Archived: Highbeech Care Home

Updated 22 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced inspection of Highbeech Care Home on 19, 20 and 28 April 2016.

The inspection team consisted of three inspectors. During the inspection we met and spoke with 11 people who lived at the home, five relatives, six care staff members, the manager, and area manager. We also had contact with the Quality Monitoring Team of Social Services.

We looked at all areas of the building, including people’s bedrooms, bathrooms, the lounge areas and the dining areas. Some people had complex ways of communicating and several had limited verbal communication. We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed the records of the home, which included, medicine records and quality assurance audits. We looked at five care plans and the risk assessments included within these, along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at the home. This is when we followed the care and support a person’s receives and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

Updated 22 June 2016

This unannounced inspection took place on 19, 20 and 28 April 2016.

Highbeech Care Home is situated in Bexhill on Sea and is registered to provide care and accommodation for up to 27 people living with dementia. All accommodation is offered on a single room basis. The home has a variety of communal areas for people to use. There is a passenger lift for ease of access between floors. There were nineteen people living at the home on the days of inspection.

There was no registered manager in place. The registered manager resigned in November 2015. A manager has been in post since January 2016 and we were told that she would apply to be the registered manager in the near future. 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.

Care plans did not all reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as diabetes and epilepsy did not have sufficient guidance in place for staff to deliver safe care. Not everyone had risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage. This had resulted in potential risks to their safety and well-being. Staffing deployment and inexperienced staff had impacted on people receiving the support required to ensure their health and welfare needs were met. Accidents and incidents were not always recorded and explored fully to determine if care practices were safe and if further action should be taken to prevent further incidents. Unexplained bruising had not been followed up to determine possible cause and had not been reported to the Local Authority for investigation under safeguarding.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Where people’s health needs had changed, such as not eating and drinking, care plans did not reflect the changes and therefore staff were uninformed of important changes to care delivery.

Information was not always readily available on people’s life history and there was no evidence that people were involved in their care plan. The lack of meaningful activities for people, specifically those who remained on bed rest or lived with dementia, at this time impacted negatively on people’s well-being.

The dining experience was not a social and enjoyable experience for people. People were not always supported to eat and drink in a dignified manner.

Quality assurance systems were in place, however there were areas that had lapsed and had not identified some of the shortfalls found at this inspection. We also found that systems were not in place to ensure that shortfalls identified through audits had been actioned by staff. For example we were told that a care plan had been identified as not in place, and the management team had allocated it to a member of staff and assumed it had since been done. Unfortunately it had not been done.

Arrangements for the supervision and appraisal of staff were now in place. It was acknowledged there were gaps in supervision for staff due to the changeover of managers. Staff told us that meetings now took place and they felt that things would now improve.

People we spoke with were complimentary about the caring nature of some of the staff. People told us care staff were kind and compassionate. However we also saw examples where staff were not treating people with respect when delivering care. We also saw that some people were supported with little verbal interaction and some people spent time isolated in their room.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches 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 this report.