Highgrove Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Processes had not always been used effectively to identify and assess potential risks to people however, staff knew people well and knew how to provide them with the support they needed. The environment was not always safe and governance checks had not always identified shortfalls. People were protected from the risk of abuse. There were enough staff to support people. Staff had the training and knowledge they needed to support people. When things went wrong action was taken to reduce the risk of events re-occurring. People and their relatives were happy with the support provided.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us staff were approachable and they felt comfortable raising concerns. One person told us, “I feel comfortable to tell them if I wasn’t happy 100%, they listen and do what they can to help me.”

Staff told us a lessons learned process was in place when things went wrong to reduce the likelihood of a recurrence. One staff member said, “When anything goes wrong, we record the occurrence, the registered managers look into it, and make necessary updates to protocols, implement remedial measures, and offer more training to improve safety.”

Healthcare professionals told us people’s needs were assessed before people moved into the home to ensure staff could meet their needs. One healthcare professional said, “[Registered manager] has always asked for information and details when arranging any assessment, questioning any areas that are required prior to agreeing to assess, to ensure that the staff are able to meet the needs of the person. Another healthcare professional said, “[Registered Manager] and, [Operations Manager] are fully involved with admissions into the home and have a definitive say regarding the suitability of people before they are accepted into the care home.”

People and their relatives told us staff had completed assessments of people’s needs before they moved into the home.

The registered manager told us, “People’s needs are assessed before they move into the home so we can make sure we are able to meet their needs and also make sure we have all the right equipment we need before they move in. We have put together forms to help us get more information from the person and their families. It’s an ongoing process and all the information is added to their care plans.”

Healthcare professionals told us people’s needs were assessed before people moved into the home to ensure staff could meet their needs. One healthcare professional said, “[Registered manager] has always asked for information and details when arranging any assessment, questioning any areas that are required prior to agreeing to assess, to ensure that the staff are able to meet the needs of the person. Another healthcare professional said, “[Registered Manager] and, [Operations Manager] are fully involved with admissions into the home and have a definitive say regarding the suitability of people before they are accepted into the care home.”

We reviewed assessments that demonstrated people’s needs had been assessed before they moved into the home. Following admission, further assessments had been completed to gain a better understanding of the person including a life history. All this information formed the basis of person centred care plans.

People and their relatives told us they felt safe living at Highgrove. One person said, “I feel completely safe, the staff are extremely good.”

Staff knew how to recognise signs of abuse and where to report their concerns, both internally and externally. One staff member said, “If I saw abuse I would speak to the registered manager, but if they didn’t take any action, I would report to the safeguarding team or CQC.”

We observed staff speaking kindly and respectfully with people. People appeared to be comfortable living at the home, and in the company of staff supporting them. The atmosphere was calm, and people were relaxed.

Safeguarding referrals for reportable incidents had not always been received by the safeguarding team. We found 1 incident of an unwitnessed fall with a head wound had not been reported to the local authority. The registered manager told us they had made a safeguarding referral however, this had not been received by the local authority, and governance systems had failed to identify this. Staff had received safeguarding training, and this was regularly updated to ensure staff understood and followed best practice guidance.

People and their relatives told us they were involved in discussions to manage risk. One relative told us, “[Relative] is not able to sit up in a normal chair as they are at risk of falling out. Staff came and spoke to me and arranged a special chair. Now [relative] can get out of bed and can easily be taken out of their room for activities.” A healthcare professional told us, “The management staff understand and mitigate the risks to people’s health, safety and welfare and this is something that we have offered support with. I have seen evidence of what appears to be the appropriate use of falls and movement alarms, use of mobility aids and stair lifts as well as applications for DoLS. I am aware that management have arranged for extra training for staff to help care for their patients when this has been identified.”

Staff knew how to identify and reduce the risk of harm to people living in the home. Staff told us they reviewed people’s needs monthly during care plan reviews or as soon as a change happened. One staff member said, “People can be at risk of falls, we prevent it by putting a sensor mat in their rooms.” Another staff member told us, “Regular training ensures that staff know when to escalate concerns and how to take appropriate action to keep residents safe. Staff at Highgrove are trained to identify risks to residents' health, safety, and wellbeing through regular monitoring, risk assessments, and observation of changes in behaviour or condition. We follow established protocols and guidelines to address these risks, including immediate interventions and long-term strategies.”

We observed staff supporting people to stay safe by giving their time to provide assurances when people needed them.

People had been assessed for risks to their health, safety and welfare however, risk assessments had not always been transferred to the new electronic care planning system which staff accessed. A recent audit of care plans had not identified this. One staff member told us, “The medical history, individual preferences, and special needs covered in the care plans at Highgrove are generally sufficient for safe and effective care. This information aids staff in providing residents with individualised care; however, there are times when care plan updates could be more frequent. Having current information would further improve staff's capacity to react to changes in residents' conditions.”

We found people had been placed at risk of their environment as regular health safety checks including safe water checks had not always been completed effectively, however people and their relatives told us they felt the environment was safe and they had no concerns.

By our second site visit regular health and safety checks were being completed. The registered manager was open and honest and said, “After your visit, we went round to check the water temperatures and found it changed at different times of the day, this has resulted in a couple of the valves being changed. We have new paperwork now in place to support a weekly temperature check process and have made it clear the water needs to run for 2 minutes to ensure the water is flushing and the temperatures are correct.”

