- Care home
Highfield House
All Inspections
11 January 2023
During an inspection looking at part of the service
Highfield House is a residential care home providing personal and nursing care to up to 45 people. The service provides support to people who are living with complex neurological conditions. At the time of our inspection there were 36 people using the service. Highfield House accommodates people across three separate wings. This includes a high dependency unit for people who require ventilation. There is also a nursing unit and a unit supporting people with their rehabilitation. Included in the staff team is a dedicated therapy team, providing on-site physiotherapy to support people's rehabilitation.
People’s experience of using this service and what we found
People received safe care and treatment. Staff were knowledgeable about how to maintain people’s safety and provided care in line with best practice guidance. Care staff worked with the physiotherapy team and other specialist healthcare professionals to ensure they had the skills to support each person at the service and knew how to use the required equipment safely, this included receiving tailored training on how to meet each person’s needs. The provider reviewed their practices in response to any incidents that occurred at the service to ensure they were learnt from and action was taken to minimise the risk of recurrence.
Safe staffing arrangements were in place. There had been a large recruitment drive since our last inspection and many new staff were in post. This had reduced the reliance on agency staff and further plans were in place to continue to strengthen the staff team. Induction processes had been improved including the delivery of more clinical training, so staff had greater knowledge prior to starting to provide hands on care. There was a regular programme of training to enable staff to update their skills. However, we recommend the provider reviews their practices to ensure agency staff are competent to undertake all activities assigned to them.
The management team had been restructured. As part of this there had been additional roles created to provide further clinical leadership at the service. Governance processes had been strengthened to enable the nursing team to discuss examples of care and how they had been learnt from to improve practice. There was a commitment to continuous improvement, a regular programme of audits and review of key service improvement.
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 good (published 11 August 2022).
Why we inspected
We received concerns in relation to the delivery of safe care and treatment, risk management and staffing arrangements. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.
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 remained 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 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.
13 July 2022
During a routine inspection
Highfield House is a residential care home providing personal and nursing care to up to 45 people. The service provides support to people who are living with complex neurological conditions. At the time of our inspection there were 37 people using the service. Highfield House accommodates people across three separate wings. This includes a high dependency unit for people who require ventilation. There is also a nursing unit and a unit supporting people with their rehabilitation. Included in the staff team is a dedicated therapy team, providing on-site physiotherapy to support people’s rehabilitation.
People’s experience of using this service and what we found
People were kept safe and free from discrimination. Regular assessments were undertaken to review risks to people’s safety and staff supported people to implement measures to minimise those risks. The new care records had systems built in to alert staff to any changes in behaviour that may indicate a change in people’s needs. People received their medicines as prescribed and there were safe practices around the storage, administration, recording and disposal of medicines. Infection prevention and control measures were in line with best practice, including in relation to the COVID-19 virus. Safety alerts were distributed across the provider’s service when incidents occurred so they could be learnt from and practice could be improved.
There were sufficient numbers of staff to keep people safe. However, we found that there was a high reliance on agency staff at the time of our inspection. The service had experienced some challenges regarding staffing due to the impact of the COVID-19 pandemic and were in the process of recruiting new staff. Staff felt well supported and had access to training. The provider had streamlined and strengthened their induction and training provision in order to further support staff and improve on staff retention.
People’s needs were assessed in line with best practice guidance. 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. Staff worked closely with healthcare professionals to ensure people’s health needs were met and people received effective, coordinated care. People’s nutritional needs were met and regularly reviewed by healthcare professionals.
People were treated well, and with dignity and respect. Staff supported people to be involved in decisions and staff supported people to be as independent as possible, and to build upon that independence during their time at Highfield House. Staff respected people’s individual differences and supported their emotional well-being. However, we found that care records focused on people’s clinical needs and was missing information about the person, what they liked and what they were interested in.
People received care and treatment that met their individual needs. Staff were responsive to any changes in people’s abilities and supported them with their recovery and rehabilitation. The team were working with the local hospice to improve end of life care and were working towards the gold standards framework, a recognised good practice framework for supporting people towards the end of their life. People communicated using a variety of verbal and non-verbal communication methods. However, this information was not was always captured in people’s care records and there was a risk that this information was not available for agency staff and newly recruited staff, impacting on the quality of interactions with people.
