Archived: Highermead Care Home

Updated 17 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by information Care Quality Commission received following an incident when a person using the service was alleged to have been harmed. Information available at the service in relation to this incident was reviewed as part of this inspection process

This inspection took place on 12 June 2018 and was unannounced. The inspection team consisted of three Adult Social Care inspectors.

A previous focused inspection of this service was completed in April 2018 when the service was rated as Requires Improvement. During that inspection two breaches of regulations were identified.

Before this inspection we reviewed information we held about the service, previous inspection reports and notifications we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with four people, three relatives, six members of care staff, the provider’s nominated individual and a health professional who regularly visited the service. In addition, we observed staff supporting people throughout the home and during the lunchtime meal. Some people at the service were living with dementia so we used our Short Observational Framework for Inspection (SOFI) to record details of people’s experiences of care. We also inspected a range of records. These included, three care plans, 11 staff files, training records, staff duty rotas, meeting minutes and the service’s policies and procedures.

Updated 17 August 2018

We carried out an unannounced inspection of Highermead Care Home on 12 June 2018. Highermead is a ‘care home’ that provides care for a maximum of 22 adults. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 11 people living at the service.

The service is on three floors with access to the upper floors via stairs or a passenger lift. At the time of our inspection only the ground floor of the building was in use. Shared living areas included two lounges, a dining room, an activities room and gardens with a patio seating area.

Highermead Care Home is owned and operated by Ark Care Service Limited. This company is based in London and also operates a second registered care home in Preston, Lancashire.

Prior to this inspection Highermead Care Home had been inspected five times since October 2016. At all of these inspections issues were identified in relation to the quality of care and support provided at the service. The service was rated Inadequate in October 2016 and Requires Improvement at each of the other inspections. The reports of all previous inspections are available on the Care Quality Commission website. These reports show that although the service had made some improvements in response to inspection findings these improvements had not been sustained. During our April 2018 inspection we identified concerns in relation the service’s staffing arrangements. As a result, we asked the provider to give us details each week of the service’s staffing arrangements. This information was provided.

On the day before this inspection the local authority informed people, their relatives and the service that they were no longer willing to commission care from Highermead. People were offered support to identify and move to alternate care placements during the week of our inspection. The provider chose to close the service on Friday, 15 June 2018 as at that time no one was living in the service. The provider has subsequently applied for this location to be removed from there registration.

At this inspection we again rated the service Requires Improvement. Risk assessments and care plans did not provided staff with appropriate guidance on how to support people whose behaviour could put them or others at risk. In addition, where incidents had occurred within the service they had not been documented or appropriately reported to senior staff for further investigation. Although accidents had been recorded there was limited evidence these had been investigated to identify any changes that could be made to improve safety in the service.

During our previous inspection we found that the service was understaffed but that all planned care shifts had been covered using staff overtime, management cover and agency staff. At this inspection we again found that the service did not employ sufficient staff to cover planned care shifts. There was a particular shortage of night staff and records showed that in the four weeks prior to this inspection only 56% of night shifts had been completed by staff employed by the service. The remaining night shifts had been completed by a staff member from the provider’s other service in Preston, Lancashire or by agency staff.

The service aimed to have three staff on duty during the day but we found the service had been short staffed on three occasions since our last inspection. In addition, we noted that the service’s domestic cleaner had been unavailable for a number of shifts. On the day of our inspection there was no domestic staff on duty and no domestic cleaning tasks were completed. Some areas of the home appeared unclean and malodours were found in areas throughout the service.

The service did not currently employ any dedicated activities staff and on the day of our inspection people were not supported to engage with meaningful activities. On two occasions people approached staff to enquire about activities but none were provided. There was a board listing activities planned for the week which included an exercise class. Staff told us the information was not accurate and one staff member commented, “There is not much going on at the moment”. We did not observe staff providing any individual or group activities during our inspection and there was limited evidence available to demonstrate the service’s activities room had been recently used. One person had been identified as being at risk of social isolation and their care records highlighted to staff the importance of spending time with this person on a one to one basis. However, there were no records to show this support had been provided.

The service is required to have a registered manager. 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 was no registered manager in post at this inspection. The acting manager had resigned and withdrawn the application to register following our previous inspection in April 2018. This was the second occasion since 2016 when an acting manager at Highermead had withdrawn from the registration process.

The provider’s nominated individual was now managing the service directly and had been based in the service since the acting manager’s departure. Staff told us they had felt well supported by the nominated individual during this period and told us, “[The nominated individual] has been here the whole time, she is approachable.” However, there was a clear lack of leadership and oversight in the service on the day of our inspection. There were no domestic staff on duty and no arrangements had been made to allocate other staff to complete these tasks.

Records showed the nominated individual had not appropriately led by example while covering care shifts. No detailed records of the care provided to people in bed had been completed during a night shift covered by the nominated individual. This meant it was not possible for the service to demonstrate people’s care needs had been met.

In addition, the service’s quality assurance systems were ineffective as they had failed to ensure compliance with the legislation. Important information in relation to how staff should support individuals was missing from their care records and incidents had not been documented and recorded. Senior staff were unaware of significant incidents that had occurred within the service.

Prior to this inspection significant concerns were raised with CQC about recruitment practices within the service. As a result we reviewed the recruitment records available for 11 staff including all staff employed in 2018. We found the service had operated safe recruitment practices and that all necessary pre-employment checks had been completed. Staff records also showed appropriate training and supervision had been provided.

At this inspection we found people medicines were now managed safely. Creams had been dated on opening and accurate records maintained in relation to medicine that required stricter controls.

People were comfortable in their surroundings and told us, “The staff are great, lovely nice people.” While relatives said, “The staff are really good with [My relative] they can always calm him down” and professionals told us the staff knew people well. Staff responded quickly to people’s care needs and people told us, “Staff come when I ring the call bell.”

Following our inspection the provider made a decision to submit an application to cancel their registration of the service.