Archived: Highground Care Home

Our inspection team was made up of two inspectors, a pharmacist inspector and an expert by experience. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the service was not safe. People's care needs were not always taken into account when making decisions about the numbers, qualifications, skills and experience of staff required. We saw staff were very busy on the day of this inspection and records showed that staffing levels were very poor at times, due to sickness and absenteeism.

The home did not have proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had not been trained to understand when an application should be made, and how to submit one. This meant that people's rights were not being safeguarded.

There were five safeguarding alerts currently open at the service and another three allegations of abuse/neglect that are currently under investigation by the local authority opened in July 2014. We discussed the issues with the manager and looked at the records. All three issues identified from July 2014 were still on going and there was no record identifying how allegations of abuse were being dealt with

The medication room was not clean and equipment was seen to be dirty. Medicines were stored inappropriately with room and fridge temperatures not being recorded appropriately.

Is the service caring?

We found the service not to be caring. People commented: 'Staff are kind and caring' ;'Generally staff are kind, give you love and make you feel you belong, there's only the odd one that shouldn't be here' ; 'Majority [of staff] kind and caring but some not so good.'

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

People were treated with respect and dignity by the staff on duty on the day of this inspection, however they were working reactionary due to numbers of staff. We observed staff interactions with the people living at the home throughout the day of this inspection. People told us they were looked after well most of the time, however there were staffing level issues that meant they had to wait to get the support they required at times.

The four care plans we looked at had little information pertaining to people's preferences, interests, aspirations and diverse needs.

Is the service responsive?

We found the service was not responsive. The complaint procedure was displayed on the notice board. Some of the people we spent time with were not able to communicate if they understood how to make a complaint. Two people said that they did know how to make a complaint and would talk to the manager or staff if they were unhappy with anything.

The care provided by staff was not always in accordance with the identified needs of the people who used the service. For example, care plans stated that some people required their food and fluid intake to be monitored to ensure they received adequate nutrition and hydration, but this was not being done consistently.

The assessment records were difficult for staff to follow and there were no summaries of information at the front of the four care plans looked at. There was no evidence that the health and care needs assessments had been carried out with the people using the service or their representatives, or that they were involved in writing their plans of care.

Is the service well-led?

We found the service was not well-led. There was a new manager in post since June 2014; the manager is not registered with the Care Quality Commission. He had received little induction to an unfamiliar role.

Staff told us that at times they were not clear about their roles and responsibilities.

The service did not have an effective quality assurance system in place. Identified shortfalls were not addressed promptly. This would impact on the people using the service as they would be at risk of unsafe care and treatment.

Systems were not in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. We identified a lack of acknowledgment and improvement of shortfalls identified by the provider's own in house monthly quality monitoring visits and the local authority quality team visit findings.

The provider did not have regard to previous reports prepared by the Commission relating to their compliance with regulations.

During the inspection 30 April 2014 we considered all of the evidence we have gathered under the outcomes we had 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?

Is the service safe

On the day of our visit we found the environment clean and fresh.

We saw enough staff on duty to meet the needs of the people living at the home and were told that the acting manager or senior members of staff was always available either working in the home or on call in case of emergencies.

We saw training records which identified that staff received training relevant to the needs of the people who lived in the home.

Is the service effective?

People told us that they were happy with their care. We spoke with staff and found that they knew the people living in the home well. We spoke with staff and checked records and found that staff had received training to meet the needs of the people living at the home.

Is the service caring?

We spent time in all areas of the home and saw and heard staff to be kind and patient to the people who lived there. We saw that the people who lived in the home were comfortable in the company of staff and happy to share a joke with them. One person told us, 'I'm happy here, the staff are lovely ".

Is the service responsive?

People who lived in the home told us that they were happy with their care. We looked at care plans and saw that they were person centred and updated to reflect the changing needs of people. We saw that relevant referrals were made to other professionals as and when required.

Is the service well led?

There has been no registered manager at Highground for some time. However there is a full time peripatetic manager in place. We were told by staff that the service has improved since this manager has been in place and we saw evidence which supported that. One member of staff said, 'There is now routine'. People who lived in the home told us that they were able to chat with the acting manager. Staff told us that the acting manager supported them to attend training.

We went back to check that improvements had taken place. The registered manager had only returned to work for a short period of time and at the time of our inspection was again absent from work. Temporary management was being provided by another home manager on a part time basis but this was not sustainable. A temporary full time manager was expected to commence duties at the beginning of January 2014. We discussed the day to day running of the home with the regional manager and temporary manager. We also spoke with two registered nurses and seven care staff to seek their views.

Comments from staff included; "We seem to have enough staff now because there aren't that many residents", "Things are a bit better but not much", "[The temporary home manager] is nice, she is very helpful", "We are not getting the support we need" and "I've had no training since I've been here, there is no support from management". This indicated that staff felt unsupported and inadequately trained to care for the people at the home.

We found that the systems in place to supervise, support and train staff were not effective. This meant that people were being cared for by staff who were insufficiently trained and did not receive the support they required. We also found that systems in place to assess the quality of the service were not being utilised effectively. This meant that things such as accidents, incidents and care plans were not properly monitored to ensure the risks to people's health and safety were being managed.

Overall people who were able to told us they were happy with their care. One person was going back to live in their own home and was very sad to leave. They told us "The staff have been wonderful and have made me better." Relatives told us "The staff are lovely here" and "I'm happy that mum is well looked after".

We looked at seven care records which were well ordered, personalised and informative to staff about the care requirements of each individual. They included information on medication, nutrition, mobility and communication.

We found that systems in place to support training and monitor the quality of the service provided were not effective. There had been a breakdown in the management structure and one of the permanently employed nursing staff was carrying out the role of acting manager. Concerns highlighted during our inspection were being addressed by the acting manager.