On our first day of inspection, we observed some furniture was visibly unclean, and others worn, meaning the surface had become permeable. This placed people at risk from the spread of infection. Window restrictors were in place but were unattached. Cupboards in the hallway that accessed a hot water tank were found unlocked and accessible to people who may not have capacity to understand associated risks. This had placed people at risk of harm. The operations manager and registered manager were responsive and improvements had been made by the second day of our inspection.

The environment was not always safe. Health and safety checks had not always been effective to prevent the risk of Legionella. Water temperature checks had been completed however, when temperatures were found to be too cold, no actions had been taken. This had placed people at risk of harm. We discussed this was the registered manager and operations manager and by our second site visit day checks had been completed and actions had been taken to ensure water safety. A new system was introduced to mitigate a reoccurrence. A Legionella risk assessment was not in place at the time of our first site visit day. This meant the provider could not be assured all risks associated with their premises in respect of Legionella had been identified and that they were managing these risks. The provider responded immediately, and we were provided with a completed Legionella risk assessment by the next day. A process was in place to checks call bells were in good working order however, when actions had been identified it was not clear these had been completed. This meant we could not be assured call bells were always working. We raised our concerns with the registered manager. By the end of our second site visit day, new paperwork had been put in place to improve the shortfalls we had identified. We were unable to assess the effectiveness and sustainability of these processes at this inspection. Other health and safety checks such as fire safety checks and lifting equipment checks had been completed regularly. Other health and safety checks such as fire safety checks and lifting equipment checks had been completed regularly.

There were enough suitably skilled and trained staff to meet the care needs of people living in the home. People and their relatives told us staff were kind, caring and always available to support them when they needed it. One person said, “When I use the call bell they come quickly, they do anything I ask them to.”

Staff told us there was enough staff to meet the needs of people currently living at Highgrove. One staff member said, “There are enough staff, everyone is performing their duties correctly.”

Staff did not appear rushed, they had time to spend with people. We saw staff supporting people in a caring and person-centred way.

Staff had not completed learning disability and autism training. From 1 July 2022, all health and social care providers registered with CQC must ensure that their staff receive training in how to interact appropriately with people who have a learning disability and autistic people, at a level appropriate to their role. This new legal requirement was introduced by the Health and Care Act 2022. This had not been identified through governance checks. Staff were provided with face to face training which was updated regularly in accordance with best practice guidance. Bespoke training was provided when requested to ensure people’s care needs could be met. The trainer told us, “We provide bespoke training based on what the home needs. They did have a person living here with bipolar, the registered managers contacted us, and we came to the home to provide bespoke Bipolar training. Staff are friendly and approachable, team work adhesively. They put training into practice from what I have seen and to a high standard.” Safe recruitment practices were in place. Staff were required to complete Disclosure and Barring Service (DBS) and reference checks prior to commencing employment in the service. DBS checks are important because they alert employers to individuals who are barred from working with people who receive a regulated activity. Staff were provided with regular supervisions and appraisals.

People and their relatives told us they felt the home was clean. One relative said, “Whenever I come here the home is always clean.”

We discussed our observations from the first day of our onsite inspection with the registered managers and the provider who told us this was not usual for the home. By the second day of our inspection changes had been implemented including new systems to ensure the home was checked and cleaned appropriately each day.

An unpleasant odour was present in a bedroom. We found several cobwebs with flies in the hallways and in people's rooms. There was a large build-up of limescale around the bath areas and the floors of the bathroom and shower rooms. This had placed people at risk from the spread of infection. We showed the provider, operations manager and registered manager and improvements had been made by the second day of our inspection. The provider told us plans were in place to replace the bathrooms.

Cleaning schedules were in place and completed daily by housekeeping staff to demonstrate which area’s had been cleaned however, these did not include the areas we had identified on our first day. By our second day site visit cleaning schedules had been updated to include the checking and removal of cobwebs, cleaning of limescale particularly in the areas it had built up previously and the checking and reporting of any furniture that had become permeable. Cleaning schedules were to be completed by housekeeping staff and signed off by a senior staff member to demonstrate clear oversight. We reviewed 3 people’s care plans and did not find assessments relating to the risk of infection, prevention and control. Assessing a person’s risk of catching or spreading an infection and providing them with information about infection is essential in supporting safety. Governance audits were in place however, had not been effective at identifying the shortfalls we found on our first site visit. For example, audits had repeatedly identified the same concerns relating to stained linen however, there was no evidence to demonstrate actions had been taken to improve.

Medicines were managed safely. People were supported by staff who knew them well. People were spoken to, and staff explained they had come to give them medicine and explained what it was for.

Staff told us they completed medicine training and had their competence assessed before they started administering medicines. One staff told us, “We are given a workbook that we need to complete every 6 months to a year, then [registered manager] observes us administering medicines and signs us off as competent.” “We don’t have any medicines errors to tell you about. If we did have a medicine error, we would tell the person and their family, speak to the GP, report it to the manager who would report it to the safeguarding team. We would have a supervision to talk about and discuss it as a team to share learning.”

Medicine administration records were clear and fully completed to show medicines had been administered safely and in accordance with the prescriber’s instructions including time specific medicines. There were safe processes for the ordering, storage and disposal of medicines. Staff responsible for medicines were trained and had their competency assessed. Medicines that required stricter controls by law were kept secure and accurate records maintained. Medicines audits were in place and actions identified including missing medicine administration records had been completed to ensure compliance.