27 April 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
One adult social care inspector undertook this inspection.
Service and service type:
Highlands Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. A registered manager means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection: This inspection was unannounced.
What we did:
Prior to the inspection, we reviewed information we held about the home including statutory notifications. A statutory notification is information about important events, which the provider is required to send us by law. The provider did not complete the required Provider Information Return. This is information providers must send us to give us key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report.
During the inspection, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We observed support being delivered in communal areas and we observed how people were supported to eat and drink at lunch time.
We spoke with eight people, six relatives, a health care professional, the manager, deputy
manager, five care staff, the activity co-coordinator, the cook and housekeeper. We reviewed the care plans for three people, the recruitment files for three members of staff, and looked at records relating to the management of the home. These included how the home managed people’s medicines, health and safety audits, quality monitoring systems, training records, accident and incident records; surveys; meeting minutes and complaint records.
Following the inspection, we received an email with information raising concerns over the staffing levels at the home.
27 April 2019
About the service: Highlands Care Home is a residential care home registered to provide accommodation for up to 26 older people some of whom may be living with dementia, have mental health needs or a physical disability. At the time of the inspection 25 people were living at the home.
People’s experience of using this service:
• Insufficient staff were employed at the home to meet people’s needs. Due to the high level of care needs of 12 of the 25 people living at the home, the number of staff available during the day and at night was insufficient to ensure people’s needs were met in a timely way. Staff were unable to supervise people to ensure their safety and people were not provided with the opportunity to engage in meaningful leisure and social activity.
• The home was not clean. Some of the furniture in people’s bedrooms and the floors in the communal areas, including bathrooms and toilets, were dirty.
• People’s freedom to walk around the home was restricted with the use of half-height doors placed across hallways. These also posed a safety risk to people who might climb over them. Following this inspection, we were told these had been removed.
• Risks to people’s health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were mitigated as much as possible. However, some improvements were required with monitoring people’s food intake and with the use of equipment used to protect people from skin breakdown.
• Some environmental health and safety checks had not been carried out. These related to the fire safety systems, managing the risk of legionnaires disease and the temperature of the hot water in people’s bedrooms.
• Medicines were being managed safely.
• People told us they felt safe and well cared for at the home. Relatives also expressed their satisfaction with the safety and care provided.
• Staff knew people well and had developed close, caring relationships. We saw people enjoyed being with staff. Staff were aware of their responsibilities to safeguard people.
• Recruitment practices were safe and staff received the training they required for their roles.
• People and their relatives were involved in making decisions about their care.
• Further consideration needed to be given to providing engagement in social and leisure activities for people living with dementia.
• The home was being supported by the local authority to establish more effective quality assurance systems to assess, monitor and improve the safety and quality of the home.
We identified five breaches of the regulations and we made two recommendations for improvement in relation to restricting people’s movement around the home and engaging people in meaningful social activities.
The home met the characteristics of a rating of “Good” for one key question and “Requires Improvement” for four key questions. Our overall rating for the home after this inspection was “Requires Improvement”.
Rating at last inspection: At the last inspection in August 2016 the home was rated Good (report published September 2016).
Why we inspected: This was a planned inspection based on the rating at the last inspection.
Enforcement: Please see the ‘action we have told the provider to take’ section at the end of the report.
Follow up: We have asked the provider to complete an action plan detailing how they will make improvements to ensure the regulations are met. We will work with our partner agencies, including the local authority, to review the progress made in the home. We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk