Highfield

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.

We found the following examples of good practice.

Effective infection control measures were in place for visiting professionals to the service. These included showing proof of a negative lateral flow test (LFT) and proof of vaccination against COVID-19 as well as a temperature check.

Staff had training how to use Personal Protective Equipment (PPE) effectively and used this correctly. Domestic staff confirmed that they had time to complete all of their job roles and duties.

People had separate visiting risk assessments and arrangements depending on their support needs and preferences. This enabled people to see their family and friends whilst feeling comfortable and safe.

Staff felt well supported by the registered manager. Staff helped cover vacant shifts caused by staff sickness or isolation and there was no use of unfamiliar agency staff. This meant that people were supported by a consistent staff team who knew them well.

People were complimentary about the way the registered manager and staff team had supported them to stay safe during the COVID-19 pandemic, whilst still ensuring that their wellbeing was supported.

Highfield provides accommodation and support for people who have various physical and neurological conditions, including dementia. The home is situated in a residential area of Bedford and is registered to accommodate up to 34 people.

We previously inspected the provider in January 2017 and February 2017 and rated them as requires improvement overall due to concerns in the areas of Safe, Caring and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found the provider had made improvements in these areas.

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

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People's medicines were managed safely, and there was evidence of learning from incidents.

People's needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by caring, friendly and respectful staff. Staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing.

Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns.

The service was well managed and the provider's quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service.

Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

This was a breach of regulation 15 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to the outstanding breach of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Highfield on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 7 March 2017.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that cleaning took place regularly, and to a good standard. We saw that the areas throughout the home that were previously not clean had been deep cleaned and maintained as clean. Thorough checks were in place where senior staff would monitor the on-going cleanliness, and staffing hours had increased within the cleaning and housekeeping team.

While improvements had been made we have not revised the rating for the key questions; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for safe and well led at the next comprehensive inspection.

Highfield provides accommodation and support for people who have various physical and neurological conditions, including dementia. The home is situated in a residential area of Bedford and is registered to accommodate up to 34 people. On the day of our inspection there were 33 people living at the service.

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.

The cleanliness of the service had not been maintained to an acceptable standard. We saw that there were a number of areas of the service which were not clean and we found that effective cleaning processes were not being implemented. During the inspection we saw that cleaning practices were not robust which had resulted in dust, dirt and stains to communal areas, toilets and bathrooms and people's bedrooms.

At times, people's dignity and respect were not being maintained. The service had not implemented sufficient systems to ensure that people always got their own clothing back from the laundry and people routinely had clothing go missing or had to wear somebody else's.

There were quality assurance systems in place at the service, however, they were not always effective. These processes had failed to identify areas of concern which were highlighted during the inspection and did not pick up on the fact that some paperwork was not being completed on a regular basis.

People felt safe living at the service. Staff members were knowledgeable about abuse and potential signs that it had occurred. They were prepared to report it and any other incidents, to ensure people were kept safe. Risks to people were assessed to ensure they could be as independent as possible whilst keeping safe. Staffing levels were sufficient to ensure that people's needs were being met and that staff were able to spend time with people engaging in conversation and positive interactions. Staff members also managed people's medicines and there were systems in place to ensure they were administered, stored and recorded correctly.

Staff members were provided with the training and support they needed to perform their roles. New staff were inducted to the service and were supported to get to know the people living there and the way the service worked. Staff received supervision to allow them to raise concerns and discuss any development needs they may have.

People were encouraged to make choices about their care and staff members sought their consent as much as possible. Where people could not give their consent, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed, to ensure that decisions were made in people's best interests. People had choices about what they wanted to eat or drink and were provided with the support they needed to maintain a nutritious diet. They were also supported to book and attend appointments with healthcare professionals to help them be as healthy as possible.

There were positive and caring relationships between people and members of staff. Staff made sure they treated people with kindness and compassion and spent time talking to them and getting to know them. Care plans were in place to help guide staff and these were reflective of the care and support that people needed. People had been involved in the production of these care plans and they were regularly reviewed with people's input, to ensure they remained up-to-date.

Activities were available at the service to help people keep busy and to explore their own hobbies and interests. Staff members knew people well and had insight into their preferences and interests, which helped them to provide people with person-centred care. There were also systems to gather people's views and opinions about the service, including complaints. Where people had complained, the provider had ensured that appropriate action was taken to manage that and resolve people's concerns.

There was a positive and open culture at the service. People were happy and staff members were motivated to provide them with the best care they could. The registered manager was a visible presence and worked alongside the staff team to ensure they were supported to do their jobs.

We identified that the provider was not meeting regulatory requirements and was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.