Highgrove House

Highgrove House is a residential care home providing personal care to up to 43 people. The service supports older people and people who may be living with dementia or a physical disability. At the time of the inspection there were 40 people living at the home.

The home is set over 2 floors and has communal areas available for people to use. Visitors can access the garden and car parking.

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

We have made a recommendation about the management of some medicines. People were kept safe, and looked after by enough staff that knew people well. A relative said, “[My relative] is well looked after, the carers are brilliant.” Risks to people’s health, and environmental risks were assessed and monitored. The home was clean and comfortable. The registered manager monitored incidents to make sure any lessons were learned to improve outcomes for people.

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 that received good levels of induction and training and people’s needs were assessed holistically. People spoke positively about the food and were supported to eat and drink healthily. People’s wider healthcare needs were met by external agencies when required.

We found a positive culture at Highgrove House and improvements had been made regarding the governance of the service. Staff kept in touch with people and their relatives, and relatives spoke highly of the support given. One relative said, “They ring me up straight away if anything happens, they are very caring.”

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 10 June 2022).

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.

Why we inspected

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 carried out an unannounced comprehensive inspection of this service on 28 April 2022. 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.

We undertook this 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Highgrove House 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.

Highgrove House is a residential care home providing personal care to up to 43 people. The service provides support to adults some who may be living with dementia or a physical disability. At the time of our inspection there were 33 people using the service.

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

People told us they felt safe at Highgrove House and staff were aware of safeguarding procedures. However, there were shortfalls in environmental safety checks because people did not always have accessible call bells to summon for help should they require it. There were shortfalls in the safe use of medicines.

Risks to people had been assessed including risk of falls, choking and nutrition. The home was following safe infection control practices. There were adequate numbers of staff and the provider followed safe recruitment processes.

The provider needed to improve their practices to ensure people could be supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. Mental capacity assessments for specific decisions had not always been carried out for some people. The provider had sought relevant authorisation to protect people from unlawful restriction under Deprivation of Liberties (DoLS). People’s care needs were assessed, and staff worked with other organisations to meet people’s health needs.

The registered provider and their staff used a variety of methods to assess and monitor the quality of the service. However, the provider’s systems and processes needed to be robust to ensure shortfalls were identified and acted on in a timely manner. We identified shortfalls in the systems for medicines management, environmental checks and the system for assessing people’s consent. Staff worked in partnership with a variety of agencies to ensure people's health and social needs were met. We received positive feedback from visiting relatives and staff regarding management.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 09 November 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

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

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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 found breaches in relation to the management of risk associated with the environment, safe us of medicines, mental capacity assessments and good governance at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Highgrove House is a residential care home providing personal care for up to 43 people, including people living with dementia. The home is in the north of Chorley. Accommodation is provided in two units.

We found the following examples of good practice.

Information at the entrance informed visitors of the current status of the home in relation to the pandemic.

There were good supplies of personal protective equipment (PPE) available in the foyer for visitors. Visitors had their temperature taken at the entrance.

There was a PPE station for staff at the entrance which allowed staff to doff and don PPE safely. Staff were observed using this appropriately.

Staff breaks were staggered to minimise the number of staff in the staff room at one time.

Communal areas of the home were not being used by residents during the current outbreak. This helped to optimise social distancing. Staff were able to take breaks in the staff room and communal areas to help maintain their social distance.

Highgrove House is registered to provide accommodation for up to 43 people who require personal care. The home is over two floors with specific units on the ground and first floors of the home. Some of the people living at the home were living with dementia and they lived on the first floor. This upper floor is accessible by stairs or lift. Each unit has access to a kitchen area, lounge and dining room and bathrooms and toilets. Accommodation is provided in single rooms, four of which are en-suite. There were 41 people who lived at the service at the time of our inspection.

The service had a registered manager in post. 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.

We spoke to people and their relatives and received positive feedback about the care provided at Highgrove House. During this inspection we found the service met all regulations.

There were policies and procedures on how the service protected people against bullying, harassment, avoidable harm and abuse. Staff had received training in safeguarding adults.

Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken. Plans to minimise or remove risks had been drawn up and reviewed in line with the organisation’s policy. These were robust and covered specific risks around people’s care and specific activities they undertook.

Concerns regarding people’s care needs had been addressed and lessons were learnt from safeguarding enquiries. Robust action had been taken to address any shortfalls identified by safeguarding professionals.

People were protected against the risk of fire. Building fire risk assessments were in place and fire fighting equipment had been maintained.

