Archived: Highfield House

Highfield House is a large detached house situated close to the centre of Heywood. The home is registered to provide accommodation and personal care for up to 25 people. There were 23 people accommodated at the home on the day of the inspection.

There was 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 looked at the staffing rotas, staff meeting records and talked to the registered manager. We found there were sufficient staff to meet the needs of people who used the service.

We looked at the safeguarding procedures and found the service adhered to their and the local authorities policies and procedures.

We saw the home had a range of policies and procedures to ensure the safety and well-being of people who used the service and the staff we spoke to were familiar with these.

Staff told us that the manager was supportive and approachable, and believed the staff worked well together.

The manager had implemented quality assurance checks to monitor and improve the service. They regularly communicated with the registered provider and area manager who would visit the service regularly to carry out her own audits of service delivery.

The service were last inspected in June 2015 when the service did not meet all the regulations and were given two requirement actions for dignity and respect due to the loss of laundry and people wearing clothes that did not belong to them and for people’s care plans not being person centred. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 24 and 25 January 2017.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report concerns to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. There were sufficient numbers of experienced staff.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us food was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Regular meetings with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The registered manager and area manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were sufficient activities to provide people with stimulation if they wished to join in.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

Since our last routine inspection undertaken on 9 July 2014 we had been contacted by numerous people including a health care professional and a relative. They raised concerns about staffing levels, staff qualifications and experience, particularly on the night shift, as well as medication and infection control practices. We also considered information we had received from the Infection Control Team following their inspection at the home.

We carried out two out of hours visits to the home. During our first visit on the evening of Thursday 28 August 2014 we spent time talking with the nominated individual (NI) the named person with overall responsibility for the home on behalf of the part of the owners, the registered manager from Highfield Manor and looked around parts of the home.

On our return visit on the morning of Monday 1 September 2014 we spent time talking with people who used the service and staff, observing how people were cared for, looking at records and at parts of the building.

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 effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led? Below is a summary of what we found.

Safe

Medication returns were not securely held and people did not always receive the medication that had been prescribed for them by their doctor.

We saw audit records that raised concerns about the competence of staff to carry out their roles safely and effectively.

Effective

Procedures introduced to remove offensive waste had created a significant malodour problem in the shower room, which most people at the home used.

There were not always enough of the right types of incontinence pads accessible to staff and available for people to use during the night.

Caring

We saw that care staff were polite and helpful to people. Those people able to communicate their needs and wishes were seen to enjoy a good rapport and humour with staff.

Responsive to people's needs

We saw that progress had been made to address the issues raised in a recent audit by the local infection control team to improve practices.

We saw that action had been taken to recruit staff into vacant staff posts at the home.

Well-led

The home had no registered manager. This is a breach of the provider's registration. The home had experienced a change of personnel within the management team which had impacted on the management of the service. We were made aware that it was the intention of the area manager to register with us as the full time manager of Highfield House.

A staff member told us that the home 'needed a full time manager'.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People who used the service did not have any complaints and were given the opportunity to raise any concerns at meetings or by completing surveys. There were policies and procedures for the protection of vulnerable adults. Any safeguarding concerns had been managed appropriately by staff. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw that a best interest decision had been made for a person using the correct channels.

The home was clean, warm and free of any offensive odours. There were dedicated domestic staff to clean the home. We saw that improvements had been made to infection control procedures to help stop the spread of infection.

We saw that the electrical, fire and gas equipment had been maintained. Staff were aware of the system for having items repaired and replaced. The home and equipment was maintained and repaired to help keep staff and people who used the service free from possible harm.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care although they were not always signed by people. The three care plans we looked at showed there had been regular reviews and any changes to people's care and condition had been recorded.

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids. We recommended that the service used recognised tools for assessing any risks around these areas.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and plans of care. The information was used to improve the service.

The meals served at the home were nutritious and people were given sufficient fluids to help keep them hydrated. We sat in the dining room for most of the inspection. We saw that people had a choice of meal. The meal was held as a social occasion for those who wanted to eat in the dining room. Three people told us, "The meals are good and we are given a choice", "I like some of the meals especially pie and chips but we also have vegetables, mashed potatoes and meat but I don't have to have it. I had cheese salad today" and "I like the meals. We have a choice and there are alternatives available".

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff interacted and chatted to people who used the service throughout the day. Three people who used the service told us, "It's the best move I ever made. The staff are wonderful and I don't have to wait long when I require assistance", "The girls are very nice" and "Staff are helpful and respectful. I don't have to wait long for assistance and get the care I need. I know I have a care plan but have never read it".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. Three people told us, "I like walking, reading and playing games such as dominoes", "We sit here and look after one another. I played bingo this morning" and "I don't join in the activities. There is nothing I want to join in with".

The manager (who has applied to become registered with the Care Quality Commission) held regular meetings with people who used the service and staff. Each day staff attended a 'handover' meeting to ensure they were up to date with people's needs. Staff were able to voice their opinions at meetings and supervision sessions.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and easily available for inspection.

The service had good quality assurance systems. The manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving. The staff we spoke with told us they felt supported and well trained, understood the safeguarding procedures and had completed an induction course. One staff member said, This manager is the best one I have had".

We looked in detail at the care records for the two people concerned and for one other person. We saw that care plans were in place and it was recorded that the Registered Manager reviewed them on a regular basis. The records for one person, who required specific personalised care, did not contain a care plan to provide care workers with information about how this care should be given.

We saw examples of records being undated. Records for the same person gave conflicting information so we were unsure of the sequence of events or the accuracy of the information recorded. We also saw evidence that confidential information regarding people living at Highfield House had been disclosed to others in error without their prior knowledge or permission.

People told us they were happy with the care they received. Their comments included '[The care workers] do very well' and 'I never need anything. [The care workers] take good care of me'. Risk assessments had been completed for people, and care plans were then put in place. These were reviewed every month.

The manager monitored staff training and arranged for it to be updated at the correct intervals. Supervision meetings had taken place for most staff and appraisals were being arranged.

The manager and the provider carried out regular checks to assess and monitor the quality of the service. Where areas for improvement were found we saw they were acted on.

People's needs had been assessed in detail, and they told us they had been involved in deciding what support was needed. One relative commented about the staff 'They do a very good job in difficult circumstances'. Another positive comment was 'Thank you to all the staff that have cared for [my relative]. She has improved very much during her time here'.

We found that people had a varied diet, and where necessary in depth records were kept of their food and fluid intake.

Although people told us they had not been told how to complain, we saw documents displayed in the home that gave instructions. Everyone we spoke with told us they would tell the manager or another staff member if they had any concerns.

The staff personnel records we saw provided evidence that the home operated strict recruitment procedures and all appropriate checks had been completed prior to a new employee starting work.

We saw evidence that all appropriate safety checks at the home were completed and an on-site maintenance person ensured any repairs were dealt with quickly.