Higham House Nursing Home

Higham House Nursing Home is a care home providing personal and nursing care to seven people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

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

Systems to monitor the quality and safety of the service were in place to ensure people received safe and person-centred care. However, this required time to be embedded into the service to ensure they were sustained, and improvements continued.

Mealtime experiences for people had improved, however, this needed to be maintained and monitored to build on the improvement.

Risks to people’s care were identified and plans to mitigate the risk were in place. There were sufficient staff deployed to meet people’s needs and people could be assured staff had been recruited safely.

Staff understood how to protect people from harm and followed good hygiene practices to prevent and control infection. Medicines were safely administered and stored.

People's needs were assessed, and care plans guided staff how to meet those needs. Further improvements were needed to care plans to ensure they detailed the support people required for their social and emotional well-being. People had access to activities, but more opportunities were needed so people could undertake activities geared towards their interests.

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.

Refurbishment plans were in place and improvements to the environment had been made. This needed to be sustained and improvements continued.

Based on our review of Safe, Effective and Well-led

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 11 February 2021) and there were multiple breaches of regulation. 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.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on 12 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person- centred care and good governance.

We undertook this unannounced focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

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. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Higham House Nursing Home on our website at www.cqc.org.uk.

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.

Higham House Nursing Home is a nursing home providing personal and nursing care to 30 people aged 65 and over. At the time of the inspection 10 people were using the service.

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

People were not always safeguarded from the risk of abuse. Unexplained bruises and injuries had not always been investigated. Not all staff could demonstrate knowledge of potential signs of abuse.

Risk assessments were in place to protect people from harm. However, these were not consistently followed by staff.

People’s meal time experience required improvement. Staffing levels needed to be reviewed to ensure there was enough staff on shift to meet people's individual needs.

People were not supported to have maximum choice and control of their lives. Staff could not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service required reviewing to ensure people did have maximum choice and control of their lives.

The provider and manager lacked oversight of the service. Audits completed did not identify the improvements required that were found on inspection.

People were protected against infection. Staff wore appropriate personal protective equipment [PPE] and the home appeared clean.

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

The last rating for this service was requires improvement (published 02 April 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the governance and oversight of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well led only.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

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.

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 Higham House Nursing Home 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 monitor the service.

We have identified breaches in relation to safe care and treatment, person centred care and management oversight at this inspection.

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

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.

Higham House Nursing Home accommodates up to 30 older people in one adapted building. At the time of the inspection, 10 people were using the service.

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

People were not always supported by enough staff to meet their needs.This meant people were sometimes left waiting for support and their choices limited. The action to manage risk in relation to the environment and health and safety were not always effective. Risks to people’s care had been identified and plans were in place to mitigate risks.

People were supported by staff who were trained, however staff training had not been regularly refreshed. This meant people could not be assured best practice was always being followed. Staff were supported but did not benefit from regular opportunities to discuss their performance or share their experiences with each other.

The home was clean and a programme of refurbishment was in place. However, the environment was not dementia friendly. We have made a recommendation about developing a more dementia friendly home.

People had limited opportunities to take part in activities or follow their interests. Care plans detailed people’s preferences about their care but staffing levels impacted on the level of choice available to them.

The systems in place to monitor and assess the quality and safety of the service were not effective and any shortfalls were not always picked up.

People were treated with respect by staff who were kind and caring and knew people well.

People were not supported to have maximum choice and control of their lives. Staff could not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service required reviewing to ensure people did have maximum choice and control of their lives.

The registered manager was approachable and people knew who to raise any complaints with. Families felt supported and welcomed at any time in the home.

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 4 January 2019). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.