This inspection took place on 6 December 2016 and was unannounced. Victoria Highgrove is a nursing home registered for up to 21 people, primarily older people. Short periods of care and support is provided where people have been in hospital, or to prevent a hospital admission, and who are in need of a short period of rehabilitation before returning home. Help provided at Victoria Highgrove includes assistance with personal care, mobility, kitchen assessments, including meal and hot drink preparation, mobility practice, home and/or access visits to assess people's home environment.
The short-term rehabilitation is a joint partnership between Brighton and Hove City Council and the Sussex Community NHS Trust who work together to provide co-ordinated care. Consultants for elderly care, GPs and a community mental health nurse visit the service. People receive support from a social work team, social care staff, medical and nursing staff, physiotherapy and occupational therapy staff. These specialists had worked with people to improve their independence and mobility prior to returning home. There are a high level of admissions and discharges due to the short-term nature of the service, and there are no long term placements. There were 20 people living in the service on the day of our inspection.
There was a registered manager for the service. 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.
A dedicated maintenance worker was responsible for the general maintenance, alongside external contactors who were used for service checks and repairs. However, areas of the environment were in need of redecoration. One visitor commented,” I feel however that on top of the excellent service that this home offers, the management should pay attention to some minor things in the home and improve on these. For example, (pointing at the window curtain) the window curtain there. It is torn and it has been like that for quite a while”. We discussed this with the registered manager who acknowledged this was an area in need of improvement. They told us service was going through a significant period of review, where local stakeholders were looking at the service provision, what was needed and how the service would best be provided in the future. Due to this the refurbishment plan had been deferred until 2017 to address this and improve the physical environment for people.
People told us they felt safe. One person told us, “I have every confidence in all the people here. They are doing a fantastic job looking after me. I depend on them totally as I cannot move by myself. That means getting up from bed, washing and getting dressed up” Another person told us,” They are really good and helpful people. I have every confidence in them and I am well supported in this home. I couldn't ask for more.” Detailed risks assessments had been completed and reviewed. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.
Staff were aware of their responsibilities from the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) Where people lacked capacity to make decisions about their care and treatment this had been considered in their best interests.
People and their visitors told us staff were kind and caring. One person told us,” This place has got excellent staff. They are absolutely fantastic in everything that they do. I have received nothing but kindness since I have been here. I really can’t fault them on anything. At first I really didn't fancy the idea of coming here from hospital but after spending here a few days, I come to like it here so much. I will be more than happy to recommend this home to anybody. It is a lovely place with caring people.” A visitor told us,” This home has got excellent people and excellent service. The workers are very hard-working and friendly. “
People told us there were adequate care staff on duty to meet their care and support needs. People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “I really do like it here I cannot think of anything that I would fault them on.” Another person told us, “The workers in this place are really caring people. At the moment I am totally depending on them. I don't know what I would do without them.” A visitor told us,” The kind of care given to residents in this place is of high standards. My mother feels absolutely safe here and based on what I have seen thus far, her dignity is respected at all time. The workers are excellent at what they do. Overall however, we think that the home provides an excellent service to the residents. I think that the home is well managed.”
Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. People were cared for by staff who had been recruited through safe procedures. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, and plans were in place to promote good practice and develop the knowledge and skills of staff.
Medicines were stored correctly and there were systems to manage medicine safely. Audits and stock checks were completed to ensure people received their medicines as prescribed.
People told us they had felt involved in making decisions about their care and treatment and felt listened to. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. People’s healthcare needs were monitored and they had access to health care professionals when they needed to.
People were supported to take part in a range of recreational activities. These were organised in line with peoples’ preferences. Family members and friends continued to play an important role and people spent time with them.
Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They felt they knew people’s care and support needs and were kept informed of any changes. Senior staff used handover notes between shifts which gave them up-to-date information on people’s care needs. They confirmed that they felt valued and supported by the managers, who they described as very approachable. They told us the team worked well together. One member of staff told us, “I love working here. What’s not to like.”
People’s nutritional needs had been assessed and they had a selection of choices of dishes to select from at each meal. People said the food was good and plentiful. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.
People were comfortable talking with the staff, and told us they knew who to speak to if they had any concerns. One person told us, “I do not have any need of complaining in this place because I am happy with pretty everything but the manager and all the workers would be the people to speak to in case there was anything to complain about”.
Senior staff carried out a range of internal audits, including care planning, checks that people were receiving the care they needed, medication, and infection control. They were able to show us that following the audits any areas identified for improvement had been collated into an action plan, work completed to address any shortfalls and how and when these had been addressed.