Highfield House Care Home

Highfield House Care Home is a residential care home providing accommodation for up to 40 people. The service is arranged over two floors and a third storey referred to as a mezzanine. At the time of this inspection there were 29 people using the service.

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

We had significant and multiple concerns at our last inspection and rated the home inadequate in two key questions and overall. We also found three breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.

Immediately following our last inspection, the provider took action to begin making the necessary improvements including placing a voluntary suspension on any new admissions to the care home. The provider brought in a regional manager to be based at the home full time to help address the significant concerns and to put in place a plan of action to make the necessary improvements. This involved making improvements to governance and oversight arrangements, and implementation of systems and processes to safely assess and manage risks to people. Staffing levels were reviewed and immediately increased, and staff terms and conditions were improved.

At this inspection we found improvements. Despite some remaining areas for improvement, such as the need to consistently improve record keeping, the service had enhanced leadership and there was a changed culture which was commented on by many people, staff and stakeholders we spoke with. The embedding of these new ways of working are now required to ensure consistency moving forward.

People told us they felt safe. People using the service and relatives were complimentary about the staff who they felt were caring and kind. People were protected from the risk of abuse and staff knew how to identify and report safeguarding concerns.

The provider had increased staffing levels in the service since the last inspection and staff had received an induction and training relevant to their role. Staff were safely recruited and the provider had completed the appropriate checks prior to them starting work. Despite this, the service still faced recruitment challenges and we received some mixed feedback about the staffing levels. We have made a recommendation about the provider monitoring the staffing levels closely.

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.

The provider had a process in place for responding to complaints and people and relatives told us they felt comfortable raising any issues with the management team.

People, relatives and staff spoke positively about the culture of the service and told us the management team were approachable and supportive.

Rating at last inspection and update

The last rating for this service was Inadequate (published 28 January 2022). This service has been in Special Measures since that date. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Previous breaches

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 undertook this comprehensive inspection to check the provider had followed their action plan and to confirm they now met legal 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.

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 Inadequate to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield House Care Home 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.

Highfield House Care Home is a residential care home providing accommodation for up to 40 people. The service is arranged over two floors and a third storey referred to as a mezzanine. At the time of this inspection there were 28 people using the service.

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

There were insufficient staff to meet people's needs. This meant people had to wait for personal care and support, staff were not available to respond to people in a timely manner. The service had experienced a high turnover of staff and challenges recruiting. As a result, the staff team was running on a high level of agency staff. The home had a core group of experienced care staff who had worked hard across the pandemic to provide a degree of consistency to people.

Medicines were not managed safely across the home. Risks to people's health, safety and welfare were not managed effectively, placing them at significant risk of harm. People's care records were not always person centred and accurate. They lacked accurate and up to date information to guide staff in how to meet their needs safely and effectively.

People were mostly protected from the risks associated with the spread of infection, including from COVID-19. We signposted the provider to further work needed.

The provider’s governance systems to monitor the quality and safety of the service were inadequate. The provider’s lack of oversight meant some previously evidenced standards and regulatory compliance had not been maintained. The lack of robust governance systems meant the provider had failed to identify and address issues we found.

Most people and relatives commented positively on the care they received from the regular and consistent staff team who they recognised worked hard under pressure due to staffing levels.

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 May 2021) and there was a breach 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 not enough improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections. This inspection has been rated inadequate.

Why we inspected

We received concerns in relation to staffing levels, infection control practice and the management of the home. As a result, we undertook an unannounced focused inspection to review the key questions of safe and well-led.

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 overall rating for the service has changed from requires improvement to inadequate. This is based on the findings 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 Highfield House Care 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 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 medicines, assessing risk, infection control, health and safety staffing, recruitment and governance.

Please see the action we have told the provider to take at the end of this report. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Highfield House Care Home is a residential care home providing accommodation for up to 40 people. The service is arranged over two floors and a third storey referred to as a mezzanine. At the time of this inspection there were 32 people using the service.

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

People told us they were happy living at the service however, we identified some shortfalls that had not always been picked up or fully actioned through the providers governance systems.

