Archived: Highfield House

We undertook a further inspection on 8 and 9 August 2016 to check that they had acted on the requirement of the warning notice and to confirm that they now met legal requirements. We had also received information of concern from other professionals who had visited the home and so spent time looking at other areas of care and service provision. We again visited the home on 20 September to further review actions taken by the provider. We also wrote to the provider seeking clarification on actions taken and documentation related to the running of the home.

This report only covers our findings in relation to 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'

Highfield House is a nursing home located in Bedlington, Northumberland. It is registered to provide accommodation with personal care for up to a maximum of 27 people. At the time of the inspection there were 16 people living at the home.

A registered manager was not in post at the home at the time of the inspection. 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. An acting manager was in charge of the home during the inspection and he supported us on both days. We were also supported by the provider on the second day of the inspection.

At the previous inspection we noted that no fire drill had been undertaken at the home in recent months. At the inspection on the 8 and 9 August 2016 we could find no formal record that a drill had been completed, although the acting manager and staff said there had been a drill, but it had not been recorded. At our visit on 20 September 2016 we saw a drill had been undertaken, but had not occurred until 15 September 2016. We also found that risk assessments for individuals related to fire safety had not been updated in line with the set review date.

At the inspection in April 2016 we found that accidents and incidents at the home were not being regularly reviewed, to identify any patterns or concerns. At this inspection we found that, whilst accident records were being completed there continued to be no review of the events to help improve safety at the home.

We had also previously found issues with the safe management of medicines at the home. In particular we found records to ensure safe recognition of people when giving medicines were not well maintained, care plans for “as required” medicines were not appropriate and temperatures in the room where medicines were stored was not regularly monitored. At this inspection we found new identification sheets had been developed and revised “as required” medicine care plans had been rewritten. Whilst room temperatures were being monitored we noted that the temperature in the clinic area was regularly above recommended levels and only limited action had been taken to address this. At the inspection on 20 September action had been taken to address the temperature issues in the clinical room.

Safety certificates to show that equipment used at the home was well maintained and safe to use had not been previously available. At this inspection these certificates were in place and available to view. At the previous inspection we had highlighted concerns about the cleanliness of certain areas of the home, including the laundry area. At this inspection we saw significant improvements had been made to the laundry area and the sluice areas. The home had been working with the local infection control service to improve overall cleanliness. However, on our return on 20 September 2016 we found that three of the four laundry machines were broken and washing had been hung in empty rooms to dry and air.

A number of new nursing staff had been employed at the home. However, it was not always possible to determine from records whether appropriate Disclosure and Barring Service checks had been undertaken.

We had raised concerns at the previous inspection in April 2016 that consent was not always sought in line with the provision of the Mental Capacity Act (2005). At this inspection we found there were still inconsistencies about how consent was gathered or how decisions about people care were made when they were unable to give consent.

The acting manager had reviewed staff training needs and was developing a training strategy. Staff had been formally signed up with the local learning development unit to access training. People continued to be supported to access health services and sufficient food and fluids were available.

People told us that they continued to feel supported and care for by the staff at the home and we witnessed good relationships and interactions. We highlighted with the acting manager some practices that could be improved to support people’s privacy and dignity.

At the previous inspection we found that care plans were in the format of the previous provider. We were told these were in the process of being reviewed. At this inspection we found there had been limited reviews of people’s care and the majority of plans had not been updated, although monthly reviews of care records were being undertaken. Where plans were updated they did not always reflect people’s full needs. The provider had dealt with a number of complaints and concerns since the last inspection and where necessary made alerted the local safeguarding adults team.

At the inspection in April 2016 we had found that there were no consistent checks and audits being undertaken at the home to ensure that the care and the environment were safe. At this inspection we found there remained very limited audits in place, although the acting manager told us he regularly walked around the home to carry out visual checks. The provider told us they had not been overseeing the home as closely as they would have liked, but had plans to improve their monitoring visits in the coming months. We had also previously found that records were not effectively maintained or stored securely. At this inspection we noted this had improved and older records had been archived appropriately.

