, ongoing issues with the heating system in some areas of the service meant continued reliance on portable heaters. Although risk assessments had been completed, the interim measures were not sufficiently robust to ensure people’s safety while a long-term solution was planned. Some cool-touch heaters had already been installed and following discussion with the registered manager further units were ordered to replace the remaining portable heaters. Issues with the guttering around the home were causing water to overflow in several areas, creating a potential risk of damp in residents’ rooms. Following the inspection, the registered manager confirmed that a date had been scheduled for the repairs to be completed, and that maintenance of gutters had been added to the annual preventative maintenance programme. Systems were in place to ensure regular health and safety checks were completed. Information in one emergency grab bag required updating but this was actioned immediately and a revised system put in place to ensure in future this was updated without delay. Staff were clear of their responsibilities in keeping people safe around the home. One staff member told us, “I would manage the risks associated with people’s care and support by making sure the environment is safe, equipment is up to date and safe to use.” People were complimentary about the home. One person told us, “I am happy with my room.”

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. The provider had a system in place to determine staffing levels based on people’s needs, and rotas reflected this. We observed no staffing concerns during the inspection, and most people and staff felt levels were appropriate. However, some feedback indicated that additional staff may be needed at peak times. One person commented, “The staff are excellent. I would say there are enough mostly. Sometimes at busy times they could do with some more maybe.” We asked the provider to continue to monitor staffing levels to ensure people received appropriate support. Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. Staff completed an induction on commencement of employment and ongoing training and refreshers to enable them to carry out their role effectively.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider had an infection, prevention and control (IPC) policy and training was available for staff. Processes were in place to ensure people were protected from the risk of infection. Personal protective equipment (PPE) was available throughout the building and used appropriately by staff.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Staff were trained in medicines administration, and their competency had been assessed. People were supported by staff who followed systems and processes to administer, record and store medicines safely. Regular medicines audits were carried out to ensure systems remained safe. However, we asked the manager to monitor to ensure that where people required thickener in their drinks that staff only dispensed the thickener prescribed for the individual and it wasn’t utilised for other people. One occurrence of patch rotation was missing for one person, and one stock count was incorrect. The senior team acted promptly to address these issues. When people were given an ‘as and when required’ (PRN) medicine PRN protocols were in place. Medicines were stored appropriately and records showed regular temperature checks were made to ensure they were kept within the recommended range. People and their relatives raised no concerns regarding receiving their medicines as prescribed. One person told us, “I get my meds like clockwork, and they will find you, wherever you are, to give you them.” A relative commented, “I am kept fully informed about their medications.”