Archived: Higham House Nursing Home

Updated 4 January 2019

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.

This inspection took place on 6 November 2018 and was unannounced.

The inspection was carried out by three inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service from statutory notifications received from the provider. Statutory notifications are a legal requirement that providers must tell us about registration changes, deaths, important events and serious incidents at the service.

We contacted Quality Monitoring Officers from Northamptonshire County Council and the Nene NHS Nene Clinical Commissioning Group, who since our last inspection had been in regular contact with the service, carrying out quality improvement visits. We contacted officers from the Northamptonshire Fire Service and Environmental Heath who had carried out fire safety and food hygiene environment visits to the service following our last inspection. All the officers confirmed the action plans they had set with the provider following their visits had been satisfactorily completed.

We also contacted the Northamptonshire branch of ‘Healthwatch England’, to establish if they had any information, to support our inspection. (Healthwatch England is the national consumer champion in health and social care). They confirmed they had not carried out any visits to the service and had not received any feedback from the public to inform our inspection.

During the inspection we spoke with five people using the service and one relative. We spoke with one registered nurse, the cook, a laundry assistant, a domestic assistant, the activity assistant, five care staff and the registered manager.

We conducted a tour of the premises to check the required improvements as identified at the last inspection had been completed. We looked at the care records belonging to two people using the service. We also looked at other information in relation to the day-to-day management of the service. This included five staff recruitment files and staff training records. We also looked at records relating to safeguarding, complaints and quality assurance monitoring of the service by the registered manager on a day-to-day basis.

Updated 4 January 2019

This inspection took place on 6 November 2018 and was unannounced.

At the last inspection in March 2018 we rated the service overall ‘Inadequate,’ in breach of the regulations and placed in special measures. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, we inspect the service again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the last inspection, we met with the provider to stress the high-level concerns we had about the service. We asked the provider what they would do, and by when to improve the key questions, ‘Safe, Effective, Caring, Responsive and Well-Led’ to at least good. The areas identified for improvement included, fire safety, building upkeep and maintenance, infection controls, cleanliness, analysing and reporting accidents, incidents, reporting safeguarding concerns, providing person centred care, respecting privacy, record keeping and governance of the service.

This is the seventh inspection of Higham House Nursing Home where the provider has failed to maintain compliance with the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Higham House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Higham House Nursing Home accommodates up to 30 older people in one adapted building. At the time of this inspection, 17 people are using the service.

A registered manager was in post. 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.

The registered manager did not always respond to requests from the Local Safeguarding Authority to carry out investigations into safeguarding concerns brought to their attention. They also did not always follow local safeguarding protocols, by reporting potential safeguarding incidents to the relevant authorities.

Medicines were managed appropriately, and people received sufficient support to take their medicines as prescribed and when required. However, medicines stocks and records were not always stored away securely.

People did not always receive person centred care, most notably at mealtimes. Staff were not being deployed to allow them to provide sufficient support to people who need assistance with eating and drinking at mealtimes. The mealtime experience needed improvement to make it a more enjoyable and social time for people.

People were treated with respect and compassion, although privacy was not always respected. There was a lack of meaningful activities, as the activity provision at the service was minimal.

Systems were not in place to plan and review staff training in a timely way to ensure staff received training that is appropriate to their respective roles and responsibilities.

Statutory notifications were not always submitted to the CQC. Failure to consistently notify CQC of events and safeguarding incidents means we cannot check the provider has taken appropriate action to ensure people's safety and welfare.

The provider did not have sufficient processes in place to assess, monitor, learn from and continually improve the quality of the service. Records relating to the management and oversight of the service were disorganised, which impacts on the ability to effectively oversee the day to day running of the service. Systems were in place to seek feedback from people using the service and relatives, however feedback received was not always been used to drive continuous improvement of the service.

People’s general health and wellbeing was monitored, and information was shared with all involved in people's care. When concerns about changes in people’s health and wellbeing were noticed staff took the appropriate action to refer people to the relevant healthcare professionals, for advice and support.

Sufficient action had been taken to improve fire safety, the building upkeep, maintenance, infection controls, and cleanliness of the service.

Staff recruitment records were made available for inspection and the records seen evidenced that appropriate recruitment checks are carried out prior to staff taking up employment. Ancillary staffing arrangements had been improved to allowing for routine deep cleaning to take place.

People spoke positively about the staff that support them and relatives felt staff always made them feel welcome. People and their representatives had opportunities to contribute to the planning of their care and support. People's needs and preferences were set out in their care plans. People's care and support needs were regularly reviewed and updated to ensure information was current to their changing needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The laundry system had been reviewed and improved to ensure people’s clothing and bedding was laundered appropriately.

At this inspection, we found the provider in breach of the legal requirements. You can see what action we told the provider to take with regards to the breaches at the back of the full version of the report.