Highgrove Care Home

Highgrove Care Home is a residential care home registered to provide care and support to up to 21 people. The service provides support to older people some of whom were living with dementia. At the time of our inspection there were 14 people using the service.

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

Highgrove Care Home was a safe place to be. People, their relatives and staff told us the care and environment was safe. Equipment, training and safety checks ensured safe working practices. People’s risks were assessed, and procedures supported them to be safe from avoidable harm, staff knew people well.

There were enough staff on duty, people told us when they needed them, staff were there. The registered manager used a dependency tool to work out safe staffing levels to meet the needs of people living at the home. Accidents and incidents were recorded and analysed to ensure lessons were learnt. 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.

Medicines were managed safely. Infection prevention and control procedures were robust and additional practices were in place to protect against COVID-19. Recruitment procedures were robust. The home worked well with external professionals.

Staff knew how to recognise, and report concerns under safeguarding. Staff were confident the management team would follow up on concerns raised. Quality assurance systems operated effectively, a range of audits monitored the quality and safety of the home. People’s views were sought and used to drive improvement within the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 7 March 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.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling, skin damage, infection or malnutrition staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Records had not consistently reflected that catheter bags were being emptied or changed regularly. During our inspection the process was reviewed by the registered manager and sytems put in place to manage catheter care more safely.

People had been involved assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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 support this practice.

People and their families described the staff as caring and friendly and the atmosphere of the home as fun. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the service and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People's care was not always delivered appropriately to ensure they were safe in the home. For example, we found that care was not always delivered in a way that fully protected people from the risks of pressure sores on their skin. Also, where a health care professional had made recommendations about how to meet a person's needs in relation to drinking fluids, these had not been incorporated into their care plan or risk assessment and staff gave us conflicting information about how to meet their needs. This put people at risk of not receiving appropriate support.

People were not protected against the risks associated with medicines. We found that medicines were not always stored appropriately in the home and people did not always receive their medicines as prescribed. There were procedures in place for recording medicines but these were not consistently followed. Staff were administering insulin to one person who used the service without having completed suitable training and been assessed as competent to carry out this task. This put people at risk of not receiving their medicines in a safe way.

There was no plan in place to ensure that the Mental Capacity Act (2005) Deprivation of Liberty Safeguards (DoLS) were fully implemented in the home. As a result proper procedures had not been followed to ensure that people were not unlawfully deprived of their liberty.

We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

Is the service effective?

Although most people we spoke with felt that their basic personal care needs were met, people were not always able to do activities that met their individual needs and preferences. People who used the service, and their relatives, felt that a better range of activities was needed, including opportunities to go out of the care home, to ensure people were stimulated.

People told us that the number of agency staff used in the care home impacted on the effectiveness of their care. They told us that there was a difference between the care provided by permanent staff and that provided by agency staff and expressed concerns about their skills and knowledge. We found that there were not always suitable checks in place to ensure that agency staff who worked in the home had appropriate qualifications, skills and experience to meet people's needs.

Records about how people's needs were being met were not maintained effectively to ensure people received the care they needed at the right time.

We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

Is the service caring?

Most of the people we spoke with told us that permanent staff who worked in the home were kind, helpful and hard-working. Relatives also told us that they were able to visit the home at any time and always found staff to be friendly and welcoming. We observed staff interacting with people who used the service and saw that they treated people with respect and dignity, offering encouragement and demonstrating an awareness of people's personal likes and dislikes.

One person who lived in the home reported a concern in relation to the uncaring and abrupt attitude of some night staff towards them. They told us that this had made them feel nervous about asking for help. We reported this to the registered manager at the time of our inspection who, in turn, reported the concern to the local authority under local safeguarding procedures. The registered manager has agreed to monitor the situation and provide further training to staff in safeguarding and dignity to minimise the risk of this happening again.

Is the service responsive?

There were not always enough staff available to meet people's needs. People who used the service told us that there were certain times of the day when staff seemed particularly under pressure. For example, one person told us, 'They're all in such a rush because they say they're short-staffed. They say they haven't got time. If I ask for help, they say 'We're busy' and I should do it myself.' Another person commented, 'I don't think there is quite enough especially when they are trying to put people to bed at the same time.' These views were echoed by some relatives we spoke with who told us that more staff were needed to support people with social activities and keep a watchful eye on people who were particularly vulnerable.

We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

The home responded to changes in people's health and well-being and we saw examples of how staff had contacted the emergency services, people's GPs and the local authority to report concerns about people's welfare. People who used the service were satisfied with the way the home liaised with health care professionals on their behalf.

Is the service well-led?

The provider did not have effective systems for monitoring the quality and safety of the service.

Checks to monitor the safety of the home were not carried out regularly. This meant there was a risk that concerns in relation to the maintenance of the premises, hot water temperatures, call bells, door alarms and fire safety would not be identified and addressed quickly.

There were no action plans arising from a visitors' survey that was carried out in February 2014 or a recent residents' meeting. This meant that the provider was not fully able to demonstrate how they took on board people's views and made improvements to the service based on their feedback.

Accidents that had occurred in the home were recorded but, while we saw that action was usually taken in response to each incident, there was no effective analysis to identify common themes and concerns. This would help ensure that action was taken to reduce risks across the whole service.

Three relatives we spoke with told us that the provider was slow to take action when they had made suggestions about how the home could be improved or requested specific changes on behalf of their family member. They felt that they had needed to apply pressure in order for changes to be made. Some relatives and staff also identified further areas for improvement in the home but did not have confidence that the provider would take action. One person said that they rarely saw the provider speak with people who used the service or their families and felt that this was needed in order for them to show they were listening and responsive to people's views.

We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

People who used the service told us that they were looked after well. One person said, "They look after us well. I like it here."

People were cared for in a clean, hygienic environment. We saw that systems for cleaning were consistent throughout the home.

There were enough qualified, skilled and experienced staff to meet people's needs. During our inspection we observed people being assisted promptly and staff answering call bells in a timely manner.

People's care records were accurate and fit for purpose. We checked the care records of three people and saw that records had been updated to reflect their needs.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us 'They look after me well.'

The home did not have effective systems in place to reduce the risk and spread of infection. One member of staff told us, 'We used to have an infection control lead but she left. This area has been neglected.' The manager told us that the home has not had a cleaner during the week since January 2013 but that all staff were carrying out the cleaning of people's rooms.

People who used the service told us that at times there were not enough staff to meet people's needs. One person told us, 'They are very short of staff. Staff let them down at the last minute. Can you get us some more staff.'

People's care records were not consistently completed and did not include an accurate record of the care that they should receive. Most of the records of people's care plans we saw had been completed, however, there were some monitoring charts that contained significant gaps and omissions.