We visited Highview Residential Home on 17 April 2014 to review two compliance actions related to the management of medicines and nutrition in the home. We also looked at three additional outcomes, care and welfare of people who use the service, safeguarding people who use the service and assessing and monitoring the quality of service provision.We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:
' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
This is a summary of what we found.
Is the service safe?
Care was planned to meet people's needs. Where a need was identified a plan was in place to meet this need. For example, one person's care record stated that they required assistance to change position. This plan detailed the frequency of position changes, the equipment required and the numbers of staff.
There were enough staff on duty to meet the needs of people living in the home and two members of the management team were available on call in case of emergencies.
People were supported by staff who were able to perform their role. We looked at the staff training matrix and this showed that all staff who worked at Highview Residential Home had completed training about safeguarding vulnerable adults. We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused. All of the staff we spoke with could name types of abuse a person could be subjected to, and said they would report any suspicions to the manager or the local authority.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. No applications had been submitted; however the registered manager explained that due to the recent Supreme Court ruling, they were in the process of preparing DoLS applications to submit to the local authority. The provider had a policy and relevant staff understood how an application should be made.
Is the service caring?
People were treated with consideration and respect and their privacy was maintained. We spoke with four people and the relatives of one person. One person told us, "It's all very well run." Another person said, "They are nice and polite." A person's relative commented, "There are no problems."
Staff communicated with people in a sensitive and considerate manner. For example, we saw a member of staff go out for a walk with one person who was becoming unsettled. We observed another member of staff sat at a table supporting a person with their meal. The staff member waited until the person had finished what was in their mouth before offering more food. We saw that bedroom and bathroom doors were kept closed when people were being supported with personal care and staff knocked on doors before entering.
Is the service effective?
Peoples' needs were assessed and care was planned and delivered to meet their needs. For example, we looked at the accident records for people living in the home. We found that where one person had fallen several times during the month, the registered manager had contacted the person's GP for further advice. We saw that as a result the GP subsequently visited and changed the person's medication. We noted that since the change, no further accidents had been recorded. One person's relative told us, that they felt that their mother's care needs were being met. People's needs were taken into account with signage and the layout of the home, enabling people to move around freely and safely.
Is the service responsive?
People accessed the services of healthcare professionals as required. A relative told us, "I am kept informed of any changes. Just recently the manager asked me if I would like to review Mum's care plan". Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians and GPs were documented.
Is the service well led?
The provider undertook a variety of audits to check the quality of the service. For example, we looked at audit reports relating to privacy and dignity, personal care, dementia, medication, health and safety and accidents. We found that actions had been taken as a result of this monitoring. For example, a recent dementia audit highlighted the need for social evenings for residents and families.
People were able to comment on the service provided. People told us that they had recently attended a resident/relative meeting which included topics such as ongoing redecoration, menus, activities and staff.