Archived: Highgrove Care Home

Highgrove Care Home is a 78 bed nursing home, providing care to older adults with a range of support and care needs. At the time of the inspection there were 31 people living at the home. The home is divided into four discrete units, although the provider had stopped using two of the units and therefore only two were in use at the time of the inspection.

Highgrove Care Home is located in Mexborough, a small town in Doncaster, South Yorkshire. The home is known locally as Highgrove Manor. It is in its own grounds in a quiet, residential area, but close to public transport links.

At the time of the inspection, the service had a registered manager. 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 and associated Regulations about how the service is run.

Staff interacted with people warmly and with respect. People’s privacy and dignity was upheld when staff were carrying out care tasks. Care plans were devised in such a way as to ensure that good care was supported effectively. Where people’s health needs changed, the provider responded promptly, engaging external healthcare professionals and altering the way people were cared for, as required.

There were effective systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. Recruitment processes were safe and we saw there were sufficient staff on duty to meet people’s needs.

The provider had appropriate arrangements to make sure people received their medications safely, although some improvements were required. We also noted that some staff needed to make improvements to their hygiene practices.

People told us they enjoyed their meals at the home, and our observations corroborated this. People’s nutrition and hydration were closely monitored to ensure they maintained good health.

The provider had appropriate arrangements in place to ensure that it adhered to the requirements of the Mental Capacity Act 2005

There was a comprehensive programme of activities, both in the home and within the community.

There were thorough systems in place for auditing the service, to ensure that people received care which was safe and of a good quality.

Staff told us they felt well supported to undertake their roles, although the provider’s formal supervision programme was not yet fully embedded.

Highgrove Care Home is a 78 bed nursing home, providing care to older adults with a range of support and care needs. At the time of the inspection there were 37 people living at the home. The home is divided into four discrete units, although the provider has stopped using one of the units and therefore only three were in use at the time of the inspection.

Highgrove Care Home is located in Mexborough, a small town in Doncaster, South Yorkshire. The home is known locally as Highgrove Manor. It is in its own grounds in a quiet, residential area, but close to public transport links.

At the time of the inspection, the service did not have a registered manager. However, the home’s manager had applied to the Care Quality Commission to become registered and her registration interview took place 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 and associated Regulations about how the service is run.

We found that staff had a caring and patient approach when supporting and caring for people. They took steps to uphold people’s privacy and dignity, and treated people with respect and kindness. Staff had a good knowledge of people’s needs, and there were plentiful activities within the home.

Safeguarding arrangements in the home were effective; staff were knowledgeable and trained in this area, and appropriate procedures had been followed when abuse or suspected abuse had occurred.

Care records were not always fit for purpose. Some lacked detail or were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where care was not being provided in accordance with people’s assessed needs.

People’s nutrition and hydration needs were not always met. This was due to a combination of poor or absent recording, inaccurate recording, and care plans and risk assessments not being followed.

The arrangements in place for obtaining and acting in accordance with people’s consent, and decision making when people did not have the capacity to consent, did not meet legal requirements. Although staff were trained in this area, we identified occurrences where best interest decisions had not been appropriately made.

Medicines were well managed, and where there had been recent, untoward incidents in relation to medication, the provider had taken appropriate steps to address this. However, the arrangements for auditing medicines were not robust.

The systems and processes in place to ensure compliance with relevant regulations were not effective. Although the provider told us that new systems were in the process of being introduced, the Commission had informed the provider 18 months earlier that their existing systems of quality monitoring were inadequate, and the provider had failed to address this in a robust or timely manner.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider had appropriate arrangements for handling and administering medicines safely but did not have appropriate arrangements on place for recognising possible abuse. People did not always receive care in a safe manner. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to keeping people safe.

Is the service effective?

People's care plans did not always support effective, safe care and care was not always delivered in the way people had been assessed as needing. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to ensuring the service is effective.

Is the service caring?

We observed staff failing to meet people's needs, and staff did not always provide engagement and stimulation to people. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to ensuring people's care needs are met.

Is the service responsive?

