Highview Lodge

Highview Lodge is a residential care home providing personal and nursing care to 53 people at the time of the inspection. The service can support up to 77 people in 1 purpose built building.

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

At the last inspection we found the provider did not have robust governance systems to monitor the service and address shortfalls in the home. There had not been enough improvement made at this inspection and the provider remained in breach of regulation. Well led had been rated requires improvement at the last 3 inspections.

At this inspection we found there had not been enough improvement and it had remained in a negative rating. Ineffectiveness of governance systems was a concern at the last inspection and the provider submitted an action plan stating how they would make the required improvements. This had not happened. The registered manager had left since the last inspection. There had been an additional 3 managers, including the manager at the time of this inspection who had only been in post 3 weeks prior to the inspection. Feedback from people, relatives, most staff and professionals was that the management had been inconsistent and communication needed to be improved but the provider had not yet made any positive changes.

At our last inspection we found that people’s safety was not always promoted. There had not been enough improvement at this inspection, and we found shortfalls in relation to medicines management, individual risks such as pressure care, falls and pressure care.

People were not always supported by sufficient numbers of staff. We found people had care missed or delayed as staff were often busy. This also impacted on mealtimes as there was not enough time elapsing between meals.

People and relatives told us that staff were kind. We saw staff were kind and caring. However, due to demands on their time, tasks were at times missed. Staff worked hard to try and minimise the impact of this. Staff felt they had enough training, which was up to date in most cases.

Care plans were in place but at times this included inconsistent information which made it unclear about how people needed their needs met. Due to staffing issues, care was not always personalised, for example, the time people went to bed, the gender of staff supporting them and how they spent their day.

Some people and relatives told us they would like there to be more to do to help prevent social isolation. There were some activities in place but these did not reach everyone as some people were cared for in their rooms and some were eating at the time.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 The last rating for this service was requires improvement (published 14 October 2022).

Why we inspected

The inspection was prompted in part due to concerns received about management, poor care and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment, person centred care, staffing and governance. You can see what action we have asked the provider to take at the end of this full report.

We have made a recommendation about the improving communication aids.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

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.

Highview Lodge is a residential care home providing personal to up to 77 people. The service provides support to older people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 63 people using the service.

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

People’s safety was not always well managed. We saw there some examples where moving and handling needed to be reviewed and better management of dietary requirements were needed. People who had modified diets did not always have food provided in the correct way and records did not always reflect actual needs.

Medicines were not always managed safely. We found that not all records and quantities tallied and recording systems, such as daily reconciliation and stock quantities carried over from previous cycles, were used consistently. Protocols for medicines on an as needed basis were not in place for all medicines or did not always include enough information.

Most people had their care needs met. We noted three people who needed their full care needs to be attended to. We also found where care needed to be more person centred and delivered in a way that promoted people’s dignity.

People and staff said there was generally enough staff to meet people’s needs. Two people told us at times there were delays for care needs to be met. Agency staff were supporting the home, many having worked at the home often. However better management of new agency staff starting, particularly around their induction to the home, was needed to ensure this did not impact on people.

Infection control practices were in place and staff knew what they needed to do. Some carpets needed to be replaced as they were worn and had malodours.

The management systems in the home were in place, however had not been effective to address the shortfalls. However, people, relatives and staff were positive about the management and leadership in the home.

Lessons learned were recorded and actions implemented. The management team told us that there had been several areas to work on, but they were committed to making the improvements. We found that they had made improvements in the areas raised at previous inspections.

Following our feedback immediate action was taken to address all points raised. These actions, and supporting records provided, gave us reassurance that risks were mitigated.

We found the management team to be open and responsive to feedback. A visiting healthcare professional told us that the management team and staff worked well with them.

People told us that their needs were met, and staff were nice. They told us they felt safe. Relatives were confident about the standard of care and told us staff were friendly. Relatives felt the management team and staff were approachable and knew people well.

People had access to food, drink and call bells throughout our inspection. We saw that staff were friendly in their approach with people. There was a programme of refurbishment ongoing.

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.

Rating at last inspection

The last rating for this service was good (published 12 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, standards of care, infection control and staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

The registered manager and their team took immediate action to address the shortfalls found which helped mitigate risks to people. This included, audits, training, implementing additional checks and surveys.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and governance systems at this inspection.

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

We recommend the provider develops a management plan to ensure that shifts are sufficiently covered during agency staff induction periods and break times.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Highview Lodge is a residential ‘care home’ registered to provide accommodation and personal care to up to 77 people. At the time of this inspection, 68 people were living at the service, some of whom were living with dementia.

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

People told us they felt safe. There were robust safeguarding systems in place to help protect people from the risk of harm or abuse. Recent safeguarding concerns raised had been investigated, and closed, by the local authority. Risks to people’s health, safety and wellbeing had been identified, assessed and reviewed regularly. Incidents and accidents at the service were analysed and action taken in response to the findings.

Staff were recruited safely to the service with all relevant pre-employment checks completed. Staffing levels were seen to be consistent and matched the dependency assessment completed by the registered manager. However, there were mixed views amongst the staff team relating to the staffing levels at the service.

Medicines were managed safely and there were comprehensive infection prevention and control procedures in place, which included the safe facilitation of visits for relatives and friends.

