Highview Home

Highview Home is a residential care home providing accommodation and personal care for up to 24 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 21 people using the service.

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

Medicines were not managed safely which placed people at risk of harm. Risks to people from the environment were not always highlighted or effectively monitored. When people were involved in an accident or incident, the provider didn't always review this to learn lessons and reduce risks to people in the future. Despite this, people felt safe at Highview Home and there were enough staff to meet their needs.

Quality assurance systems were not always effective for people. Audits monitoring the quality of the service were not consistently completed and up to date. This meant the action taken by the provider had not always ensured people received consistent, good and safe care. However, people spoke positively about Highview Home and relatives felt their loved ones were well cared for. Systems were in place to seek feedback and resolve people's complaints.

People's care plans and risk assessments did not always assess their person-centred needs. People living with dementia weren't always supported with accessible information to assist them to make choices. However, people and relatives felt staff knew them well and understood their likes and dislikes. The provider ensured daily activities took place and these were tailored to what people found enjoyable.

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 requires improvement (published 08 September 2022) and there were breaches of regulations. 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 the provider remained in breach of regulations.

Why we inspected

The inspection was carried out to follow up on breaches found at the last inspection. The inspection was also prompted in part due to concerns received about the management of accidents and incidents and the governance of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

You can see what action we have asked the provider to take at the end of this full report.

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 and will take further action if needed.

We have identified breaches in relation to how people’s safety was managed and how the service was run at this inspection.

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

Highview Home is a residential care home registered to provide accommodation and personal care for up to 24 people. Support is provided to older people and people living with dementia. At the time of inspection there were 22 people.

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

Governance systems were not always effective to ensure care plans contained enough guidance for staff to follow. Governance systems had not identified that care plans were completed in line with peoples needs and wishes. Medicine management audits had not identified that stock was not being controlled in order to ensure continuity of medication.

There was no Registered Manager at the service at the time of Inspection. A manager had recently been appointed who was applying for registration with the Care Quality Commission.

People, relatives and staff we spoke to, knew who the newly appointed manager was, and felt able to approach them. Staff felt the newly appointed manager had started to make improvements to the service, whilst we did see some improvement, further improvement was required.

People did not always receive person centred care and there were not enough activities available for people to enjoy. People and relatives were not consulted about their wishes about the end of their life and were not involved in reviews of their care.

People told us they felt safe and staff knew how to recognise and report safeguarding concerns. At our last inspection we found concerns in relation to infection control practices. At this

inspection we found the provider had taken action in response to our concerns and had made improvements.

People told us staff were kind and caring and treated them with dignity and respect and we observed some of this. However, there was a lack of systems in place to ensure the service was consistently caring and people were fully involved in their care.

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 06 May 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 not been made and the provider was still in breach of regulations

At this inspection because we only looked at the ‘Safe, Responsive and Well led’ key questions. This was because our planning did not identify any concerns about the other questions.

This service was registered with us on 17 April 2020.

Why we inspected

The inspection was prompted in part due to concerns received about the infection and control practices within the service and the care provided to people with distressed behaviours. A decision was made for us to inspect and examine those risks.

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 improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 regulation 9 safe management and processes and medicines management and person centred care. Regulation 12, safe care and treatment and regulation 17, governance 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.

Highview Home is a residential care home registered to provide personal care for up to 24 people. Support is provided to older people and people living with dementia. At the time of inspection there were 22 people

living at the home.

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

Governance systems were not always effective to ensure care plans contained enough guidance for staff to follow. Systems had not identified that monitoring records were not always accurate and completed in line with people’s needs. Accidents and incidents were not analysed to assess for patterns and learn lessons to minimise the risk of re-occurrence. Audits were carried out to monitor medicine management, but they had not identified the concerns we found on inspection in relation to patch rotation and protocols for when medicine was given as required.

People, relatives and staff all knew who the newly registered manager and felt able to approach them. Staff felt the newly registered manager had started to make improvements to the service, whilst we did see this further improvement was required.

People did not always receive person centred care and there were not enough activities available for people to enjoy. People and relatives were not consulted about their wishes at the end of their life and were not involved in reviews of their care.

Staff told us there were enough staff in the day, but at night-time more staff were required due to people’s increased needs. People told us they felt safe and staff knew how to recognise and report safeguarding concerns. At our last inspection we found concerns in relation to infection control practices. At this inspection we found the provider had taken action in response to our concerns and made improvements.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not been completed for some key decisions when people lacked capacity.

People told us staff were kind and caring and treated them with dignity and respect and we observed this. However, there was a lack of systems in place to ensure the service was consistently caring and people were fully involved in their care.

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 inspection was a targeted inspection (published 23 December 2020). We did not rate the service at this inspection because we only looked at a part of the key question safe where we had specific concerns.

This service was registered with us on 17 April 2020 and this is the first inspection where a rating has been given.

The last rating for the service was under the previous provider Mr Gordon Nuttall, the service was called The Keepings and was good, published on 11 December 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the infection and control practices within the service and the care provided to people with distressed behaviours. A decision was made for us to inspect and examine those risks.

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 improvements. Please see the responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 regulation 9, person centred care and regulation 17, governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Highview Home is a residential care home registered to provide personal care for up to 23 people. Support is provided to older people and people living with dementia. At the time of inspection there were 22 people living at the home.

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

We received information raising concerns about infection prevention and control in relation to the COVID-19 pandemic. This included concerns about staff not wearing the appropriate PPE and how relatives were supported to visit people.

We found people were not always protected from the risk of infection due to poor infection prevention and control systems. Some staff were not wearing PPE in line with the latest guidance. PPE was not available to staff when they first arrived at the home. This meant they had to walk through communal areas before putting on their PPE.

There was no screening of people visiting the home to assess if there were any increased risk or if they had symptoms of COVID-19. Isolation periods for new people who were admitted to the home were not followed in line with guidance.

We found one communal area was being decorated and was out of use. There had been no consideration of how people could be supported to socially distance in the other areas of the home. There was lack of understanding of good practice guidance in relation to laundry and domestic activities.

People and staff were supported to access regular COVID-19 testing.

Rating at last inspection

This service was registered with us on the 17 April 2020 and this is the first inspection.

The last rating for the service was under the previous provider Mr Gordon Nuttall, the service was called The Keepings and was good, published on 11 December 2019.

Why we inspected

We undertook this targeted inspection to check on specific concerns which we had received about infection control risks. A decision was made for us to inspect and examine those risks. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 the service can respond to coronavirus and other infection outbreaks effectively.

We found evidence that the provider needs to make improvements. Please see the safe section of this report.

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 a breach in relation to safe care and treatment at this inspection in relation to infection prevention and control.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.