Highborder Lodge

Highborder Lodge is a residential care home providing accommodation and personal care to up to 40 people. The service provides support to older people and people living with Dementia. At the time of our inspection there were 32 people using the service.

The service is also registered to provide care and support to people living in their own homes. However, at the time of our inspection, this service was not being provided. Everyone living at Highborder Lodge had access to en-suite facilities, communal living and dining spaces and garden.

People’s experience of using this service and what we found

People were not always protected from avoidable harm. People’s care plans and associated records were not always current, accurate and did not provide staff with the correct information they required to safely meet people’s needs.

People did not always receive care and support which fully respected their wishes. Immediate action was taken by the management to address these concerns.

Monitoring systems were not always effective as the records supporting the management of the service were not always reliable. These systems had not always identified or addressed concerns found during our inspection, including concerns in relation to people’s care records, cleanliness of the home, people’s person centred care and medicine management.

People’s medicines were not always stored in accordance with manufacturers guidance and provider’s policies. The management took immediate action to address this concern.

People told us they felt safe. They told us the staff were tolerant, patient and friendly. Although there had been challenges in recruiting staff, there were enough staff to ensure people’s care needs were met.

There were a range of activities and events for people to enjoy. However, some people who were not mobile, or were living with dementia were not always supported to access or enjoy these activities. Additionally, while we observed there were enough staff to meet people’s needs, staff did not always take the opportunity to engage with people and promote their wellbeing.

The provider, registered manager and staff had learnt from incidents and used this to inform their actions.

People and their relatives felt the registered manager was approachable. The registered manager had sought feedback from healthcare professional which was positive.

Staff told us they felt supported and enjoyed working at Highborder Lodge. Staff had received training to meet people’s needs.

We were assured the service were working in accordance with current government COVID-19 guidance

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 4 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included information of concern about people’s care and support.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highborder Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Highborder Lodge experienced an outbreak of COVID-19 in December 2020 and January 2021.

We found the following examples of good practice.

¿ People’s relatives were supported to visit the home. The provider and registered manager had set up and were using a visiting ‘pod’ in accordance with recognised safe visiting guidance. Alternative ways, including the use of technology, had supported people’s ability to remain in contact with their relatives. The registered manager was aware of changing in visiting guidance and was prepared to support visits in line with this guidance, including the use of COVID-19 testing processes for visitors.

¿ People had been supported to socially distance where appropriate. People were being supported to by staff to self-isolate where necessary. There were a number of communal areas people could use. These spaces were also used to promote social distanced activities.

¿ Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and were supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection.

¿ People’s health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. Healthcare professionals had continued to provide clinical support to people as this was required.

¿ The registered manager and staff had reflected on the outbreak of COVID-19 and the actions they had taken to support people. All staff had focused on reduce the risk of infection spreading which had included the correct use of personal protective equipment (PPE) and isolation of people affected by COVID-19.

¿ People and staff were tested in line with national guidance for care homes. Testing had helped the registered manager identify when full infection control measures needed to be implemented and when staff needed to self-isolate.

¿ As part of full infection control measures laundry and waste arrangements had been correctly implemented to reduce the spread of infection.

¿ The home was clean and staff had clear guidance on maintaining the cleanliness of the service. This included the additional cleaning of frequently touched surfaces to reduce the risk of infection spreading.

¿ Staff had received training and support in relation to infection control and COVID-19. The registered manager and staff took immediate action to manage an outbreak situation and to support people’s wellbeing.

Highborder Lodge can accommodate up to 40 people and some people who live with dementia. At the time of our inspection 32 older people were receiving support, some of whom lived with dementia.

Accommodation was provided in one main building across several floors. People had their own bedrooms, some with private washing and toilet facilities. Shared accommodation could be made available. The home had several different communal rooms which people could use to relax in, join in socially distanced activities and eat. When the weather allowed, a good size garden with seating, provided an alternative place to meet with family members.

We found the following examples of good practice at Highborder Lodge.

• A ‘Visitors Code During COVID-19’ was in place and the guidance for one consistent visitor for each person was followed.

• Visitors were asked to pre-book their visit times. This helped staff to control the overall number of visitors in the building at any one time. This helped to reduce the risk of infection transmission between and by visitors.

• Clear information and guidance was in place for all visitors on arrival to the home as well as appropriate personal protective equipment (PPE) and hand sanitiser.

• People’s and staffs’ temperatures were checked daily, as well as the monitoring for other COVID-19 related symptoms. Where necessary isolation and testing guidance was then followed.

