Highfield 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

People felt safe and had no concerns. They confirmed they knew how to raise any concerns should they need to. Staff were knowledgeable with regards to safeguarding and there were clear processes in place. People were informed about risks to their health, safety and wellbeing and staff were proactive in responding to ensure appropriate support was provided. Risk assessments were completed and regularly reviewed however, some assessments would benefit from additional information and improved detail for staff. People felt comfortable in the environment they lived in and felt they had all of the equipment, facilities and the level of comfort they needed. We identified that some areas of the service required remedial maintenance works. The registered manager responded positively to the feedback offered and took immediate action. Staff were recruited safely and were deployed in sufficient numbers to meet the needs of people. A thorough induction and training plan was in place to ensure staff were trained and had the skills necessary for their roles. People were supported with their medicines in a way that met their individual needs and preferences. Where improvements were needed with regards to the assessment of risk relating to medicines, the registered manager took action. Staff raised issues and concerns with regards to medicines appropriately with the prescriber.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider had robust systems and processes in place. This included up-to-date policies and a log which the registered manager used to record any concerns raised at the service, the action taken and any outcome, once determined. The processes in place enabled clear reporting and recording. In turn, this also helped the sharing of any learning or feedback from partner agencies received by the service following any safeguarding concerns being raised with all staff members.

People told us they felt safe and had no concerns. People and those who matter to them had safeguarding information in a form they could understand and felt comfortable to raise concerns, should they need to. Relatives told us they felt their family members received good care. One relative said, “[Relative] is still settling in and is finding it hard to adapt. I have nothing but praise for the home. They have long-serving staff, the same staff as when [previous experience].”

Staff had a strong understanding of safeguarding including when and how to take appropriate action. They expressed a shared commitment to taking immediate action to keep people safe from potential abuse or neglect. This included working with partner agencies and visiting professionals in a collaborative way. One staff member said, “I have raised safeguarding’s in the past where certain staff are not showing the right values. To me it comes down to how to treat resident, someone that is here for a job or some who has the right values. I always listen to people. I also work on the dementia unit and so I get to know them well. Listening to them. I would go to the registered manager or deputy manager, and they will action it.”

We observed staff interact with people in a kind and respectful manner. Where people needed assurance, we saw staff were compassionate and provided timely support.

People said they felt informed about risks to their health, safety and wellbeing and ways to keep themselves safe whilst living at the service. They told us they could openly express if they needed additional support to manage any risks. One person said, “I have lived here about a year. I am safe. I have had no accidents. I move using the hoist, I have my personal sling which they wash at night.” Relatives felt involved in decisions about people’s care and were kept informed where appropriate.

We observed when people communicated their needs and emotions, staff interacted in a kind manner to try and reduce the persons anxiety and provide the support they needed.

Risk assessments were in place and highlighted people’s risks. However, in some cases, we found further development was required to ensure all information to mitigate the risk to the person was documented. For example, we found where some people had to have their food modified, this was not always clear on the guidelines in place or the actions staff should take to mitigate the risk to people. Individual meetings were held on a regular basis to complete a review of the person’s care and support needs, their experiences and outcomes. These also provided a process to ensure all risks were identified, mitigated and reviewed.

Staff gave examples where they had highlighted risks to people to senior staff, and this had been addressed promptly. One staff member gave an example where they found a person’s mobility showed signs of decreasing, they recognised this and shared with the appropriate leaders. Partner agencies supported with appropriate equipment and, as a result, this reduced the risks to the person’s safety. The person was then able to safely move around the home.

We found the service was clean with good standards of hygiene being maintained. However, we found that parts of the home required some remedial works and some areas required some additional considerations and signage to help people navigate their way and maintain their orientation. On our second visit to the service, the registered manager had acted upon feedback and had started to address some of the improvements identified.

There were robust processes in place to ensure that the environment was safe. Equipment in place was checked, routinely serviced and tested as required. There was a plan in place for routine maintenance and redecoration at the service which was reviewed by the provider. Actions needed were prioritised and assigned a timescale. As reported above, following our visit and feedback, the registered manager reviewed the prioritisation for some remedial works and took action.

People felt comfortable in the environment they lived in. One person said, “I am quite happy here. Yes, I am safe. It is very, very nice. I have everything I need, and all the facilities. I can go out for a walk with the management, I have my frame. I have everything I need.”

Staff felt they worked in an environment that was safe and had all the equipment they needed. They confirmed all equipment was in working order. Equipment was assigned individually to people including their own personal slings for use with hoisting equipment where needed. One staff member said, “I think generally it is a safe place to work, we have equipment that is here for years, everything is still in working order. We have changed the slings; everyone has their own. The management team do adapt and change things if needed.”

Staff told us they received training which was appropriate and relevant to their roles. Some staff spoke about how the management team ensured there were opportunities for them to pursue personal development, with a view to progress into new roles if they wished. One staff member said, “[Leaders] have been really supportive with me studying. I shadow the nurses; I shadow team leaders. I think for right now training is sufficient, we do medicine rounds, we get training such as first aid training, catheter care, come in every year. I also do e-learning.” In addition to training, staff received the support they needed to deliver safe care and evidence good practice. This included supervision and appraisals and, where needed, professional revalidation.

On both days where we visited the service, we observed appropriate staffing levels with a mix of skilled and experienced staff on duty. Staff were effectively deployed across each area of the building and this helped make sure people received consistently safe, good care that met their needs.

Staff recruitment was safe and all essential pre-employment checks were completed prior to a staff member starting work. There was a robust induction plan in place, with ongoing training completed by all staff. Staffing levels were consistent and matched with the dependency tool used by the registered manager to determine the required number of staff on duty to meet people’s needs. Audits were completed to ensure that staffing levels were sufficient and that people’s requests for support via their call bells were responded to in a timely manner.

People and relatives felt that there were enough staff to meet their needs. One person said, “Everything is fine, they are very friendly here, they seem to like to please you. They always knock on the door. They bring me my medication morning and evening and I ask for pain relief when I need it. I can have a shower when I want to. I feel I could change how they look after me if I wanted to. There are lots of activities, but I prefer to watch sport on the TV. I would go to the manager if I was not treated well.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were processes in place to ensure that people received medicines safely. This was supported by an electronic medicines administration record (e-MAR). However, care plans and risk assessments sometimes lacked the necessary detail to support staff with managing specific healthcare needs. Some medicines with known additional risks had not been appropriately risk assessed or recorded at the time of the assessment. The registered manager responded promptly to the concerns raised and took action to addressed these. PRN protocols (documents to support staff to know how and when to administer a ‘as and when’ medicine safely) were in place and accessible at the point of administration. There was a process in place to support the use of covert medicines (where a medicine is hidden in food or drink and given without the person being made aware) however, currently no people living at the service received their medicines this way.

People were supported to receive support with their medicines in a way that met their individual needs and preferences. Staff interacted kindly with people whilst conducting the medicines administration round. People at the service were supported to self-administer medicines where possible. Medicines used ‘when required’ (PRN) to alleviate anxiety and agitation were used infrequently and always in combination with de-escalation techniques. People did not always have a diagnosis to support the prescribing of some medicines, which could alter their ability to express themselves. Staff were aware of this and had raised with the GP.

Staff told us there was a good training and induction process for medicines management. Staff were given 3 months to shadow and learn how to administer medicines before being able to sign off as competent. Additional training was available for nurses beyond this period. Both internal and external audits were conducted at the home and learning from this was shared with the staff. This had happened recently, and staff told us they had received feedback for improvement from this review.