There was a medicines policy in place and staff who administered medicines had been trained to safely support people with their medicines.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. People who used the service gave positive feedback on the quality of the service. Some people were unable to give us feedback due to their complex needs. We spoke to their relatives. Feedback from relatives about care standards was positive. Choices were generally promoted however we found two people felt they had not been fully supported to exercise their choice in relation to accessing the community independently.

People using the service had access to healthcare professionals as required to meet their needs. Staff had received training deemed necessary for their role. Staff competences had been checked in medicine management. Staff had had also been provided with annual appraisals. We found improvements were required to ensure all care staff were up to date with their training.

We found that people’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided. People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed. There were a variety of activities provided to keep people occupied.

The environment had been adapted to suit the needs of people who lived at Highgrove House however further improvements were required to make the environment dementia friendly.

We received positive feedback from people, relatives and staff regarding management of the service. There were established management systems at the service. The registered manager had provided oversight of duties they delegated to other staff.

Quality assurance systems were in place and various areas of people’s care been audited regularly to identify areas that needed improvement. We found audits had been undertaken of medicines records, care plans, and infection control. There was a business contingency plan to demonstrate how the provider had planned for unexpected eventualities which may have an impact on the delivery of care and treatment.

Feedback from people and their relatives showed they felt they received a good service and they spoke highly of the staff. Relatives told us the staff were kind, caring and respectful and were considerate in their approach to dealing with some challenging situations. Professionals we spoke to confirmed this.

We found the service had a policy on how people could raise complaints about their care and treatment. People and their relatives told us they could raise concerns and felt listened to.

Highgrove House is registered to provide accommodation for up to 43 people who require personal care. The home was over two floors with specific units on the ground and first floors of the home. Some of the people living at the home were living with dementia and they lived on the first floor. This upper floor is accessible by stairs or lift. Each unit has access to a kitchen area, lounge and dining room and bathrooms and toilets. Accommodation is provided in single rooms, four of which are en-suite. At the time of the inspection there were 41 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

We spoke with people living in the home and they made positive comments about their home. They told us that care staff were available to help them when they needed assistance and that staff respected their privacy. Some people who were living with dementia could not tell us their views but those people who could told us they felt safe living there. We were told “I do feel safe here. I am quite happy”.

People who lived at Highgrove House said they knew the registered manager of the service well and saw them every day to talk with and felt comfortable doing so. People told us that they would be comfortable raising and complaints with the registered manager.

We noted that there was a clear structure and lines of responsibility within the home and being promoted by the registered manager. The registered manager had notified the CQC of any incidents and events as required by the regulations.

The registered manager used a range of methods to get feedback from people living, working and visiting home in the and promoted open communication. The registered manager and quality consultant had implemented a programme of auditing the care planning systems and practices in the home to help promote continued improvement .The registered manager was well regarded by people we spoke with who lived in the home and the visitors we spoke with.

They service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. We saw that care staff had received induction training and on going training and development and had regular supervision and annual appraisal.

We saw examples of staff giving people their attention, offering reassurance and displaying empathy. We also saw an example of where this was not applied. We recommended that the registered manager formally checked the level of dementia awareness training of non-permanent staff have before they worked with people living with dementia. This was to make sure they could respond appropriately to the needs of people living with dementia.

People had a choice of meals and drinks and they told us the food was “good” and “fantastic” and that they enjoyed their meals. People were involved in discussions and feedback about food at their ‘residents’ meetings.

The service worked with local GPs, district nurses and health care professionals and external agencies to provide appropriate care to meet people’s different physical, psychological and emotional needs.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

There was a system for logging comments made about the service and the care received. We looked at the most recent and how they had been managed. We could see that statements had been taken and enquiries carried out so the matter could be resolved to the complainant’s satisfaction.

Medicines were being correctly administered and stored and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for. We have made a recommendation about referring to current National Institute for Health and Care Excellence (NICE) medicines guidance regarding best practice guidance.

The environment was being redecorated and was being kept clean by domestic staff. The registered manager had identified the need for changes in the environment to support people with dementia. This included new furnishings and dementia-friendly features to support people with visual, hearing and mobility impairments associated with dementia. We have recommended that the registered provider seek advice and guidance on dementia friendly environments to enhance the support of people living with that condition.

Some items of furniture such as easy chairs had tears in the fabric. We have made a recommendation that the registered provider acts in line with current best practice in infection control. This was to replace damaged furniture to minimise the risks from cross infection.

We discussed with the acting manager the concerns we had received. The concerns had been received directly by the Care Quality Commission (CQC) and had been anonymous.

