Highfields Nursing 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

People and those important to them were supported to understand safeguarding and how to raise concerns when they didn’t feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. There were enough staff to support people with their needs, although we observed a poor lunchtime experience where people were placed at risk of having unmet needs. The management team were immediately responsive to our concerns, and ensured they reviewed the staffing allocation and timing of the lunch service to rectify this. Safety risks to people were managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service.

This service scored 75 (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 felt able to speak up if they had a concern. They also felt improvements would be made to their care if needed. One relative told us, “I would feel comfortable if I had to complain. I can come here any time to see my family member.” People and relatives told us that if an incident happened; the management and staff team included them in discussions, to reduce the risk of similar events happening again.

Staff told us that they had regular reflective supervision sessions to review what was working well, and what could be improved at the service. Staff gave examples of how the staff team had learnt from incidents. For example, the manager explained, “We reviewed the findings from a safeguarding outcome for one person. They live with complex needs and were at risk from the equipment we had in place initially due to their behaviours. We reviewed the equipment, and sourced an alternative, which enables us to manage their falls risk without the use of wires.”

There were clear processes to review incidents and then make improvements. Staff were provided with the opportunity to reflect after incidents, to ensure learning and improvement could occur. Staff meetings allowed staff to reflect on what was working well, and what could be improved at the service. There was a clear policy on the duty of candour. This policy guided the service to tell the person (or, where appropriate their advocate) when something has gone wrong. We reviewed complaints that had been made and saw this policy had been followed by the management team.

People and relatives told us that communication between the care home staff and other health providers was good quality. One relative told us, “When my family member was in hospital, the staff rang the hospital to let them know that they needed encouragement and support to eat.”

Staff had a good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. For example, where people were being supported by an external health care team for support with their cognitive needs due to a diagnosis of dementia.

Partners told us the service had been responsive and had implemented their recommendations when working with them. We saw the management team were working alongside health and social care agencies to ensure they sought timely input for people when required.

Staff kept clear summary documentation on people’s holistic needs in the form of a hospital admission pack. If the person required a hospital admission, this document could go with them. This meant hospital staff would have clear guidance on how the person preferred to be supported and relevant clinical information. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, where people required input from a dietician or speech and language therapist for support with their food and nutrition management.

People told us they felt safe from abuse. All of the people who were able to communicate with us during our visit said they felt safe. All relatives we spoke with felt their family members were very well looked after by kind, respectful and caring staff. People and relatives told us that there were no unlawful restrictions imposed upon them. They were free to complete their own routines and live their lives as they wished. Some people would be at risk if they did not have continuous supervision and control, where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. The manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

We saw people and staff had positive relationships. There was an open culture of communication, and we saw no evidence that people were at risk or fearful of the staff team. Our observations raised no concerns regarding safeguarding at Highfields Nursing Home.

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. People were kept safe when they visited the community. The service worked with relevant partner agencies to ensure risk assessments and appropriate plans were in place to support people who went on visits and trips to external venues.

People and relatives told us that they were able to communicate their needs, to receive the right type of support. People and their relatives told us that staff understood their needs well and offered support to keep them safe. One relative told us, “The staff know when my family member has a water infection by picking up quickly on their symptoms. If they ever need to go to hospital, they sort it out straightaway.”

The manager and deputy were experienced and knowledgeable, and staff appeared happy and relaxed in their presence. Any concerns were actioned quickly by the manager during the inspection. The manager displayed a passionate attitude to want to improve the service and was responsive where any shortfalls had been identified. People and staff all appeared at ease with the management team.

We saw people were supported safely. Some people living at Highfields could become distressed, we saw staff were quick to respond to people and offer support that reduced their anxiety. On one occasion we observed a person who was not responded to promptly by staff during the lunch period, placing this person and others at potential risk of having unmet needs. We raised this with the management team, who attended immediately to provide support for people. They then conducted a review with the staff team to ensure this did not occur again. We were assured by their responsive approach. This meant people were kept safe from harm, as this potential incident did not escalate. The management team showed they had learned lessons from this and shared this with the staff team for embedding improvements moving forwards.

