We inspected Highfield Private Rest Home on 20 December 2017 and the inspection was unannounced. Highfield Private Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Highfield Private Rest Home is a large detached house. Accommodation is provided over three floors, with a passenger lift and stair lifts allowing stair free access. There are communal sitting and dining rooms together with a sun lounge. Large enclosed gardens are accessed at the rear of the property.
At the last comprehensive inspection in June 2016 the overall rating for the service was Requires Improvement. Five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to ensure that medicines were managed safely and that equipment was fit for purpose. Recruitment processes were incomplete. They did not ensure people were not unlawfully deprived of their liberty. People’s individual needs and preferences had not been established. The provider also failed to ensure systems and processes used to improve the service were effective.
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 questions safe, effective, responsive and well-led to at least good.
At this inspection we found some improvements had been made and some breaches in regulation had been met. However, there were still improvements to be made and embedded to ensure improvements were sustained. We found two continued breaches and one new breach.
A registered manager worked at the service each day. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Shortfalls had been identified by a specialist consultant regarding the fire safety arrangements at the service. Action had not been taken to remedy these and there was a risk that people may not be evacuated from the service quickly in the event of an emergency.
When new staff were being employed the registered manager had not consistently recorded their decisions to employ people.
People’s medicines were stored, managed and disposed of safely. There was guidance for staff to follow about how to keep people’s skin healthy. Staff understood their responsibilities in relation to infection control. The service was clean and tidy.
Risks to people, including the risks of abuse and discrimination, were assessed, monitored, managed and reviewed. Accidents and incidents were recorded and analysed by the registered manager to check for any patterns and to ensure that referrals to health professionals had been made when required. Incidents were used as a learning opportunity to drive improvements at the service.
There were enough staff on duty to keep people safe. Staff completed an induction and regular training to keep their skills and knowledge up to date. They met with a senior member of staff on a one to one basis to discuss their performance and personal development.
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’s physical, mental, emotional and cultural needs were assessed and reviewed. They were encouraged to eat a healthy and balanced diet and to drink well. Staff supported people to stay as healthy as possible and worked with health and social care professionals; following any advice they were given.
Areas of the service had been refurbished since the last inspection, including people’s bedrooms. People were encouraged to bring small items of furniture in to the service with them to personalise their bedrooms.
People and their relatives told us they were treated with kindness and compassion. Their privacy and dignity were promoted and their independence encouraged. People were involved in making decisions about their care and support. Staff knew people well and made sure people and their relatives had information about external bodies that could provide independent advice.
People were encouraged to remain as active as possible and keep busy. They told us there was always plenty to do and that they did not feel bored or isolated. People and their relatives knew how to raise a complaint and felt the registered manager would listen to them if they had a concern. Staff knew about whistle-blowing and how to take concerns to outside agencies if they needed to.
People’s choices for their end of life care were discussed and recorded to make sure staff could follow their wishes. The registered manager and staff spoke passionately about the end of life care and support they provided. Extra staff were available when needed to ensure people were not alone.
Regular checks and audits were carried out by the registered manager and action was taken to remedy any identified shortfalls. People, relatives, staff and health professionals were encouraged to provide feedback on the day to day running of the service.
There was an open and inclusive atmosphere at the service. Staff spoke with people and each other in a kind and respectful way and valued each other’s views.
All services that provide health and social care to people are required to inform CQC of events that happen, such as a serious accident, so CQC can check that appropriate action was taken to prevent people from harm. The registered manager notified CQC and the local authority in a timely manner.
It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the service.
You can see what action we told the provider to take at the back of the full version of the report.
This is the second consecutive time the service has been rated requires improvement .