Highfield

Updated 29 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was completed by 2 inspectors.

Service and service type

Highfield is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Highfield is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This 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. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 13 people who used the service and 7 relatives about their experience of the care provided. We spoke with 15 members of staff including care workers, senior care workers (team leaders), housekeeping staff, cooks, the registered manager, and other members of the management team.

We reviewed a range of records. This included 6 people’s care records and numerous medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies, procedures and audits were reviewed.

Updated 29 November 2023

About the service

Highfield is a residential care home providing personal care to up to 34 people. The service provides support to people who may be living with a physical disability, or dementia. At the time of our inspection there were 34 people using the service.

Highfield is a 2 storey building. People have access to their own personalised bedrooms and share communal areas such as lounges, bathrooms, dining areas and a garden.

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

People were not always as safe as they could be living at the service. Some risks to people had not been rectified in a timely manner, and records were unclear if people had been supported fully in line with their support needs. Deployment of staff meant there was a risk people would not have staff to support them when needed, increasing risks to people being harmed. Some areas of the service were not clean and posed an infection, prevention and control (IPC) risk. Staff did not have formal training to support people in line with some of their support needs. We have made a recommendation about staff training.

People did not always receive person centred care and were not always being supported to follow their interests and hobbies. People went for long periods of time without staff interaction increasing the risk of isolation and boredom. Staff did not always treat people with dignity and respect. Staff were unsure how to effectively communicate and offer choices to people who did not use verbal communication.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The management team and provider audits were not always effective in identifying and driving improvements at the service. There were some negative aspects to the culture of the service meaning people were not always supported to have good quality care. This had not been fully addressed by the provider.

Despite our findings we received positive feedback from people and relatives about their support. One relative said, ‘‘[Family member] is loving living at the service and staff have given them their sparkle back.’’

Staff were trained in safeguarding and knew how to report concerns. There were enough staff to support people with their care needs and staff were recruited safely. People were supported safely with their medicines. Staff had training to perform their roles effectively. People were supported to eat and drink in line with their support needs. Health professionals were asked for support if people needed this.

Staff spoke with people with kindness and compassion and people were visibly happy being supported by them. Staff knew people well as individuals and supported them to be independent if this was their choice. An activities coordinator was in post, and they had started to have a positive impact at the service, although more work was needed to improve people's social opportunities. Complaints were responded to thoroughly and in a timely manner. People received kind and dignified care at the end of their lives.

The management team and provider were passionate about providing good care for people. They took our feedback seriously and started putting improvements in place immediately. People, relatives, and staff were asked for their feedback about the service. Staff worked with other professionals to help people achieve good outcomes.

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 the service under the previous provider was good (report published 04 May 2018). We also completed a targeted IPC inspection (report published 03 March 2022) and found no concerns. At this inspection the rating has changed to requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We also received some concerning information about how people’s falls were being safely managed.

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, people receiving person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.