People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical and social needs. Staff knew how to support people to manage risk. For example, where people lived with a risk of falls there were clear plans in place for staff to follow to ensure people were supported safely to reduce the risk in the least restrictive way to people. Where incidents had occurred, there were opportunities for the management team staff to review what had happened and ensure measures were put in place to prevent re-occurrence. There were clear processes in place for how to respond to an emergency. Staff had clear evacuation processes to follow, and these processes considered the unique needs of people. Each person had an individual Personal Emergency Evacuation Procedure (PEEP) in place which was specific to their identified needs and regularly reviewed. Staff had relevant received training on how to support people’s individual needs. Some people at the service could become distressed due to their dementia diagnosis. Staff had received training on how to support people when they became anxious or distressed. People’s communication needs were clearly recorded. This allowed staff to understand people’s needs and wishes and support them to stay safe.

People and relatives felt the environment was managed safely. People showed the inspection team their bedrooms, they explained how their bedrooms felt safe to them. We saw people’s bedrooms had been personalised to their own tastes and included any equipment or adaptations to ensure their safety and dignity was maintained. People told us the call bells in their bedrooms were always working and accessible. This meant they could request staff support if needed. One person said, “The staff come quite quickly. They put it (buzzer) on the table for me.” Another person said, “Sometimes they [Staff], take a bit longer when they are busy, but I have no complaints.” We saw from records that the staff team and people had been part of regular fire drills, so they knew how to evacuate the building.

Staff knew how to monitor the safety of the environment, and where to record any maintenance concerns. Staff were confident that the building was well maintained to keep people safe. We saw the provider had invested significantly in the service since our last visit. The flooring in the main foyer had been replaced, so no longer posed a risk to people living with a risk of falls. The service had been decorated throughout and was in the process of being fully refurbished to a high standard. The management team had clear processes in place for monitoring the safety of the environment. For example, the manager documented their regular checks around the building and explained how they passed concerns to the maintenance person to resolve. We saw that any areas identified, had been promptly resolved to keep people safe. Staff knew how to respond in the event of an emergency evacuation. For example, if a fire alarm sounded, staff could explain how people would be supported to move into a safe space.

Some people at the care home used equipment (like walking frames or hoists). We saw these pieces of equipment were clean, well maintained and stored appropriately. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to fire-fighting equipment Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive. The service employed a dedicated, experienced, full time maintenance person. They ensured the service was a safe and stimulating environment for people living with dementia and those less physically able. The service was decorated with local memorabilia, and reminiscence items, to encourage people to participate and enjoy the design of the service.

The environment was kept safe, by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems.) Systems were in place to ensure the water quality was maintained to reduce the risk of water-borne bacteria (like legionella.) The gas heating system was regularly serviced to prevent harm to people. People had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked and audited by the manager, to ensure they were working and effective.

People and their relatives and visitors told us there were enough staff, and any needs were responded to quickly. One visitor told us, “‘Any time I need help for [Name], the staff are attentive.” A relative told us, “I can’t fault it. The service. It’s a homely, lovely feel. Such caring staff’.”

Some staff felt there were occasions when they were stretched as a staff team. With the lunch period being one example. One staff member said, “The lunch time can be challenging, we have people who require assistance with eating. We also have people who require 1:1 support, and we have agency staff covering. It can depend on the skills of these staff. Sometimes they can struggle with supporting people effectively.” We shared these concerns with the management team, who raised the quality concerns with their regular agency, and reviewed their lunch service times, staffing allocation and deployment over this period. We were assured by their responsiveness. Staff felt the service provided sufficient training for them to ensure they were skilled and knowledgeable in their roles. They explained how it had supported them to be more effective in their roles. A staff member said, “The manager leaves me to get on with things in my area and respects my skills and knowledge.” Staff told us they had regular opportunities to meet their line manager on a one-to-one basis for supervision. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed.

We observed occasions when there were shortfalls in the staff numbers available to provide safe and effective support for people. We observed a poor lunchtime experience on our first day of the assessment visit, where people were placed at risk of having unmet needs. We raised this with the manager, deputy manager and operations manager, who were immediately responsive to our concerns. They attended to support the lunch service to ensure people received the support and assistance needed and conducted a review and debrief with the staff team. Subsequent changes have been made to the meal service times, and to the staff allocation tool, ensuring staff are deployed effectively across the service. This provided assurance that staff are able to provide timely support to people at all times. We are assured by the management teams’ prompt response. We saw staff were suitably trained to complete their roles. Staff used their training and understanding of people as individuals, to respond effectively to people’s needs. One relative we spoke with gave positive feedback about the staff team, saying, “Although my family member lives with advanced dementia, they know people’s faces.” They explained this was because a lot of staff had been at the home for a long time, and therefore, there was consistency of staffing.

