Highfield Scheme Limited

We found the following examples of good practice

The registered manager had established effective infection prevention and control procedures which were understood and followed by the staff. A screening process had been implemented for visitors, which included health and temperature checks as well as lateral flow tests for coronavirus.

A regular programme of testing for COVID-19 was in place for staff and people using the service. This meant swift action could be taken when any positive results were received.

The registered manager confirmed there were plentiful supplies of Personal Protective Equipment (PPE) and stocks were carefully monitored. PPE was readily available for staff to access when they were supporting people with personal care. PPE was disposed of safely, which helped reduce the risk of cross contamination. Staff had been trained in infection control practices and posters were displayed to reinforce procedures. We observed the management team were using PPE appropriately. The registered manager confirmed there were sufficient staff to provide continuity of support should there be a staff shortage. Staff were allocated to specific settings and were only reallocated in extreme circumstances. This was to ensure safe staffing levels for people using the service and minimise risk. The registered manager told us they took into consideration staff experience and their vaccine status.

The registered manager informed us the staff maintained social distancing wherever practicable and ensured people were advised about good levels of ventilation. Where the provider was responsible for the cleanliness of people’s environment, the staff followed enhanced cleaning schedules which included all areas of people’s homes. The staff returned completed cleaning records to the office on a monthly basis to enable the registered manager to carry out an audit. In addition, the management team carried out regular checks to ensure the appropriate standards of hygiene had been maintained.

The registered manager praised the resilience, commitment and creativity of the staff team. They explained, the staff had enabled people to participate in meaningful activities in their own house throughout the pandemic and within the community when this became possible. The registered manager added the staff worked effectively as a team and everyone was well supported by the provider.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. The registered manager was the designated lead for infection prevention and control and ensured staff were promptly informed of current guidance and good practice issues.

The service was managed by 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 2008 and associated Regulations about how the service is run.

At our last inspection carried out on 16, 17 and 18 February 2016 we rated the service as ‘Good’ overall. However, we found the provider did not have robust recruitment procedures for the safety and well-being of people who used the service. Following the inspection we received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made.

We found there were management and leadership arrangements in place to support the day to day running of the service. Comments from staff indicated there was discontentment about some aspects of management, but we found action had been taken to make improvements.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. Staffing arrangements were sufficient. Support was provided in response to people’s agreed plan of care.

People we spoke with indicated they felt safe with the service. Staff spoken with were aware of the signs and indicators of abuse. They knew what to do if they had any concerns and were confident in reporting matters. Staff had received training on safeguarding and protection.

Risks to people’s well-being were being assessed and managed. Systems were in place to maintain a safe environment for people who used the service and others.

Where applicable people were supported with shopping for provisions, cooking, eating and drinking. People’s individual dietary needs, likes and dislikes were known and catered for. Arrangements were in place to help make sure people had a balanced diet and healthy eating was encouraged.

People were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

We observed positive and respectful interactions between people using the service and staff. People made positive comments about the staff team.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities, preferences and routines before they used the service.

Each person had a care plan, describing their individual needs, preferences and lifestyle choices. This provided guidance for staff on how to provide support. People’s needs and choices were kept under review and changes were responded to.

Staff expressed a practical awareness of promoting people’s dignity, rights and choices. People were supported to engage in meaningful activities in their homes and in the community. Beneficial relationships with relatives and other people were supported.

People were supported as much as possible to make their own choices and decisions. We saw staff consulting with people and involving them in routine decisions. We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

Processes were in place to support people with any concerns or complaints. There was an ‘easy read’ complaints procedure for people, which provided step by step guidance on making a complaint.

There were systems in place to consult with people who used the service and staff, to assess and monitor the quality of their experiences.

Highfield Scheme Limited is registered to provide personal care and support to people with a learning disability living in their own homes. This includes people living in shared accommodation as part of a supported living arrangement. The aim of the service is to promote each person’s personal development, their independence and maximise their potential in all areas of life.

Services provided by the scheme included support to maintain people’s health, social and intellectual wellbeing as well as guidance with home making skills, budgeting and life choices. The service can be available seven days a week, 24 hours per day in response to people’s individually agreed care package. At the time of the inspection Highfield Scheme was providing support for 34 people.

The service was managed by 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 2008 and associated Regulations about how the service is run.

At the last inspection on 26 June and 1 July 2014, we asked the provider to take action to make improvements in relation to ensuring people who used the service were safeguarded against the risk of abuse. Staff were not confident in raising matters of concern and had not received up to date training on safeguarding matters. Appropriate records had not been kept on safeguarding investigations and outcomes. We received an action plan from the provider indicating they would meet the relevant legal requirements by 1 December 2014. At this inspection we found sufficient action had been completed to make the required improvements.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having robust recruitment procedures for the safety and well-being of people using the service. You can see what action we told the provider to take at the back of the full version of this report.