People were protected against risks associated with medicines because the provider had appropriate arrangement in place to manage medicines. We observed the lunchtime medication round at the home. The senior carer who was undertaking the medication round talked us through each person's medicines and how they recorded any medication given or refused. We saw that people were given time to take their medication and the senior carer sat with people to ensure they had taken their medicines.

People told us they were happy with the service they received from the home. One person told us, "They (staff) are great with me here. I can honestly say they are a great lot and they look after me".

When we undertook this inspection the provider was still in the process of responding to concerns identified during our last inspection on 15/04/2014. During that inspection we had found delivery of care had not been appropriately planned, recorded and risk assessed. There was limited or no recorded evidence of consent and medication issues needed to be addressed. The provider did not effectively assess and monitor the quality of the service provided.

During this inspection we could see that the service provider had begun to address the issues from the last inspection as improvements had started to be made. The provider was working within time scales provided by the Commission to produce a report on actions he planned to take to meet requirements. We did not assess all the outstanding compliance actions from the inspection undertaken on 15/04/2014.

We looked at Highgrove House's medication processes and found that improvements had been made to meet standards. Medication was dispensed, recorded and disposed of safely and staff had received refresher training to underpin their knowledge and skill.

We spoke with staff, the manager and provider. We also discussed care provision with people who lived at the home, undertook a tour of the building and observed care practices. We found people were receiving appropriate care which was meeting their needs.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People appeared comfortable and relaxed during our inspection. We observed care being provided in a safe and supportive manner. A relative told us, 'The staff are very caring and are friendly and warm when we arrive'.

However, care planning and risk assessment was poor and inconsistent. People's changing needs and care provision was not always assessed or regularly reviewed. One relative told us they were not involved in this. This meant people were at risk of unsafe care because the provider had not ensured care planning was clear.

We observed medication being dispensed in a safe and supportive manner. However, medication risk assessments were not in place and medication was disposed of in an unsafe and inappropriate way. This meant people were at risk from unsafe practice in relation to medication.

Staff and relatives told us that staffing levels had improved recently. Rotas we checked confirmed this. We were told that use of agency carers was recent and as a result of staff sickness. We were able to verify that staffing levels adequately ensured safe support levels for people living at Highgrove House.

Is the service effective?

Highgrove House worked effectively with other providers. Where people's health deteriorated, this was generally managed well. The appropriate external professional was referred to and actions taken were recorded.

Although some care records were personalised and in-depth, we found inconsistencies throughout the files we reviewed. People or their relatives were not involved in care reviews. There was no recorded evidence of consent to care provision. Records were often unsigned, not dated or incomplete.

Highgrove House provided specialist dementia care. However, staff had limited understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. This meant there were potential gaps in staff training in caring for people with dementia.

Is the service caring?

People appeared to be comfortable and relaxed during our inspection. Staff engaged with people in their care in a friendly, supportive and appropriate manner. Relatives told us they were happy with the care provided.

However, care planning and risk assessment was incomplete and inconsistent. This meant people were at risk from inappropriate or unsafe care. The provider had not ensured records were up-to-date, reviewed and signed by staff.

Is the service responsive?

People's needs were assessed before they accessed the service. This meant Highgrove House was able to confirm that they could meet the individual's support needs. The home worked effectively with other providers in responding to people's deteriorating or changing health.

However, care was not reviewed regularly and consistently. Additionally, this did not involve the individual concerned or their relative. This meant the home did not always monitor if people's care planning was continuously meeting people's changing needs.

Is the service well-led?

At the time of our inspection it was unclear who was in charge of the day-to-day management of Highgrove House. On arrival to the home we were made aware that the registered manager was on sick leave. We were informed that a senior carer had been made acting manager in her absence. However, this person was also on leave. We checked with the staff on duty to see who was in charge, but we could not confirm this. This meant people were at potential risk from a service that may not always be well lead.

The majority of staff told us that there was a lot of conflict within the care team. The provider assured us he was aware of this issue and was putting actions in place to manage this.

Although there were a range of quality internal and external audits in place, we found issues that had not been picked up. The provider was unable to confirm the home's safety certification. He was additionally unable to provide evidence of staff and service user or relative feedback.

Staff we spoke to were able to recognise potential safeguarding issues and systems were in place to deal with safeguarding issues if they arose. The people who lived at the home told us they felt safe.

People were protected from the risk of infection because appropriate guidance had been followed. Service users care was provided by staff who were aware of Infection control procedures and protocols.

The premises were clean and tidy and the design, layout and security of the premises were fit for purpose to meet the needs of the people living at the home.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.