Staff had received suitable training to do their role. The management team ensured there were always suitably skilled staff working. Once staff were trained, there were clear ongoing processes to assess their competency. If needed, further support and training was then given to improve staff skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. Safe recruitment processes were followed. For example, previous employers were contacted to give references for the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the Police database for convictions or warnings that may impact the staff members safety to work with people. The service employed some nurses. These nurses were registered with the regulatory body (The Nursing and Midwifery Council). The management team completed regular checks to ensure their nursing registration was maintained.

People and their relatives told us that the home was always kept clean. We observed people being supported with personal care by staff wearing appropriate personal protective equipment. People and their relatives told us that staff wore personal protective equipment as needed.

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. Staff understood the risks of COVID-19, how to spot symptoms and what action they should take to keep the person and other safe. Staff had received food hygiene training; they were able to explain what actions they took to reduce the risk of food borne infections.

The home was clean and hygienic. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. We saw any dirt or spillages in the home were quickly resolved. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easily to read escape routes. Staff had access to firefighting equipment throughout the home and fire alarms were throughout the building. We saw the kitchen was managed in a hygienic way by an experienced cook, along with a knowledgeable, established team, to ensure people were not at risk of food borne infections. The most recent check from the food standards agency, had rated the service 5 stars on the 30 November 2023.

There were clear processes and policies in place, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. If an infection outbreak occurred (for example diarrhoea and vomiting), there were clear processes in place to reduce the risk of this spreading to other people at the service. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

People told us that they were involved with reviews of their medicines. We observed people being given their medicines in their preferred way, by staff who understood their needs. People told us that staff gave their medicine at regular times, and as their prescription required. People told us that they had ‘as needed’ medicines like paracetamol for occasional pain relief. They explained that staff supported them to take these ‘as needed’ medicines in line with their changing symptoms.

Staff were able to explain how they supported people to take their medicines safely. One staff member told us they were confident in raising concerns with the management team and said, “They would act without delay if they thought anyone was at risk of harm. The clinical training had improved significantly since our last visits. They spoke highly of the external training which the nursing staff had completed. And felt confident in the care staff to escalate concerns as needed.” We discussed with the management team, the current lack of clinical lead in the service. We were advised that this role was being advertised, and the provider was seeking to appoint the ‘right person’ to ensure they would fit in with the established staff team. Staff knew who to report medicine concerns too. For example, if they felt a person’s medicine was no longer effective, they understood where to document this, and which health professionals to contact. Some people at the service were prescribed controlled drugs. These are subject to enhanced restrictions due to the addictive nature of these medicines. We saw staff had followed national legal requirements by storing these medicines in an extra secure place. Where medicines needed to be stored at a certain temperature, this had been done. For example, some people required their medicines to be stored in a fridge. Staff had checked the fridge temperature on a daily basis to ensure it was working as expected.

We found some concerns with the documentation for people requiring ‘as needed’ medicines, although we did find improvement overall in medicines management practice across the service from our previous inspection. For example, one person required pain relieving medicine at a reduced dosage due to their weight. We found this person had no protocol in place to give clear guidance for staff on what symptoms the person would show, how much dosage should be offered and the effect of this on the person’s pain levels. Some of the medicines administration records we reviewed for people were unclearly recorded where staff had given prescribed medicines for people. We raised our concerns regarding the documentation and recording of medicines with the management team, who provided a review and a robust plan to improve this moving forward. We were assured by their approach. Medicines were stored in a locked area in the service. However, the code for the door to the medicines room was visible for people and visitors at the time of our visit. We raised this with the management team, and this was immediately removed to ensure safety was maintained We observed staff were patient and kind when administering medicines for people. They gave an explanation of what the person was taking and sat down at the same level as the person, this was very person centred. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, to ensure they were following best practice.