We found some further improvements were needed to provide people with safe care and support. Therefore we have made a recommendation about ensuring risk to people’s well-being and safety are properly considered. We have also recommended the service improve their practice on safely supporting people with their medicines.

We also discussed with the registered manager the value of revising the arrangements in place for re-decoration and up-grading of the properties with the landlord, people using the service and their representatives.

People we spoke with and spent time with indicated they felt safe with the service. Staff spoken with were aware of the signs and indicators of abuse. They knew what to do if they had any concerns and were confident in reporting matters. Staff had received training on safeguarding and protection.

People we spoke with told us they were satisfied with the service. They said: “It’s okay,” “Things are fine” and” I’m really happy.”

People were supported with their healthcare needs and medical appointments and their general wellbeing was monitored. Where applicable they were supported with shopping for provisions, cooking, eating and drinking.

There were systems in place to ensure all staff received regular training and supervision. We found some training was over-due, but this matter was in hand.

We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

Processes were in place to support and encourage people to make their own decisions and choices.

People made positive comments about the staff team including their caring approach and attitude. One person told us, “The staff are always nice.” We observed staff providing people with sensitive support and guidance with daily living needs and activities. Staff were aware of people’s individual needs, backgrounds and personalities. They told us they were familiar with the content of people’s care records.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities, and preferences before they used the service. Each person had a support plan in place to direct staff on meeting and responding to their assessed needs. People’s needs and circumstances were kept under review. People told us how they were supported to engage in activities within the local community and were encouraged to pursue their hobbies and interests. Staff responded to people as individuals and promoted their rights, choices and independence.

Processes were in place to support people with any concerns or complaints. There was a formal system to manage, investigate and respond to people’s complaints and concerns. People could also express concerns or dissatisfaction within their support reviews. There was an ‘easy read’ complaints procedure for people, which provided step by step guidance on making a complaint.

We found there were management and leadership arrangements in place to promote an efficient day to day running of the service. During the inspection the registered manager expressed commitment to the ongoing improvements at the service. There were processes to monitor and develop the services provided, in consultation with the people who used them.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

People who used the service and their relatives told us they were satisfied with their support from Highfield Scheme. However we found some practices were lacking in effectively safeguarding and protecting people from abuse. A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

Progress was needed on assessing peoples' capacity to make their own decisions and choices and ensuring staff provide support in people's best interests.

People's care records were not up to date. This meant there was a risk people's changing needs and preferences were not being identified and effectively responded to.

Is the service effective?

People were involved in discussions about their care and on-going reviews.

Arrangements were in place for care workers to develop their skills and receive appropriate training. Staff were being supervised and had opportunity to discuss work practices. However, we found some training had not been updated.

Is the service caring?

People spoken with told us they were satisfied with the care and support they experienced from Highfield Scheme. They told us, 'It's okay' and 'It's nice I like it'. Relatives spoken with said, 'The care can't be faulted, they understand (my relative's) needs', 'It's the best care imaginable' and 'They treat people very well'.

People told us they were happy with the care workers. One person said they were 'Okay' and we observed some positive interactions between people using the service and staff. Relatives spoken with said:'They are like another family', 'They are all excellent' and 'We have always got on well with the staff'.

Care workers were seen to be attentive and respectful in their approaches when supporting people. However, we found there were some routines and practices that did not promote a person centred approach.

Is the service responsive?

Some arrangements were in place to review people's needs and abilities. This meant their individual needs and choices should be considered and planned for.

Care workers spoken with were aware of the emergency procedures, including contacting health care services and reporting matters to the management team as needed.

Is the service well-led?

The service had a registered manager responsible for the day to day operation of the service. There was a team of office based managers. However, we found the management team structure, including designated roles and lines of accountability were unclear. Several staff spoken with described the managers as supportive and approachable. However, some considered there were unfair management practices. Some staff expressed a lack of confidence in managers appropriately acting upon concerns.

We found people were involved with decisions which affected them informally on a daily basis. People had been invited to complete satisfaction surveys for their views in the service.

There were some systems in place to assess and monitor how care and support was provided, and to monitor the quality of the service. However we found further checking systems and plans for development were needed.

People were being involved as far as possible in planning and consenting to their care and support and were enabled to make decisions about matters which affected them.

People told us the support they received was good and that they had care plans describing how their support should be provided. We found some progress could be made with assessing risks, to show how choices and decisions had been made.

We found arrangements were in place to safely support people with their medicines. But to keep things safe, clearer records should be kept to confirm the actual support provided.

People told us they liked the staff who provided their support. We found the staffing arrangements ensured people received good care and support.

There were systems in place to help support people to make complaints and raise concerns.