Highcroft Hall Residential Care Home

Highcroft Hall Residential Care Home is a care home providing accommodation and personal care to 42 older people, some of whom were living with dementia. The service can support up to 52 people.

People’s experience of using this service and what we found

The management of people’s prescribed medicines was not entirely effective to ensure people received their treatment as directed by the prescriber. Not everyone who used the service felt valued or important. The provider’s governance was not completely effective to assess, review and monitor the quality of the service provided.

People felt safe living in the home and staff knew how to safeguard them from potential harm. Risk assessments were in place to mitigate any potential risk to people. Systems were in place to reduce the risk of cross infection. Lessons were learned when things went wrong. We received mixed comments whether there were always enough staff on duty.

Staff had access to training and supervision to ensure they had the skills to provide a safe and effective service. People’s involvement in their assessment ensured they received a service the way they liked. People were supported by staff to eat and drink enough to promote their health. The provider worked with other agencies to ensure people received a seamless service. The environment was suitable to meet people’s needs. People had access to healthcare services when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who were kind and who delivered care in a way that respected their right to privacy and dignity. People were involved in decisions about their care.

We found that not everyone we spoke with felt there were sufficient opportunities to engage in social activities. People were able to maintain contact with people important to them. Complaints were listened to and acted on. People’s wishes with regards to their end of life care was obtained and recorded. The registered manager had been in post six months and understood the duty of candour. People were encouraged to have a say in how the home was run. The provider worked with other agencies to ensure people received appropriate care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 22 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Highcroft Hall Residential Care 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. Highcroft Hall accommodates up to 52 people in one adapted building comprising of three units, two of which specialise in caring for people living with dementia. Thirty-three people lived at the home at the time of our inspection visit.

At our last inspection in January 2018 we identified significant improvements were needed throughout the service. We judged the home as 'Inadequate' in two of our key questions and identified four breaches of the Health and Social Care Act 2008. Following our January 2018 inspection, the overall rating for the service was assessed as 'Inadequate' and the service therefore remained in 'special measures'. In addition, the conditions we imposed on the providers registration in relation to falls management remained in place. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame.

This inspection took place on 21 and 22 August 2018 to follow up on our previous findings. We returned on this occasion to check whether people were safe and that the provider was taking the necessary action to improve the quality of care and reducing the risks to people. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. In addition, we found that the registered provider had made significant improvements in and was complying to the conditions we imposed. We found the service was now meeting the regulations.

There was a registered manager in post at the time of 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.

Although previous breaches of regulations had been met and improvement made there was still risks to people that had not been consistently mitigated. People were protected from potential abuse because staff were trained to recognise and respond to safeguarding concerns. People received their medicines as prescribed. People were supported by sufficient numbers of staff. People received care and support from suitable and appropriate staff because the registered provider was committed to safe recruitment practices.

The provider and registered manager had not ensured they acted consistently in accordance with the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make decisions and give consent, appropriate best interest meetings had not consistently taken place. People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians. People were supported with their dietary needs but we received mixed views from people in respect of the quality of food.

People described staff as nice and caring and confirmed their right to privacy and dignity was respected. Those people able to manage their own care were encouraged to do so. People's involvement in their care planning ensured they received a service the way they liked.

Care plans contained person-centred information about what was important to people and about how their needs should be met. This helped staff to get to know people and provide responsive care. People told us that they enjoyed the activities that were provided. People knew how to complain and were confident their concerns would be listened to and acted upon in a timely manner.

We found that some improvements had been made to promote the safety and governance of the service. The provider had taken the necessary actions to mitigate risks to people. We recognised the improvements made following our last inspection. However, the shortfalls that we identified within this inspection showed that further improvements were still required.

Highcroft Hall 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.

Highcroft Hall accommodates a maximum of 52 people in one adapted building. At the time of the inspection there were 40 people living at the home.

There was not a registered manager in post. The previous registered manager left their role in December 2017. A new manager had been recruited and was in the process of completing their induction. They had submitted an application with us to register. 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 overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people who were at risk of falling were not identified or managed to keep people safe and this left people at risk of serious injury. Staff moving and handling practices were unsafe and people were being supported in a way that could put them at risk of harm. People had extended waits for support as there were not always sufficient numbers of staff available to support them. There were errors in the recording of medications that meant we could not evidence that medications had always been given to keep people well. Staff had been recruited safely and staff knew how to report concerns of abuse.

People who were at risk of weight loss did not have their weights or dietary intake monitored effectively to ensure that concerns could be addressed. People were not always referred to healthcare services in a timely way and where healthcare professionals had made recommendations, these were not always followed to ensure people were supported to maintain their health. People’s rights were upheld in accordance with the Mental Capacity Act although staff knowledge of this varied.

People were supported by staff who were caring in their interactions with people but did not spend time with people when able too. Staff interactions with people had been limited to when care was being provided and people spent long periods with little stimulation. People were not always treated with dignity. People were given choices and supported to remain independent where possible.

There was a lack of activities available for people. People did not always feel involved in the review of their care but this was being addressed by the manager. Where complaints had been made, these had been investigated in line with the provider’s procedures.

Audits were completed but had not identified the significant concerns we found at this inspection. The provider had failed to act on feedback where this was provided. Staff felt supported by the new manager.

This inspection took place on 16 August and 18 September 2017 and was unannounced.

Highcroft Hall is a residential home which provides care and accommodation for a maximum 52 older people and people who lived with dementia. At the time of our inspection visit, 50 people lived at home.

At our previous inspection in August 2015, the home was rated ‘Good’ in all areas. During this visit we found improvements were now required in all areas and there were breaches in relation to Safe care and treatment, Good governance and Staffing.

The home 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 2008 and associated Regulations about how the service is run.

There were not always enough staff on duty to meet people’s needs, particularly at the week-end and on the second floor of the home.

Risks associated with people’s care, in particular regarding the risk of falls were not managed well. A number of people had experienced injuries as a result of falls and training provided to staff to assist people to move safely had not always resulted in safe practice.

Risks to people’s well -being was not always identified and acted on. Systems and processes to monitor the quality and safety of service were ineffective in ensuring people were kept safe.

People and relatives told us staff were caring, but staff did not have time to deliver more individualised person-centred care.

There were planned activities for people, but there was not enough emphasis on activities which reflected the hobbies and interests of individual people. The activity worker and care staff did not have enough time available to fully meet people’s social and emotional needs.

Staff understood how to safeguard people from harm, and the provider’s recruitment process reduced the risks of employing staff unsuitable to work in the home.

People had a choice of meals and mostly enjoyed the food provided.

Medicines were managed safely, and people received healthcare which met their needs.

Staff understood the principles of the Mental Capacity Act, supported people to make informed choices, and where necessary acted in people's best interest.

People and relatives mostly felt their concerns or complaints were listened to and addressed. Complaints were managed in accordance with the provider's complaints policy and procedures.

The provider had systems in place to identify and act on poor practice; however, not all of what we saw during our inspection visit had been identified by the registered manager or provider.

You can see what action we told the provider to take at the back of the full version of the report

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspection again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People told us that staff showed them respect and we saw staff promote people's privacy, dignity and independence. One person told us it was a, 'Happy home, staff are good' and another said they were, 'Very satisfied' with the service.

We saw people received care that people told us they needed or was recorded in their individual care plan. This meant that their health and wellbeing was promoted. Staff were aware of people's needs.

People told us that there were times during the evening and night where there were not always enough staff available to ensure people's safety.

We saw the home had effective systems in place to gain people's views of the service and regularly monitor the quality of service that people received.

People told us they felt able to raise concerns and some said they had been dealt with appropriately.