Highfield Residential Home

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

The care home accommodates up to 15 people in one adapted building and provides care to older people some of whom are living with dementia, and or physical or sensory disabilities. At the time of our inspection there were 13 people living at the home.

There was a registered manager in place. 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 previous inspection of this home in August 2016 we found improvements were needed in three of the five key questions. At this inspection we found that the provider had made improvements so that people received care that met their needs.

People said they felt safe and staff knew how to recognise signs of abuse or harm and how to report this. Staff knew the risks people faced in relation to their health conditions and how to support people with these. People were complimentary about the availability of staff and the provider practiced safe recruitment with the required checks carried out before staff started work.

People received their medicines on time from staff who had been trained to administer these safely. There were processes in place to ensure the premises and equipment were regularly checked and to manage the prevention and control of infection. The manager reviewed accidents and falls to ensure people had the right support to keep them safe.

Staff had effective support, supervision and training to develop the skills needed to care for people effectively. People told us they enjoyed the meals and we saw staff offered people hot and cold drinks throughout the day. People were supported to access health professionals when they needed. Staff supported people to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service support this practice. The provider was improving the premises and facilities. To ensure these were suitable to meet the needs of the people who used the service further consideration of signage and colour schemes to help people orientate themselves was needed.

People were very complimentary about the caring approach of staff. They said they were kind and considerate. We observed caring and friendly relationships between people and staff. We saw people’s dignity and privacy was respected and they were supported to express their views about the care they received. There were examples of a compassionate response to people’s emotional needs.

People told us they had choices and made decisions about their care needs and that staff respected these. People were particularly complementary about the social opportunities available to them. They had access to a range of community based activities of their choosing, with access enhanced by use of the provider’s mini bus. Staffing was planned so that people had one to one support with their social events. People's care was centred on them and they had been involved in this process. There was clear system in place to manage complaints which were investigated and responded to.

The management of the home had improved with a full management team now in place. People spoke very positively about the management style being open and friendly. The registered manager had improved their oversight of the service and was carrying out regular checks to ensure people experienced good outcomes. Quality assurance audits needed some minor strengthening to ensure the provider was looking at all aspects of the service. There were links with other agencies to gain advice and share best practices to improve the quality of care to people. People’s views on the service were sought and staff were confident the provider’s improvement to the service would continue such as the extension currently being built.

At our last inspection in May 2015 we found the provider’s capacity to identify and manage risks to people’s safety was limited. Systems were not in place to check medicine safety and the induction and training of staff needed further improvement. People had not been actively involved in planning all aspects of their care and developing a personalised care plan.

Improvements were needed in relation to assessing and supporting people’s independence, managing mealtimes and applying the Deprivation of Liberty Safeguards (DoLS). The provider did not have an effective system which allowed him to identify where improvements were needed. Opportunities for people to voice their opinions about the quality of the service were limited and a lack of activity for people to enjoy was evident. At this inspection we found that the provider had made some improvements but these were not sufficient to ensure the service was run adequately and safely.

Highfield Residential Home provides accommodation and personal care for a maximum of 13 people. At the time of our inspection there were ten people living at the home The provider is also registered to deliver personal care in the community from this location.

The provider was also the registered manager and they were present during our 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.

Staff did not always receive an induction into their role to ensure they had the skills and training to do their job.

People were not actively supported to follow their interests and take part in social activities.

The providers quality assurance system was not effective in monitoring the service and identifying where improvements were needed.

People told us they felt safe in the home and we saw the registered manager and staff knew how to involve other professionals if incidents of a safeguarding nature occurred.

Risks to people’s safety had been identified and preventative measures were in place to reduce risks.

People were satisfied with the numbers of staff on duty. People and their relatives had no concerns about staffing levels and described the staff as friendly and caring.

People told us they had their medicines when they needed them and were supported to have their health care needs met. Staff made appropriate use of a range of health professionals and followed their advice.

People were actively involved in planning all aspects of their care and personalised care plans were in place.

We observed positive interaction between staff and people who lived at the home. People told us staff were kind and patient. People told us staff respected their need for privacy and protected their dignity. The Deprivation of Liberty Safeguards (DoLS) had been considered as part of people’s care planning to protect the legal and civil rights of people using the service.

People told us they enjoyed the meals provided and mealtimes were a sociable occasion.

The provider had a system in place for dealing with people’s concerns and complaints and had followed these. Meetings had taken place where people had information about the proposed changes and could make suggestions about the quality of services they received.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with three members of staff, the provider and two people who lived there.

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

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived at the home and a member of the management team was available on call in case of emergencies. One person told us "Everything is fine here, it's a great place to live."

Staff records demonstrated that mandatory training was up to date and that staff were trained sufficiently to meet the needs of people who lived there.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care that was delivered and that their needs were being met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and were supported to gain additional qualifications.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us "Staff are great, just see how lovely they are."

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and interests which were used to help staff understand each person's personality and emotional state. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. People were asked for their feedback on the service they received and had completed surveys with positive information about their experience. Staff told us that they were clear about their roles and responsibilities and that management support was excellent. They said that they were supported to provide safe and effective care.

The people we spoke with told us they were happy with the home and the staff. One person said, “The staff look after me well, I am happy here.” Another person told us, “The staff are good and they meet my needs, I am ok here.”

People we spoke with confirmed that staff had spoken to them about how their needs were to be met and their choices were reflected in the care they received.

Staff knew about the needs of the people they were caring for. We looked at care records for two people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that improvements had been made with the systems for administering people’s medication.

Recruitment processes ensured that staff employed were suitable to work with people.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

People spoken with told us they were happy with the care and support provided. One person said, “I am very comfortable here, the staff are good, and I am cared for”, another person told us, “I am happy here and feel safe. The staff are lovely”.

People told us that staff respected their privacy and dignity and they confirmed they were given choices about their care, how they spent their day and about what food they wanted to eat.

We saw that people’s needs were assessed, and care plans were in place. Staff spoken to were able to tell us about people’s needs. This ensures they receive support in a way they prefer.

We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home. This ensures people are safeguarded from harm.

We found that improvements were required to ensure medication was administered safely.

Staff spoken with told us they felt supported by the manager, and have regular training opportunities. This ensures staff are able to deliver care to an appropriate standard.

We found that there were systems in place to monitor the quality of the service.