Concerns received by CQC regarding the management of the service had been investigated by the provider, under the direction of the local authority. All enquiries had been completed at the time of our inspection; but the outcome had not been determined. However, the regional director verbally confirmed they had no concerns.

Staff had a clear understanding of their roles and responsibilities, but shared concerns regarding a lack of cohesion amongst the staff team, and issues within the leadership team. We observed an absence of any interaction or communication between the management team. Feedback from relatives also indicated that there were issues within the leadership team. A number of relatives told us that they did not feel listened to, did not receive a positive response to their views or opinions and when they raised concerns with the management team, they were responded to in a way they considered inappropriate.

The registered manager told us they remained committed to delivering a high-quality service but acknowledged the negative impact that the COVID-19 pandemic had had upon people, staff and themselves. Support had been arranged for the registered manager and staff team by the provider organisation and had been made available for people by local system partners. With an absence of an outcome to the provider enquiries, no formal action plan was in place. Actions we were told were being taken to address the concerns raised had not yet had a positive impact or led to changes at the service.

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 good (published 06 May 2020).

Why we inspected

We received concerns in relation to staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highview Lodge 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.

Highview Lodge is a residential care home providing accommodation and personal care to 73 people aged 65 and over at the time of the inspection. The service can support up to 77 people.

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

People, staff and relatives spoke positively about the registered manager and the provider. There was a positive culture throughout the service which focused on providing care that was personalised. However, the regular checks and audits completed by the registered manager did not identify the shortfalls we found during this inspection. The provider also completed audits at the service, however the resulting action plan lacked specific details and the timescales set for actions were unachievable. A variety of methods were used to assess and monitor the quality of the service but the results of these were not consistently shared with staff. This combination of issues meant that service monitoring, and subsequent improvement planning, was not fully effective.

Systems were in place to keep people safe and the risks associated with people's safety, health and wellbeing had been assessed. Staff were aware of their responsibilities to report any concerns and knew the systems in place to do this, both internal and external to the service. There were enough staff to meet people's needs and recruitment procedures were robust. Medicines were managed safely.

People had their needs assessed prior to moving into the service to ensure their needs could be met. Care plans were then further developed as staff became familiar with people’s needs, choices and preferences, however the recent transfer of care plans to an electronic system meant that some detail had not been not included.

Staff received training and supervision for them to perform their role. People's nutrition and health were supported and promoted, although observations of mealtimes on the first day of the inspection were not positive. The service worked with health and social care professionals to ensure people received timely care and that their health needs were met.

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. However, we found that some capacity assessments had not been completed and DoLS application had not been made in all cases where they were required. The registered manager was aware of the need to review consent arrangements and was completing this at the time of the inspection.

People were treated in a kind and caring and both they, and their relatives, spoke positively about the staff. Staff knew people well and supported them to make decisions and choices and express their views. Staff respected people privacy and dignity and encouraged people to remain independent.

People received personalised care and were treated as individuals. People benefited from a variety of activities and social engagement with staff. Relatives expressed confidence in the service and found it to be a friendly, welcoming environment.

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 good (published 28 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Highview Lodge provides accommodation and nursing care for up to 77 people, some of whom live with dementia. At the time of our inspection there were 74 people living in the home.

The service had a registered manager in post. 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 were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by staff who were exceptionally caring and respectful, and who knew them well. People enjoyed living in a person centred home which catered for their requirements.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits, such as GP appointments, optician appointments, chiropodists and hospital visits.

There was a formal process for handling complaints and concerns. The registered manager encouraged feedback from people and acted on the comments received to continually improve the quality of the service. There were effective quality monitoring processes in place to ensure that the home was meeting the required standards of care.

We saw that the people who lived in the home were well cared for, staffing levels had been increased to meet the people's identified needs. Staff had undergone training and were now meeting the peoples' needs in a person centred manner.

The people looked well groomed and well cared for and those we spoke with confirmed this. Visitors told us that they were happy with their relative's care.

The staff told us that they now have time to care for the people and engage with them in order to stimulate them and to improve their wellbeing.

We had mixed comments from the people who live at Highview Lodge, some told us that the liked living there and others said that they wanted to go home. We were told that the staff were nice but that they were very busy. One person said that it was a 'dammed awful place' and that they wanted to go home.

We found that staff worked in a task led manner and had unreasonable workloads which meant that they did not have time to offer person centred care to the people.

We found that staff had to complete a high number of domestic tasks, which left little time to meet the needs of the people beyond their basic care. We saw that people were left unattended for long periods of time. We saw that people's dignity and independence was not promoted.

We heard staff discuss people's needs in a public area where they could be overheard. If the staff had withdrawn from the area to discuss the person concerned, in private, the rest of the people would have been left unattended.

The records we reviewed showed that the staff had received training in all mandatory area of care delivery and that all the staff had been trained in the care of people who have a dementia.

The staff we spoke with consistently told us that they would like to be able to deliver person centred care but they didn't have the time. They told us that they like to take their breaks while chatting to the people as this was usually the only opportunity they got to chat to the people.

Visiting health professionals told us that the care of the people had improved in the past year and that they worked well with the staff.