Highfield Care Centre

Highfield Care Centre is a 'care home' which provides accommodation and personal care for up to 88 older people some of whom may be living with dementia. At the time of the inspection there were 40 people using the service. Accommodation is spread out over four units, at the time of the inspection two units were in use.

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

The provider had oversight of the maintenance of the service and was in the process of addressing maintenance issues raised during the previous inspection. Incidents or accidents were recorded and managed effectively. A range of quality assurance systems were in place to monitor and improve the service. People received medicines safely, however we were concerned about how medicine awaiting removal was stored. Allergies were not consistently recorded for all people, this was raised with the registered manager who took immediate action to address this issue.

There was a registered manager who had been in post since the last inspection. Throughout the inspection the registered manager was honest and open with us. Any concerns raised during the inspection process were immediately addressed, for example feedback from external professionals highlighted communication with staff could be improved. We shared this information with the registered manager who discussed with staff and put related quality assurance checks in place.

People and their relatives told us the improvements they had experienced in the care at the time of our last inspection had continued and further improved one person said, “I think it's getting better here, I am very happy”. Feedback from external healthcare professionals was positive however we were told communication could be improved.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 21 December 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 21 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield care centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Highfield Care Centre is a 'care home' which provides accommodation and personal care for up to 88 older people some of whom may be living with dementia. At the time of the inspection there were 59 people using the service. Accommodation is spread out over four distinct units of the home. At the time of the inspection three of these were in use.

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

Medicines were not managed safely. Medication administration records did not always show medicines had been administered as prescribed. Medicines had been audited; however, the audits were not effective in ensuring safe management of medicines. This put people at risk of harm.

Not enough staff were deployed across the service. This meant there was a risk people did not always receive the care, support and supervision they needed. Systems were not in place to accurately calculate safe staffing levels. People did not have enough access to meaningful activities.

Most people and relatives we spoke with told us they or their family member felt safe and were happy with the care at the service. However, we found some risks to people's health and welfare were not properly recorded. This meant people were at risk of avoidable harm. Care records did not always contain enough information or had inconsistent information about people's needs. This meant staff were not always provided with the information they needed. This put people at risk of not having their needs met.

Systems and procedures to provide management oversight and monitor the safe delivery and quality of care provided to people were not effective. Audits were not always completed and when they were, they were not effective in identifying areas of improvement. The service was not well-led. Leadership was ineffective; staff lacked support and guidance. Systems and processes were not robust enough or fully established to learn from safety-related incidents.

People told us they liked the staff and said they were kind and caring. People shared their positive experiences of living at the service. They said they were treated with dignity and respect by staff. The provider told us they were increasing staffing levels on some shifts. We have not been able to review the sustainability of these changes.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 29 August 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection sustained improvement had not been made and the provider was again in breach of the regulation found at the previous inspection and further breaches were found.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. The inspection was also prompted in part due to concerns received about risk management in the service as we had received high numbers of notifications regarding unwitnessed falls and physical altercations between people who used the service.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Highfield Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, medicine management, good governance and record keeping.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Highfield Care Centre is a 'care home' which provides accommodation and personal care for up to 88 older people some of whom may be living with dementia. At the time of the inspection there were 53 people using the service. Accommodation is spread out over four distinct units of the home. At the time of the inspection three of these were in use.

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

People and relatives provided good feedback about the service and told us that good outcomes were experienced. We found staff were kind and caring, treated people well and there was a person-centred culture within the home.

We identified infection control and cleaning practices did not always promote safe care. COVID-19 personal protective equipment (PPE) requirements were not consistently followed, and some areas of the home were unclean. Some improvements were also required to the medicine management system to provide assurance that medicines were consistently managed in a safe and proper way.

In most cases, risks to people’s health and safety were properly assessed and managed. Measures were put in place to help prevent accidents such as falls. Detailed analysis took place following any untoward events and we saw there was a culture of learning from adverse events.

People said they felt safe and safeguarding procedures were in place which were well understood by staff. The building was safely maintained and was in the process of being refurbished.

There were enough staff deployed to ensure people received prompt care and support. We observed communal areas were appropriately supervised. Staff were recruited safely and received a range of training.

Whilst the overall rating for the service has deteriorated since the last inspection in January 2019, we felt assured that over the last few months improvements had been made in some areas. A number of new systems and processes had been put in place which demonstrated that risk was better managed, new training and guidance had been provided to staff and working relationships with others had improved. These improvements need to continue and be sustained and further improvements are required in respect of medicines management and infection control practices.

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 Good (published 14 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and safeguarding within the home. As a result, we undertook a focused inspection to review the key questions of ‘Is the service safe?’ and ‘Is the service well-led’ only.

Prior to this inspection, we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We found evidence that the provider needs to make improvements. Please see the ‘Is the service safe?’ and ‘Is the service well-led?’ sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified one breach of regulation. This was in respect of the provision of safe care and treatment, specifically in relation to infection control and medicines management. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield Care Centre 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 Care Centre is registered with the Care Quality Commission to provide accommodation and personal care for up to 88 older people some of whom may be living with dementia. There were 49 people using the service at the time of this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

People told us they felt safe and staff knew how to keep them safe from harm and abuse. Staffing levels were sufficient to provide safe care. Medicines were managed safely and people received them as prescribed. Staff received training and understood how to recognise signs of abuse and who to report this to. Safe recruitment practices were followed to make sure staff were suitable to work with vulnerable adults. Staff were trained in good hygiene practice and were supplied with personal protective equipment such as gloves and aprons. Risk assessments contained enough detail to enable staff to keep people safe from harm.

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 were supported to make choices and retain their independence. Staff had a good awareness of the need for consent. People told us they enjoyed the food at the service. There was a varied menu available to people and specialist diets were catered for. People were supported to maintain their health. They received consistent care and had access to health professionals as required. Staff received training, support and supervision to enable them to be effective in their role.

The environment had been developed to support people’s diverse needs. This included clear signage and colour-contrasting equipment to increase visibility for people living with dementia. There was a positive and inclusive culture at the service. The provider and registered manager promoted a culture of dignified and respectful care. People told us they were supported by staff who were kind, caring and compassionate. Staff knew people well and made sure people received care and support that was personal to their needs and responsive to any changing needs. Care plans were person-centred and gave good detailed guidance for staff to follow.

People were supported to participate in meaningful activities they enjoyed. A church service was arranged so people’s spiritual needs were met. Staff also supported people to access community facilities and to maintain contact with friends and relatives.

People and their relatives had regular contact with the registered manager and reported no difficulties in raising any concerns about the service if necessary. Systems were in place to manage complaints. Quality assurance processes were in place to monitor the quality of care delivered. There was a commitment for improvement through quality assurance systems, audits and learning from any shortfalls identified.

The registered manager was committed to providing good quality care and support for people. Staff told us the management team were very approachable and accessible; they said they were well -supported in their role. People, their relatives and staff were positive about the way the service was managed.

The registered manager and staff worked in partnership with external health and social care professionals to ensure people's health and social care needs were met.