We found five breaches of regulations. These related to person centred care, need for consent, safe care and treatment, good governance and fit and proper persons employed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Highfield House is a nursing home located in Bedlington, Northumberland. It is registered to provide accommodation with personal and nursing care for up to a maximum of 27 people. At the time of the inspection there were 19 people living at the home.

There was a registered manager at the home on the first day of the inspection, but she had tendered her resignation and was leaving the home that week. 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.

Staff had an understanding of safeguarding issues and potential abusive situations. They were able to describe the action they would take if they had any concerns. A potential safeguarding matter had been recently brought to the provider’s attention whilst we were inspecting the service. The provider took the correct action and informed all the key authorities. Staff were also aware of the whistleblowing policy and told us they would immediately raise any concerns they had about care.

We noted that there were some odours in certain areas of the home. There were also some cleanliness issues related to waste bins and pull cords being grubby. We were concerned that laundry areas posed both a potential infection control risk and a fire risk, through the storage of linen in the same environment. Toilets, bathroom and sluice areas were clean and tidy.

Safety certificates for lifting equipment, gas appliances and the home's fixed electrical systems were not immediately available. The provider subsequently sent us information to confirm that such checks had been undertaken. Checks on fire safety equipment had been carried out. There had been no fire drill since the provider had taken over the service. The home had a maintenance man to deal with day to day repairs.

People’s and staff’s views of staffing levels were mixed, with some telling us there were enough staff and others suggesting it would be helpful to have more. The registered manager gave us different information about staffing to that which we had been told by the provider. The provider told us that in the future there would be five staff on a morning shift and four in an afternoon. The provider had not appointed any new staff. Staff appointed by the previous provider had been subject to appropriate recruitment procedures.

We found some issues related to the safe management and administration of medicines. Some people’s medicine records did not have information to assist in their identification. People on “as required” medicines did not always have appropriate care plans. Temperatures in the clinical room, where medicines were stored, were not monitored to ensure that medicines were kept in appropriate conditions.

People felt staff had the right skills to support them. Staff confirmed they had access to a range of training, although we could not find an up to date central record to ensure training was regularly monitored. Staff also told us regular supervision took place and they received annual appraisals and records confirmed this.

People told us they were happy with the meals provided at the home and could request alternatives. We spent time observing mealtimes at the home and saw a variety of options were available. Kitchen staff had a good understanding of people’s dietary needs. A sufficient supply of food stuffs were available. People’s weight and dietary intake were regularly monitored and reviewed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the need to ensure people made decisions about their care or the need to consider best interests. Some older care plans did not always explicitly reflect current legislation over best interests decisions. The registered manager confirmed applications had been made to the local authority to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA.

People we spoke with told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care and demonstrated supporting people with dignity and respect throughout the inspection.

Care plans were person centred, mirrored people’s individual needs and were reviewed to reflect changes in people’s care. Care plans also took note of advice from visiting professionals. Some activities were offered for people to participate in, but people also had the opportunity to spend time on their own or in their rooms pursuing their own interests.

People said they would speak to the manager if they wished to raise a complaint but had not made any formal complaints recently. There had been no formal complaints since the provider took over responsibility for the home. Information about how to make a complaint was not on display.

There had been a clear and significant breakdown in communication and trust between the provider and the manager. This had led to poor management and governance of the home. We received a variation in responses to our questions about the home from both parties.

We could find no information or records to show that audits and checks had taken place regularly at the home. There were no available audits on care record, medicines or cleanliness. The provider had not implemented robust systems to oversee that the effective management and monitoring of the home was taking place.

Staff told us there had been a very unsettling period at the home with the change of provider and the manager leaving. They told us that staff morale was low at the current time. The provider had arranged a staff meeting to address some of the issues and reassure staff. A prospective new manager was in the process of obtaining DBS clearance and making application to the CQC.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Safe care and treatment and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.