Staffing levels remained a concern since our previous inspection. The registered manager and provider told us they were taking action to increase staff at night and review the responsibilities and deployment of staff during the day. Staff were recruited safely, and they received appropriate training and support to equip them with the necessary skills.

At our last inspection we had concerns about the safe management of people’s medicines and found a breach of the Regulations. At this inspection there were some concerns with the completion of medicines records, however, overall, there were some improvements and medicines were generally stored and managed well.

Staff knew how to safeguard people from the risk of harm and abuse and had a good understanding of how to recognise and report potential harm or abuse and were confident the provider would take action in line with local safeguarding procedures. People and relatives praised staff for being kind and caring.

The registered manager took prompt action when informed of our findings and was keen to make any improvements necessary and to continue moving the service forwards.

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.

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 13 January 2021). At that inspection there was a breach of 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.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 concerns with staffing levels continued. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Why we inspected

We received concerns in relation to a potential safeguarding concern. As a result, we undertook a focused inspection to review the key questions of Safe 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield House Care Home is a residential care home providing accommodation for up to 40 people needing residential and dementia care in one adapted building. The service is arranged over two floors and a third storey referred to as a mezzanine. At the time of this inspection there were 32 people using the service.

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

Our previous inspection in November 2019 found systems to monitor the quality and safety of the service had not been effective. Management and leadership had been inconsistent, and the culture created did not support the delivery of high-quality person-centred care. This inspection was prompted because we received information raising concerns about risks to people, poor care, insufficient staff and low staff morale. Our visit found frequent changes in managers had impacted on the quality and safety of the service. Failure to have a consistent manager in place had led to continued shortfalls in governance arrangements and risks associated with fire safety, medicines and people’s welfare were not always being identified or managed. Where audits had identified improvements were needed, these did not reflect how issues were to be addressed and monitored to ensure the required improvements were made, by whom and by when.

We have made a recommendation about developing a robust system to assess and monitor the quality and safety of the service to drive the required improvements.

Fire systems and equipment were checked regularly, however, these had not identified the risks of locking gates to stairs, which were also fire exit routes. Although the area manager took immediate action to have the locks replaced with keypad locks which automatically release in the event of a fire, routine checks had not identified this risk.

People’s prescribed medicines, including controlled drugs were not always stored, administered and disposed of safely in accordance with relevant national best practice guidance. People were at risk of harm where their medicines were not being administered accurately in accordance with prescriber instructions.

Improvements were needed to ensure risks to people were identified, and all reasonably practicable measures taken to reduce that risk, including but not limited to choking and pressure wound management. Poor record keeping was placing people at risk of not receiving the care and support they needed, such as ensuring they received adequate fluids to remain hydrated and repositioned to prevent pressure wounds developing.

Of the nine people spoken with, five informed us there were not enough staff to meet their needs, resulting in them waiting for long periods of time for staff assistance to help them to the toilet. People told us baths and showers were only available if there was enough staff. Staff confirmed at times there were not enough staff to ensure people received timely care and support. We observed people who were looked after in their bedrooms, including those on end of life care were not getting the same quality of interaction as others. The manager informed us they were in the process of recruiting new staff and would be reviewing staffing levels.

Overall people and their relatives spoke positively of the service, with food scoring highly. Friends and family believed the precautions regarding COVID 19 had been managed well in accordance with government guidelines but were saddened by the impact of visiting restrictions on their family and themselves.

People, their relatives and staff told us in the short time the new manager had been in post, under their direction the culture in the service had improved. Staff felt supported, had better direction and leadership, and had received training that gave them the skills and knowledge they needed to carry out their roles effectively.

Infection control and prevention measures were in place and we were assured the service had systems in place to respond to coronavirus and other infection outbreaks effectively. Staff were clear of safeguarding processes, and when and how to raise concerns.