Risks were not always appropriately assessed or responded to, and we found that the provider did not have appropriate arrangements in place for recognising the risk of abuse. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to assessing risks and managing the risk of abuse.

Is the service well-led?

The provider had recently recruited a new manager who demonstrated a good understanding of the measures needed to improve the care provided, however, this had not yet been embedded into care practice. The systems in place for monitoring and auditing the quality of care were not effective. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to monitoring and auditing the quality of care.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider did not have appropriate arrangements for handling or administering medicines safely, or for responding to allegations of abuse. People did not always receive care in a safe manner. We have told the provider they must take steps to achieve regulatory compliance in relation to safeguarding and medication.

Is the service effective?

People did not always receive the care they were assessed as needing. We have told the provider they must take steps to achieve regulatory compliance in relation to people's care and welfare.

Is the service caring?

Staff told us they wanted to spend more time engaging with people, but were unable to do so. We observed staff failing to respect people's dignity or privacy. We have asked the provider to tell us how they will make improvements in relation to people's dignity being respected.

Is the service responsive?

Risks were not always appropriately assessed or responded to, and we found that the provider did not take all required steps when dealing with allegations of abuse. We have told the provider they must take steps to achieve regulatory compliance in relation to people's care and welfare, and safeguarding.

Is the service well-led?

The manager named in this report as the registered manager was no longer in post at the time of the inspection, however, the provider had not formally notified CQC of this, which is a legal requirement. The manager at the time of the inspection was not registered with CQC. We found the provider had failed to make a number of legally required notifications to the commission.

During our inspection we spoke with ten people who used the service and three relatives. We also observed care interactions in the communal lounge and dining areas and in people's bedrooms on all three floors. All of the people we spoke with said they were happy with the care provided. Comments included, "This is a lovely place to live. If it wasn't any good I'd be straight out the door." "I get such help with everything. I think it's a marvellous place" and "I'm a happy lady. I've got everything I need here." The relatives we spoke with also said they were happy with the standard of care being provided. One relative said, "I know X is well cared for here. She's happy and I'm happy." Another relative told us, "It's a friendly home and people are looked after. I've no complaints at all."

We observed staff interactions with people who used the service in communal areas and in people's rooms. We found staff were polite, friendly and caring. People seemed relaxed and comfortable in the company of staff.

Our review of the management of medicines showed not all people were protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. This was in relation to the recording and safe administration of medicines.

There were enough qualified, skilled and experienced staff to meet people's needs. People we spoke with were complimentary about the staff. They told us they thought there were enough staff to meet their needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People who used the service felt the staff were trained to deal with their needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Medicines were prescribed and given to people appropriately. There was guidance on how and when medicines prescribed 'when required' should be used. Appropriate arrangements were also in place in relation to the recording of medicine. We looked at medicine charts for people who used the service and saw the receipt and administration of medicines was recorded correctly. We found medicines were kept safely and stored appropriately.

We found people experienced care, treatment and support that met their needs or protected their rights. People's care and treatment was being planned and delivered in line with their individual care plans. Assessments had been regularly evaluated and action taken where required.

We looked at the management of medicines. Evidence showed improvements had been made since our last inspection in September 2012. However not all people were protected against the risks associated with the management of medication because the provider did not have appropriate arrangements in place to manage obtaining, recording, handling, administration and use of medicines safely.

Evidence showed there were enough qualified, skilled and experienced staff to meet people's needs. One relative we spoke with told us there was always enough staff on duty when they visited. We found staff received appropriate training and professional development.

We found people experienced care, treatment and support that did not met their needs or protected their rights. People's care and treatment was not always being planned and delivered in line with their individual care plans.

Evidence showed improvements had been made since our last inspection in August 2012 however not all people were protected against the risks associated with the management of medication because the provider did not have appropriate arrangements in place to manage medicines.

Although we found people were cared for, or supported by, suitably qualified, skilled and experienced staff appropriate staffing levels in the nursing unit were yet to be determined. Evidence showed not all staff were receiving appropriate training, supervision and appraisal.

The provider had a system in place to monitor the quality of the service.