Archived: London Care Highdown Court

London Care Highdown Court is an extra care housing service, covering two schemes in Worthing.

‘Highdown Court’ offers 54 one and two-bedroom apartments for rent and shared ownership purchase and is run by Saxon Weald. ‘Elizabeth House’ offers 34 ‘studio’ style flats and is run by Worthing Homes. The Elizabeth House scheme was acquired by the provider in September 2020. At the time of the inspection, London Care Highdown Court was providing personal care to 41 people at Highdown Court and 11 people at Elizabeth House.

The accommodation is rented or owned and is the occupant's own home. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People spoke positively about their care and support, and spoke highly of the staff team. One person said, “It has been brilliant here." Another told us, “They are really generous with their care and love.”

Staff had received cards of thanks expressing gratitude for their care and support, especially during the challenging circumstances of the COVID-19 pandemic. One read, ‘Thank you for the extra care and attention given to us during this horrible year.’ A second, ‘Thank you for having such a kind heart and going the extra mile for us’.

Since our last inspection a registered manager had been appointed. Everyone spoke of improvement in the care and management of the service. People were encouraged in their involvement and development of the service. There were systems in place to oversee and improve the quality of the services provided. The management worked closely with other professionals, including the housing scheme managers, local authority commissioners and specialist healthcare professionals.

Additional staff had been recruited and people had confidence their care calls would be fulfilled, and their needs met. People felt safe. Risks related to their care had been assessed and staff knew how to support them safely. People were supported with their medicines in line with their needs. Staff had received additional training in how to manage the risk of infection caused by COVID-19.

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.

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 requires improvement (published 12 January 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 22 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and governance at the service.

We undertook this focused inspection following a monitoring call with the service in July 2021. The evidence and feedback gathered during this process indicated the service had improved. We inspected to check they had followed their action plan, to confirm they now met legal requirements and to review the rating for the service. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Care Highdown Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

London Care Highdown Court is a domiciliary care service providing personal care to 41 older people at the time of the inspection. People using the service lived in a block of 55 flats within one building in Worthing.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

There had not always been enough staff to meet people’s needs. This had resulted in some late and missed care visits. When this had occurred, the risk of people not receiving the support they needed had not always be considered and mitigated. The provider had since arranged for more staff to be at the service than were required to complete planned care visits. There was a reliance on the use of agency staff whilst recruitment for more regular staff was ongoing.

Staffing levels and management changes had impacted on staff morale. The regional manager had recently been spending more time at the service and people and staff told us this was having a positive impact. Recruitment was taking place for a permanent manager.

There was not consistent and robust management oversight of accidents, incidents and the impact of late or missed care visits. Quality assurance process were not always robust.

People were supported to access health care support as required and professionals told us that staff worked with them to support people. However, the changes in staffing and management had sometimes impacted on partnership working.

People’s privacy was respected. People were treated with dignity and their independence respected and supported. People’s views on their day to day care and support were sought. When improvements were needed to improve people’s experiences these were not always identified.

Care plans included detail about people’s life histories and how they preferred their support. Staffing shortages and changes had impacted on how responsive staff could be to people and how well they knew the people they were supporting.

People told us they felt safe and staff understood how to report any concerns about people’s safety and welfare. People received support with medicines and food and drink as required. Infection prevention and control was well managed.

People’s needs and choices had been considered and assessed. 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.

Regular staff had been supported with training, supervision and appraisals.

People knew how to make complaints. Complaints made had been responded to in line with the provider’s policy.

People were supported in accordance with their wishes at the end of their lives.

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 Requires Improvement (published 14 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and people having late or missed care visits. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of Regulations in relation to staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

London Care Highdown Court provides care and support to people living in specialist ‘extra care’ housing. They provide support to people living with dementia, people with learning disabilities or autistic spectrum disorders, people living with mental health conditions, older people, people living with physical disability and people with sensory impairments. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

People using the service lived in 52 one or two bedroomed purpose-built flats in Highdown Court.

Not everyone using London Care Highdown Court receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 40 people were receiving the regulated activity of ‘personal care’.

There was a registered manager in post at the time of the 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.

There had not always been sufficient managerial oversight of the care visit system. People had a variable experience ascare visits had not always been planned and allocated correctly. This meant that some people had sometimes had visits later than they expected or their visits were shorter than expected. People told us that sometimes this meant tasks would not all be completed. Staff told us that they had to rush to fit in additional visits to people. The registered manager was recruiting new staff to meet people’s visit times and length.

People had not always been treated with dignity by all staff. One person’s dignity had been compromised by a member of staff. This was raised with registered manager who took appropriate action immediately. However, other people told us staff treated them with dignity and respect. On person said, “We’re treated with a great deal of respect.”

Assessments took place before people moved into London Care Highdown Court and people’s needs, including risks, were considered and planned for. Staff knew people well, including their life histories.

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 told us they were treated with kindness and compassion and their privacy and independence were respected.

People told us they felt safe. Systems and processes were in place to learn from things that went wrong and prevent reoccurrence. People’s views were surveyed annually and the registered manager identified actions in response to any improvements required. People told us they could discuss any concerns with the registered manager and complaints were listened and responded to.

People told us they enjoyed activities on offer in the communal lounge and photographs around the building showed some parties which had been enjoyed by people and staff.

Staff worked with healthcare professionals and other relevant people and professionals to ensure people received the right support. People received the right support with their medicines and risks around infection control were well managed. People who needed it received support with eating and drinking and preparing meals.

There were safe recruitment procedures, training, staff meetings and supervision to help support the staff team. The provider had systems to motivate staff, such as the care worker of the year award.