Why we inspected

We carried out an unannounced focussed inspection of this service on 01 December 2020. This was because the service had not had a registered manager in post since the last inspection in November 2019, which is a breach of the providers conditions of registration. We also received concerns in relation to lack of staff, medicines management and people’s care needs not being met. As a result, we undertook a focused inspection to review the key questions of safe 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Rating at last inspection: The last rating for this service was good (published 12 March 2020) with a rating of requires improvement in the key question well led. At this inspection we found not enough improvement had been made in well led. 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 improvement.

Please see the safe and well led sections of this report. 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 Highfield House Care Home on our website at www.cqc.org.uk.

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 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highfield House Care Home is a residential care home providing personal care without nursing to 33 people aged 65 and over at the time of the inspection. The service can support up to 40 people in an adapted building over two floors.

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

We were prompted to bring this inspection forward because of concerns shared with us regarding the management of the service. On our arrival at Highfield House Care Home the regional manager was at the service and informed us that the registered manager had left the afternoon prior to our inspection because of performance issues. They had been supported to improve but had not finished their probation. A new manager had been already been appointed. They had been covering for the registered manager during a period of absence. This showed us that the provider had acknowledged people’s concerns regarding the management of the service, investigated them, and had taken action to put things right.

People were well protected from bullying, harassment and abuse by staff that were trained to recognise abusive situations and knew how to report any incidents they witnessed or suspected.

Staff we spoke with during the inspection understood their responsibilities to raise concerns and there were arrangements in place for reviewing and investigating incidents when things went wrong.

Personal risks to people had not always been fully assessed or steps put in place to keep people safe. However, an audit of people’s care records had been carried out and it was identified that people’s care plans and risk assessments needed to be reviewed and updated. This meant that risks to individual people would be identified and action taken to help protect them from harm. The reviews were in progress.

The service was undergoing a program of refurbishment and decoration. We saw that risk assessments had been undertaken around keeping people safe while the work was being carried out.

Staffing levels were sufficient to keep people safe. People were protected by staff that had been safely recruited.

Medicines had not always been managed in a way that ensured that people received them safely and at the right time. On examination we found there were some shortcomings in its management. However, most of our concerns in regard of the medicines had already been noted and action was being taken to better manage the medicines and retrain staff.

The home was clean, and staff had access to equipment that protected them and the people they supported from cross infection.

People’s needs were assessed, and they received care in line with current legislation from staff that had the knowledge and skills they needed to carry out their roles.

People's nutritional and hydration needs were assessed to ensure they received appropriate support that met their needs. The service worked to ensure that people received person centred care when they used and were supported by different services.

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, meaning people were asked for their consent by staff before supporting them in line with legislation and guidance.

Staff who spoke with us talked about the people who used the service in a caring and positive way. People told us that staff were kind, caring and protected their privacy and dignity. We saw evidence in records that people were able to express their views, and staff listened to what they said and took action to ensure their decisions were acted on.

People had not always received care that was personalised and responsive to their needs, the care plans did not always properly reflect all the person’s needs and were generally of a mixed quality. However, the service was in the process of updating and reviewing people’s care plans to improve their quality and consistency. People’s experiences, concerns and complaints were listened to; steps had been taken to investigate complaints and to make any changes needed.

The service has gone through many changes recently, having been registered under three different providers within a year with five different managers. This has had a negative effect on people’s wellbeing. However, the provider had recognised how disruptive and unsettling this was for people and were taking steps to listen to them and their relatives’ concerns and worries. Staff were also being supported because many of them had worked under all of the previous providers and had to get used to the many different management styles. There was still work that needed to be done, but work was underway to make improvements to the quality of the service people received.

There were various quality assurance systems in place that the registered manager was expected to carry out, but they had not always been carried out and this had led to a deterioration in the quality of care people received. Since this had been identified, steps had been taken to improve the quality of the audits and to the service offered to people. During our inspection we found that quality assurance audits were in place and improvements had started to be made. The new manager was being supported by their line manager and the deputy manager while they settled into their new post and became familiar with the service.

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

Rating at last inspection

This service was registered with us on 22 January 2019 and this is the first inspection.

Why we inspected

The inspection was prompted by concerns shared with us in regard to the management of the service. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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