• People were supported to remain socially engaged and not to become lonely. Staff helped people remain in contact with other family members and friends and to join in socially distanced group activities or enjoy a one to one activity with a staff member.

• People were admitted to the home safely. Managers ensured people’s care needs were appropriately assessed prior to admission. COVID-19 testing was arranged and completed prior to admission and isolation guidance followed following admission.

• The environment was kept clean. Cleaning and laundry processes had been reviewed to also reduce risks associated with potential COVID-19 infection.

• There were well thought through emergency arrangements in place which covered all emergencies as well as a potential COVID-19 infection outbreak in the home.

• Checks were in place by service managers and an external health and safety consultant to ensure the services infection, prevention and control processes and arrangements were followed safely.

Highborder Lodge is a residential care home providing support for up to 42 people. Nursing care and support is provided by district nurses and local GP’s as required. Several people at Highborder Lodge were living with the first stages of dementia. There were 31 people at Highborder Lodge at the time of the inspection.

There was a registered manager in post at Highborder Lodge. A registered manager is a person who has registered with the Care Quality Commission 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.’

At the last inspection on 23 and 24 August 2016, we asked the provider to take action to make improvements around staffing levels, the management of complaints and the safety of the environment. We also asked them to take action where concerns had been identified to improve the quality and service provided to people. Following the inspection, the provided submitted an action plan detailing how they would address the shortfalls and meet the requirements of the regulations. The provider told us all of the actions would be completed by July 2017. At this inspection we found this action had been completed and the provider met the requirements of the regulations.

The service was safe. People were protected from the risk of abuse. Staff had received safeguarding training and had a policy and procedure which advised them on what to do if they had any concerns. Risks had been identified to people’s well-being and action had been taken to minimise these. There were safe and effective recruitment systems in place. Staffing levels were sufficient; people received high levels of support from staff who had a good understanding of their needs and preferences. Medicines were administered safely and people told us they received their medicines as prescribed.

The service provided to people was effective in meeting their needs. Staff had the relevant skills and had received appropriate training to enable them to support the people living at Highborder Lodge. Staff received good support from management through regular supervisions and appraisals. People were encouraged to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the staff had acted in accordance with legal requirements. People and relevant professionals were involved in planning their nutritional support. People had access to a variety of healthcare professionals and appointments were arranged as required.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained people’s dignity. People were supported to engage in activities specific to their cultural or religious backgrounds and diversity was promoted throughout the service. People had end of life care plans which clearly reflected their wishes and preferences.

The service was responsive to the needs of people. People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities. People were supported to access and attend a range of activities. Where complaints had been made, there was evidence these had been managed appropriately.

The service was well-led. The registered manager and senior staff were approachable. Quality and safety monitoring systems were in place and these were effective in identifying shortfalls within the service and drive improvement. The views of relatives and people living at Highborder Lodge were taken into account to improve the service. People, their relatives and staff spoke positively about the strong leadership offered by the registered manager.

Highborder Lodge is a residential care home. Nursing care and support is provided by district nurses and local GP’s as required. Several people at Highborder Lodge were living with the first stages of dementia. There were 34 people at Highborder Lodge at the time of the inspection.

There was a registered manager in post at Highborder Lodge. A registered manager is a person who has registered with the Care Quality Commission 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.’

Our inspection highlighted shortfalls where a number of regulations were not met and improvements were required. People did not always receive a service that was safe. Staffing levels were not always sufficient to ensure the safe care and treatment to support people. Staff also told us they struggled to spend quality time with people due to short staffing levels.

The service was not always responsive. Complaints had been dealt with but people said they were not always satisfied with the outcome of their complaint. Care plans were person centred and provided sufficient detail to provide safe care to people. Care plans were reviewed and updated regularly.

The service was not always well-led. The majority of the staff we spoke with stated the registered manager’s approach when speaking with staff was poor and this had resulted in low staff morale across the home. Staff stated the registered manager should be more hands on.

Risk assessments were implemented and these provided a clear framework for managing risk to people. People were protected from abuse and neglect. There were clear guidelines for staff to follow when reporting concerns. People were protected from the spread of infection through safe infection control practices. The administration, storage and recording of medicines was safe.

People were receiving effective care and support. Staff were receiving appropriate training related to their role. Staff received regular supervision or appraisals. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and where people’s liberty had been deprived Deprivation of Liberty (DoLS) applications had been made. People’s personal living areas were personalised.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained people’s dignity. People had end of life care plans which clearly reflected their wishes and preferences.

Quality assurance checks and audits were completed on a regular basis. Where issues had been identified, these had been actioned. People and their families were asked to provide an opinion through surveys.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.