Archived: Highcroft Manor

Updated 27 September 2017

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 23 and 24 March 2017 and was unannounced. The inspection was carried out by two inspectors from the Care Quality Commission.

Prior to this inspection we received concerns that the service did not always identify and take action when people’s health needs deteriorated. We reviewed past inspection reports and statutory notifications sent to the Care Quality Commission (CQC) by the provider. Statutory notifications are information about important events at the service, such as safeguarding concerns, which the provider is required to send to us by law.

We also spoke with the local authority and clinical commissioning group, who have commissioning and monitoring roles with the service. We also contacted Healthwatch for their information about the service. Healthwatch is a consumer organisation that has statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services.

During the inspection we met all 23 of the people who lived at the service, we spoke with seven people about the care and support they received. Some people at the service were unable to engage in conversation with us about their care, due to the complexity of their needs. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with five relatives of four people, who were visiting over the two days of our inspection, to seek their views of the service. We spoke with eight care staff that included the registered manager, two nurses, four care staff and the chef. We reviewed the care records of nine people who were using the service and four staff recruitment files of staff that had been recently recruited at the service.

We also looked at other information related to the running of and the quality of the service. This included quality assurance audits, maintenance schedules, training information for care staff, staff duty rotas, meeting minutes and arrangements for managing complaints.

Updated 27 September 2017

This was a second comprehensive inspection carried out on 23 and 24 March and was unannounced

Highcroft Manor accommodates and provides care, including nursing, for up to 30 older people mostly with dementia care needs. There were 23 people in residence on the first day of our visit and 22 on the second day because one person had been admitted to hospital.

The provider is a partnership; one of the partners is also the registered manager. The registered manager also managed another location. 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 had not fulfilled their requirements to the Commission as they had not provided notifications of all incidents or deaths that had occurred in the home.

There had been a systematic failure in all areas of assessment and monitoring of people’s care resulting in risks to people’s health and well-being. People did not always have their risks assessed or completed plans to mitigate their known risks. Staff did not always have access to plans of care that would provide instruction on how to provide care that met people’s needs.

People received care from nursing staff that required more clinical supervision and training to meet people’s needs. People were not sufficiently monitored for their health and nursing staff did not always act promptly on abnormal clinical observations. People could not be assured that they would receive all of their medicines as prescribed or their wounds managed appropriately.

People were not protected from potential harm as staff did not have strategies or plans to follow to protect people when people had behaviours that challenged others. Staff did not understand their responsibilities to report all incidents. Staff were not always kind; there was insufficient supervision of staff to ensure that they were supported to carry out their roles.

There were not always enough staff deployed to meet people’s needs. People did not always have the ability to call for assistance and staff had little time to talk or support people with activities or socialising. Care was mainly task focused and did not take account of people's individual preferences and did not always respect their dignity. People were not always supported to have sufficient to eat and drink to maintain a balanced diet.

People were not protected from the risks associated with a poorly maintained environment. There was a failure to assess the environment for potential risks to health and safety or implement changes to protect people from potential risks.

People could not be assured that their verbal and written complaints would be addressed. There were no adequate systems in place to receive and act on complaints. People’s records of care had not been maintained and all records in the home were disorganised.

We identified that the provider was in breach of nine of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and two Regulations of the Care Quality Commission (Registration) Regulations 2009 (Part 4). We took urgent action to impose a condition on the location’s registration to prevent the service taking any new packages of care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will complete our enforcement action of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.