Archived: Highbeech Care Home

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.

We carried out this inspection to look at the care and treatment that people who used the service received.

This inspection was carried out by one person.

As part of our inspection we spoke with the people who used the service, manager, visitors and care staff available during the inspection. We also looked at four care plans and other documentation within the home.

Not everyone living in Highbeech Care Home were able to tell us about their experiences of living there. We were able to meet all the people who used the service. We spoke with three people, who told us 'I am happy to help with drinks.' We also spoke with visitors who told us, 'I am really impressed with this home, they keep me informed and all the staff are so kind.'

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and investigations. Some staff had received training on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The home had appropriately made a referral to DoLS in the past. This meant that people would be safeguarded as required.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff were supported by the management team to deliver care and treatment safely and to an appropriate standard. The training programme and duty rota showed us that there were sufficient trained staff on duty to meet the needs of the people they care for. All staff had received regular supervision and appraisals.

Is the service effective?

We found during our inspection that the service was effective. Staff we spoke with were able to tell us about people who lived in the home, and their individual needs. People were supported to maintain independence when possible. We saw that the interaction between staff and the people who used the service was supportive and kind. People were encouraged to enjoy the garden and were able to walk wherever they wanted to.

Is the service caring?

We found during our inspection that the service was caring. We saw staff interacting in a positive manner, speaking to people in a calm respectful manner at all times. We saw that people were encouraged to participate in activities and responded to warmly and with affection by staff throughout the day.

Is the service responsive?

We found during our inspection that the service to be responsive. We saw evidence that when people's needs had increased, the manager had made appropriate referrals to outside agencies. This included advice from the district nurse, dietician and mental health team.

Is the service well-led?

People who used the service and their relatives were encouraged to make their views known and raise any concerns if they arose. People who lived at Highbeech told us that staff were kind and the food was good. One visitor told us, 'So pleased with the home, I trust them totally to look after X.'

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Staff we spoke with told us they felt supported and listened to. Some also told us that they had received appropriate training.

There were 24 people living at Highbeech Care Home at the time of this inspection visit. We used a number of different methods to help us understand the experiences of people using the service, because some people who used the service had complex needs which meant they were not able to tell us their experiences.

People spoken with told us that they were well looked after and were able to do as they wished. One person said, 'The staff are very good they help you as needed. I can do as I want."

We found that before people received any care or treatment they were asked for their consent and agreement and the staff acted in accordance with their wishes.

Care plans were personalised and contained clear instructions on how people should be cared for and supported.

We looked at the systems and processes in place for the safe management of medicines. We found that some record keeping and practice within the home had not always ensured the safe administration of medicines.

Staff told us that they had training and development opportunities and they were well supported by the provider. We saw evidence of training undertaken and planned training.

The practice had procedures in place to review the quality of the service provided. These processes had ensured information provided was used to improve the service.

We looked at systems in place in relation to cleanliness and infection control. These were found to be effective with the standard of cleanliness being at a high level.

We reviewed the recruitment practice and found the practice followed was thorough.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.