There was clear leadership and governance at the service. The governance structure was mapped to the provider’s mission and values statement and enabled the staff to clearly identify areas of the service they wanted to develop and improve. Staff, people and relatives were encouraged to express their views and opinions and be involved in the development of the service. Staff worked closely with other agencies and there was a commitment throughout the staff team to continuous improvement.
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 outstanding (Published 1 February 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
23 November 2017
During a routine inspection
Highfield House can accommodate up to 45 people across three floors, each of which have separate adapted facilities. People were able to interact across the floors. Highfield House specialises in providing care for people who are medically highly dependent due to their complex physical and/or neurological disorders. At the time of our inspection 37 people were using the service.
At the last inspection on 9 October 2015 the service was rated ‘Good’ overall and for each key question. At this inspection on 23 and 27 November 2017 the service had improved their rating for the key questions ‘Is the service effective’ ‘Is the service responsive’ and ‘Is the service well-led’ to ‘outstanding’. This meant the service was now rated ‘outstanding’ overall.
People, relatives, staff and healthcare professionals were very complimentary about the management team at Highfield House. They felt the management team were approachable and interested to hear from them their experiences and any suggestions to improve practice. Healthcare professionals felt there was a drive within the staff team to improve and develop their practice.
Since our last inspection the provider had developed their corporate values. The provider had updated their policies and procedures linking them to their values and adopting the five CQC key questions as their desired outcomes. The provider’s values and behaviours underpinned their governance framework and there were robust procedures in place to review and improve the quality of service delivery. Staff worked in partnership with other agencies, this included liaison with their local NHS trusts, Clinical Commissioning Groups (CCGs) and the local authority. The service followed public health England guidance and implemented NHS initiatives at the service. There were systems in place to enable staff to continuously learn, improve, innovate and ensure sustainability of service. The provider issued safety alerts in response to any incidents that occurred. They had also developed a staff newsletter which was themed on the 5 CQC key questions to further enhance staff’s understanding of the five questions about how the care they provided fitted into these and the provider’s values.
Staff were very passionate about their roles and working at Highfield House. Staff, people and relatives were keen to share with us their experiences of Highfield House and staff were very proud of the work they did. There was an obvious drive and commitment within the team to provide high quality personalised care. All of the healthcare professionals we received feedback from were very positive about the quality of service delivery and joint working arrangements.
Staff stayed up to date with and delivered care, support and treatment in line with best practice guidelines. This included guidance from the National Institute for Health and Care Excellence (NICE) and Royal College of Physicians (RCP). The management team organised for authors from recently published guidance to come to the service to speak to staff and families about the new guidance available. There was a comprehensive training programme in place and robust processes to ensure staff were competent to undertake their allocated tasks. Training drop in sessions were held daily for staff to update their knowledge on the provider’s mandatory training topics as well as ‘skills sessions’ held for staff to update their clinical knowledge.
The service provided healthcare support in line with the principles of the NHS England’s vanguard initiative for enhanced models of care which ensured proactive review of people’s healthcare needs and streamlining processes to ensure accurate and complete information was available in the event people required emergency hospital admission. The chef worked with specialist healthcare staff to ensure meals provided met people’s complex dietary requirements. An accessible environment was provided which took account of people’s physical and sensory needs. Staff adhered to the Mental Capacity Act 2005. 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, relatives and healthcare professionals were extremely positive and complimentary about the care and support provided to people. Care was person-centred and met people’s individual needs. Assessments were regularly undertaken to review people’s needs and any changes in the support they required. Detailed support plans were developed instructing staff about how to support the person. Care staff worked with the therapy team to support people’s rehabilitation and help people to develop their independence. A range of devices were used to support staff to assess and improve people’s cognition, memory and attention span, as well as using rehabilitation computer games to incorporate fun into people’s recovery. Staff followed the ‘six steps to success’ programme to ensure high quality end of life support was provided. An annual memorial event was held to remember those that had died. A range of activities were provided at the service and in the community. There were different sessions available which targeted different groups of people depending on their needs. One to one activities were provided as well as a group activity programme.
The service had systems for ensuring concerns about people’s health and welfare were managed appropriately and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People felt safe at the service and told us they received prompt support from staff. People’s dependency levels were reviewed daily and there were sufficient staff, with appropriate skills and knowledge, to meet people’s needs. This included providing one to one support for people with high risk complex care needs and recruiting specialist clinicians required to provide people with safe care and treatment. Staff assessed risks to people’s safety and systems were in place to minimise risks to people and to alert staff as people’s risk levels changed.
