Highfield Care Home

Updated 5 September 2018

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.

This inspection took place on the 25 and 26 June 2018. We subsequently followed up information on the 25 July 2018. The inspection team consisted of an inspector, a bank inspector, a professional advisor and an Expert–by-Experience. The professional advisor was a registered nurse and focused on the provision of nursing care within the service. An expert by experience is a person who has personal experience of care services and caring for an older person.

The provider had completed a provider information return (PIR) prior to the inspection. This is a form that asks the provider to give key information about the service, what it does well and the improvements they plan to make. Prior to the inspection we reviewed the information we held about the service including notifications of incidents that the provider had sent to us since the last inspection. A notification is information about important events which the service is required to send us by law.

Prior to our inspection we spoke with stakeholders including commissioners of services. We also looked at safeguarding concerns reported to us. This is where one or more person’s health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect.

As part of the inspection we undertook a SOFI (Short observational framework for inspection.) This is a tool we use to capture the experiences of people who use services who may not be able to talk with us and involves observing care and interactions between staff and people who use the service.

There were 49 people living in the service and we spoke with eighteen of them, 10 visitors and 12 staff. We spoke with the registered manager, the deputy manager and the area manager. We looked at three staff records, people’s care records and records relating to how the safety and quality of the service was being monitored. We observed care practice and medication administration.

Updated 5 September 2018

Highfield Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highfield Care Home is a 53-bed residential and nursing care service providing care, treatment and support, including end of life care and support for people living with dementia. On the days of our unannounced inspection on 25 and 26 June 2018 there were 49 people living at the service. Saffron suite was a specific part of the service which catered for people with a diagnosis of dementia.

The service had a registered manager who was present during the inspection. 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.

The last inspection of the service was conducted in July 2017 and we rated the service as, ‘Requires Improvement’ overall, and we found two breaches of the legal requirements. Equipment was not always maintained at the correct setting or regularly checked to make sure that it was working effectively. Care staff were not familiar with people’s needs and the care plans did not provide sufficient direction to staff.

At this inspection, we found that improvements had been made. We found that there were clearer systems in place to check on equipment and ensure that it was safe to use when needed. Risk assessments were in place to manage risks and reduce the likelihood of harm, however further work was needed to ensure consistency of practice in relation to some of the documentation and moving and handling.

The care plans were more detailed and informative, and provided clearer guidance to staff on people’s needs and their care preferences. Staff knew people well and there were effective handover systems in place to ensure that key information was communicated to those who were supporting individuals.

There were systems in place to review any accidents or incidents and to identify any learning or improvements needed. Staff received training on how to recognise abuse and we saw that concerns about individual’s wellbeing had been appropriately escalated to the relevant authorities.

There was enough staff available to meet people's needs. Staffing numbers had been calculated based on the needs of the people using the service. There were clear processes in place to check on staff suitability prior to them starting work at the service which included references and disclosure and barring checks.

New staff received training to ensure that they had the skills and knowledge they needed to meet people's needs. Additional training opportunities were made available to staff to update their knowledge and maintain their skills and competency.

People were supported to eat and drink and maintain a balanced diet. There were clear systems in place to monitor those individuals at risk of malnourishment.

People had good access to health care support which included access to the GP, optician, specialist nurses and dietician. The service worked with other organisations in a collaborative way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's ability to make decisions was assessed in line with the requirements of the Mental Capacity Act (MCA) 2005. Where appropriate Deprivation of Liberty Safeguard (DoLS) authorisations were in place to lawfully deprive people of their liberty for their own safety.

The environment was well maintained and comfortable. We have made a recommendation that further advice is sought on creating an environment that would further support people with dementia.

People looked well-groomed and were wearing communication aids such as spectacles and hearing aids. People told us that they were treated with dignity and their independence was promoted. There were systems in place to support people and their relatives to express their views about the quality of the service and suggestions were welcomed.

People had access to a range of interesting and stimulating activities which promoted their wellbeing.

There were systems in place to respond to people’s concerns and investigate them. We have made a recommendation about the management of complaints.

The registered manager was supported by a deputy manager and a clinical lead. Staff supervisions, appraisals and team meetings were used to reflect on practice and explore what could be done differently. The registered manager worked with other agencies including the local authority quality team to drive improvement at the service.

Quality assurance processes were in place, which provided the registered manager and provider with oversight of the service. Information was collated on a range of areas and analysis undertaken to identify patterns and manage risks. The providers representative visited the service on a regular basis and completed a report on the quality of care which set out actions and timescales for delivery.