Highfield House 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 House can accommodate up to 45 people across three floors, each of which have separate adapted facilities. People were able to interact across the floors. Highfield House specialises in providing care for people who are medically highly dependent due to their complex physical and/or neurological disorders. At the time of our inspection 37 people were using the service.
At the last inspection on 9 October 2015 the service was rated ‘Good’ overall and for each key question. At this inspection on 23 and 27 November 2017 the service had improved their rating for the key questions ‘Is the service effective’ ‘Is the service responsive’ and ‘Is the service well-led’ to ‘outstanding’. This meant the service was now rated ‘outstanding’ overall.
People, relatives, staff and healthcare professionals were very complimentary about the management team at Highfield House. They felt the management team were approachable and interested to hear from them their experiences and any suggestions to improve practice. Healthcare professionals felt there was a drive within the staff team to improve and develop their practice.
Since our last inspection the provider had developed their corporate values. The provider had updated their policies and procedures linking them to their values and adopting the five CQC key questions as their desired outcomes. The provider’s values and behaviours underpinned their governance framework and there were robust procedures in place to review and improve the quality of service delivery. Staff worked in partnership with other agencies, this included liaison with their local NHS trusts, Clinical Commissioning Groups (CCGs) and the local authority. The service followed public health England guidance and implemented NHS initiatives at the service. There were systems in place to enable staff to continuously learn, improve, innovate and ensure sustainability of service. The provider issued safety alerts in response to any incidents that occurred. They had also developed a staff newsletter which was themed on the 5 CQC key questions to further enhance staff’s understanding of the five questions about how the care they provided fitted into these and the provider’s values.
Staff were very passionate about their roles and working at Highfield House. Staff, people and relatives were keen to share with us their experiences of Highfield House and staff were very proud of the work they did. There was an obvious drive and commitment within the team to provide high quality personalised care. All of the healthcare professionals we received feedback from were very positive about the quality of service delivery and joint working arrangements.
Staff stayed up to date with and delivered care, support and treatment in line with best practice guidelines. This included guidance from the National Institute for Health and Care Excellence (NICE) and Royal College of Physicians (RCP). The management team organised for authors from recently published guidance to come to the service to speak to staff and families about the new guidance available. There was a comprehensive training programme in place and robust processes to ensure staff were competent to undertake their allocated tasks. Training drop in sessions were held daily for staff to update their knowledge on the provider’s mandatory training topics as well as ‘skills sessions’ held for staff to update their clinical knowledge.
The service provided healthcare support in line with the principles of the NHS England’s vanguard initiative for enhanced models of care which ensured proactive review of people’s healthcare needs and streamlining processes to ensure accurate and complete information was available in the event people required emergency hospital admission. The chef worked with specialist healthcare staff to ensure meals provided met people’s complex dietary requirements. An accessible environment was provided which took account of people’s physical and sensory needs. Staff adhered to the Mental Capacity Act 2005. 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, relatives and healthcare professionals were extremely positive and complimentary about the care and support provided to people. Care was person-centred and met people’s individual needs. Assessments were regularly undertaken to review people’s needs and any changes in the support they required. Detailed support plans were developed instructing staff about how to support the person. Care staff worked with the therapy team to support people’s rehabilitation and help people to develop their independence. A range of devices were used to support staff to assess and improve people’s cognition, memory and attention span, as well as using rehabilitation computer games to incorporate fun into people’s recovery. Staff followed the ‘six steps to success’ programme to ensure high quality end of life support was provided. An annual memorial event was held to remember those that had died. A range of activities were provided at the service and in the community. There were different sessions available which targeted different groups of people depending on their needs. One to one activities were provided as well as a group activity programme.
The service had systems for ensuring concerns about people’s health and welfare were managed appropriately and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People felt safe at the service and told us they received prompt support from staff. People’s dependency levels were reviewed daily and there were sufficient staff, with appropriate skills and knowledge, to meet people’s needs. This included providing one to one support for people with high risk complex care needs and recruiting specialist clinicians required to provide people with safe care and treatment. Staff assessed risks to people’s safety and systems were in place to minimise risks to people and to alert staff as people’s risk levels changed.
Safe medicines management processes were adhered to. Staff followed best practice guidance to prevent and control the spread of infection. Systems were in place to report incidents and learning was shared in response to any errors made, including issuing safety alerts to all staff about how to prevent similar incidents from recurring. Staff followed best practice in regards to safeguarding people from avoidable harm.
Staff had developed therapeutic and caring relationships with people. Staff were aware of people’s preferred name and their preferences in how they were supported. Staff respected people’s individual differences, their religious preferences and their culture and provided any support people required with these. People’s privacy and dignity was maintained. A dignity champion was nominated who held various events to promote dignity and explore people’s understanding of what it meant to maintain people’s dignity. Staff were aware of people’s communication methods and provided them with any support they required to communicate, including use of technology, in order to ensure their wishes were identified and they were enabled to make decisions and choices about care and service delivery.
A complaints process remained in place and complaints received were investigated appropriately. Many of the complaints received since our last inspection focused on the building work that was previously carried out and this had now been resolved. The service received many compliments about the staff and the care and support people received whilst at Highfield House.