Safe medicines management processes were adhered to. Staff followed best practice guidance to prevent and control the spread of infection. Systems were in place to report incidents and learning was shared in response to any errors made, including issuing safety alerts to all staff about how to prevent similar incidents from recurring. Staff followed best practice in regards to safeguarding people from avoidable harm.
Staff had developed therapeutic and caring relationships with people. Staff were aware of people’s preferred name and their preferences in how they were supported. Staff respected people’s individual differences, their religious preferences and their culture and provided any support people required with these. People’s privacy and dignity was maintained. A dignity champion was nominated who held various events to promote dignity and explore people’s understanding of what it meant to maintain people’s dignity. Staff were aware of people’s communication methods and provided them with any support they required to communicate, including use of technology, in order to ensure their wishes were identified and they were enabled to make decisions and choices about care and service delivery.
A complaints process remained in place and complaints received were investigated appropriately. Many of the complaints received since our last inspection focused on the building work that was previously carried out and this had now been resolved. The service received many compliments about the staff and the care and support people received whilst at Highfield House.
9 and 12 October 2015
During a routine inspection
This inspection took place on 9 and 12 October 2015. We last inspected the service in October 2013. At that inspection we found the service was meeting all the regulations that we assessed.
Highfield House is a purpose-built care home providing accommodation, personal and nursing care for up to 27 people who are medically highly dependent due to their complex needs. The service specialises in the care and management of people with a wide range of neurological problems including those in a minimally awareness state, and people needing mechanical ventilation.
There was a registered manager in post at the time of our inspection. 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 manager and members of staff clearly understood their roles and responsibilities to protect people from harm. Risks were assessed, and appropriate provision was made for staff to manage these effectively. People consented to their care and treatment and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them safely.
People were cared for by a multi-disciplinary staff team who were qualified, supported and trained to meet their needs. The provider had a proactive approach to the personal and clinical development of staff, who were well trained and skilled. They were provided with specific training and development, and supported to carry out their role competently and had opportunities to develop further.
Management were proactive in following safeguarding procedures, the manager had made a safeguarding alert to a local safeguarding authority when the care provided by another service was unsafe.
Medicines were managed safely. The provider had policies and procedures in place for the storage and administration of medicines which reflected the guidelines recommended by the National Institute of Clinical Excellence (NICE) for managing medicines in care homes.
People had enough to eat and drink throughout and there were suitable arrangements in place to identify and support people who were nutritionally at risk.
The home had systems in place to ensure there was an appropriate number of staff on duty at all times, and there was a good balance of knowledge, skills and experience
People were supported with access to healthcare services and staff were involved in the regular monitoring of their health. The service worked effectively with a range of healthcare professionals and was pro-active in referring people for treatment.
The service had policies and practices to support people and their relatives around end of life care.
The home was well managed, and had effective quality monitoring process in place to drive continuous improvement and high quality care. Action plans were developed and discussed with the staff team for learning and making improvements.
15 October 2013
During a routine inspection
We met with and spoke to senior staff during the inspection including the service's manager, two deputy managers and the Director of Nursing from the provider's organisation. The Director of Nursing confirmed the current manager of the service would shortly be submitting an application to the Commission to become the registered manager for the service. We also spoke with three members of staff from the care and nursing team.
We looked at people's records and noted their care and support needs had been assessed and plans were in place to meet these needs. Risks to their health and wellbeing had been identified and plans were in place to manage these. We noted information about people was reviewed and updated regularly so staff had up to date information about people's current care and support needs. Staff received appropriate training to keep their skills and knowledge up to date to meet these needs.
Medicines were administered appropriately and stored safely in the home.
People were provided with information about how to make a complaint if they were not happy with the service. Their views and experiences were sought and acted on by staff. The service had systems in place to monitor the quality of service that people received.
2 October 2012
During a themed inspection looking at Dignity and Nutrition
The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.
We spoke with seven people who use the service, three relatives of people who use the service and seven staff members during our unannounced visit to Highfield House.
People who use the service we spoke to were positive about the standard of care being delivered and said that they were treated with dignity and respect.
One relative told us that 'the care staff are excellent' and 'you get the impression that they really do care'. Other comments included 'my relative requires assistance with personal care and eating and staff do this with a great deal of skill' and 'I am very pleased with the care they are receiving, staff are very polite, never lose their temper and are very patient'.