Highview Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Mealtime experience continued to need further improvement. People’s needs were assessed prior to them moving into the service. There were regular reviews with outcomes monitored. People were mostly supported in line with the principles of the Mental Capacity Act. However, some practice relating to relative’s involvement needed to be reviewed. People were supported to live healthier lives for the most part. However, some staff communication style impacted this as people did not always understand the benefits of care offered. There was effective working together to help ensure people received the right care.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed before moving to the service and they felt the team were able to meet their needs. People and their relatives told us they had enough information and support. A relative told us, “Before they moved into the home, I was extensively questioned as to their capabilities, mental alertness, medical needs and preferences and if they had any interests or hobbies.”

Staff told us people’s needs were always reviewed and outcomes shared. A staff member said, “We have handovers.”

Care plans had a preadmission assessment included which helped develop the main body of the plan.

People and relatives gave mixed views about if they had enough to eat and drink, sufficient choice and support. A person said, “The food is fine.” A relative said, “I’m worried [person] doesn’t eat when I’m not here, they can’t cut it up or manage alone so they don’t eat.” We reviewed the person’s records and saw they were noted as eating and weight measurements remained stable. We did note they were recorded as having food they did not like. Their relative told us they had shared this with staff several times. Another relative told us, “[Person] needs new dentures. They should have the top set by now and work to provide the lower set should begin in September. This obviously makes eating difficult and they often complain about the food but what I’ve seen looks OK to me, but their complaints may be due to lack of dentures. This dental work seems to have taken a long time.” Another relative said, “I believe that [person] needs assistance whilst eating and I don’t believe this is being done.” A 3rd relative raised concerns about if their family member was eating when they were not there. Staff were working in accordance with planned care needs. However, the mealtime experience needed improving. Staff did not use the show plates of food to help people make a choice, except for only one unit. Staff shouted to people ‘chicken or fish’ with no explanation of what the meal was. Condiments were not on tables and a person sat very low in their wheelchair, so their plate was at eye level. There was missed opportunities for engagement and to make it a more social experience. The chef understood about different dietary needs and prepared modified foods before the trolley was sent to the units.

The management team told us mealtime experience audits had been in place prior to the visit and they provided us with these. They advised ongoing learning was in place.

Care plans included information about how to ensure people received the right care and treatment. Mealtime checks were carried out by a member of the management team. We found these found the same issues as we observed.

People, and most relatives, told us staff knew them well. However, some staff could not answer questions about people, including their names so this may increase the need for people to have to tell their story more than once. We noted some care staff took direction from senior care staff and did not know the information first hand.

Staff told us they worked with health and social care professionals to ensure people had the right care and support. This included mental health teams, district nurses and GPs.

Feedback from a visit shared with us from partner agencies found there had been an improvement in relation to capturing information about people’s care and support.

People’s care plans included a record of information obtained on their admission to the home. This was transferred into and fed the care plan.

People told us they could see a health or social care professional when needed. Most people were up from their beds. Some people in bed needed help to reposition. However, at times they declined the support which increased risk of skin damage. We saw staff ask people if they wanted to turn, but due to some communication barriers and lack of explanation, the approach did not help people understand what was being asked and why it was a benefit to them. We noted one of the people who declined positioning, according to their records, already had a pressure ulcer. This person stayed in the same position for all of our visit and most of the period of time we reviewed in records. People in communal areas were being encouraged to join in with activities to help encourage movement and socialisation.

Staff knew how to respond if there were changes in a person’s health.

Care plans included a record of information relating to health and social care support provided from professionals.

People’s care needs were reviewed regularly and in between if needs changed.

Staff were able to explain how they monitored people’s health and wellbeing. They were aware of what action to take if needed.

There were systems in place to have overview of people’s care needs, wounds and infections for example, and this included progress updates.

People told us they were able to make their own choices.

We had limited feedback from staff, those we had contact with were aware of the Mental Capacity Act (MCA). However, we had a discussion with 2 senior staff about how they supported a person who had capacity when the person’s choices were conflicting with their family member’s requests. We asked they considered using an advocate or exploring the issue further to ensure the person’s choices were respected. Staff approach needs to ensure the principles of the MCA are followed.

People’s care plans included capacity assessments which detailed how capacity for the decision was assessed. Also, best interest decisions where needed, and also if Deprivation of Liberty Safeguards (DoLS) were requested or in place. However, we noted in a person’s care notes their family member was asked for consent relating to the gender of staff supporting them. The person’s care plan states they have full capacity to make their own decisions. Processes need to ensure the principles of the MCA are adhered to.