Highstone Mews Care Home

Highstone Mews Care Home is a residential care home that provides accommodation and personal care for adults with a range of care and support needs, including adults who are living with dementia. The service also provided a small number of intermediate care placements for people who were discharged from hospital but needed more time to recover. The home can accommodate up to 62 people in one adapted building over two floors. At the time of this inspection there were 61 people using the service.

People’s experience of using this service and what we found

People received a good standard of care and we saw many examples where people had achieved better health outcomes after moving to the home, made possible due to the dedication and skill of the staff team. The service had developed extremely strong working relationships with local health professionals which ensured people’s healthcare needs were fully met. People received care from a knowledgeable staff team who had access to a wide variety of training and support.

The service was safe and people were cared for by staff who treated them with kindness, dignity and respect. Risks to people's health and safety were assessed and mitigated. Medicines were managed in a safe and proper way. Incidents and accidents were logged and investigated and learnt from where appropriate. There were enough staff to keep people safe and meet their needs in a timely manner.

People were supported to take part in a range of activities and planned events at the home. People’s feedback showed this could be further improved to help them remain meaningfully occupied in between planned events. Since we last inspected the provider had completely reformed the home’s environment and this genuinely impacted positively on people’s lives as they had real influence over decisions about how the service should look.

Staff were knowledgeable about people’s needs. The service used an electronic care planning system which supported staff to regularly review the care and support people needed. Further consideration was needed to clearly demonstrate people, their relatives and representatives were consulted as part of the care review process and minor improvements were needed to the quality of information in people’s ‘intermediate care’ plans to better support staff to deliver person-centred care. The service fully met the requirements of the accessible information standard, ensuring creative aids were available to support people’s communication and understanding.

There was a truly person-centred culture with the management and staff team, and all were highly involved in peoples’ care and support. The service sought and developed its own best practice to be at the forefront of high-quality care. A range of audits and checks were undertaken to ensure continuous improvement of the service.

Staff encouraged people to make their own decisions and they obtained consent from people before care was delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

The home was warm and welcoming and there was clear leadership evident throughout the home. Staff were knowledgeable and knew people well, there were positive caring relationships between staff and the people they supported and these positive relationships were extended to relatives we spoke with.

The home offered person centred support which was clearly recorded in people’s care plans. There were life histories of people to give staff insight into the lives people had led and what was important to them; this was particularly relevant where people were living with dementia.

The home was well-presented and had been adapted for people who were living with dementia, and offered an interesting array of tactile areas and a sensory room in addition to the clear signs and coloured doors, which helped people identify their own rooms and communal areas.

The home had introduced new practices since our last inspection which were benefitting people who used the service for instance the ‘react to red’ programme (which is an awareness tool to remind staff to react to red areas on people’s skin, or to red items in the home), the home was also extending support to the families of people who lived at the home and those who no longer had relatives at Highstone Mews but may have needed some continued support following a death of a loved oneby offering the opportunity to continue visiting the home in a social capacity for as long as they wished.

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.

Further information is in the detailed findings below

Highstone Mews is a care home registered to provide accommodation and residential or nursing care for up to 60 older people, some of who are living with dementia. The ground floor of the home is configured to provide personal care for up to 30 people. The first floor provides nursing care for up to 30 people and both floors support people who are living with dementia. The first floor had been separated into two units since our last inspection; one unit offered nursing care and the other unit specialist care for people living with dementia.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People and their relatives told us they felt the care and support was safe and of a good standard.

Staff understood their roles and responsibilities in keeping people safe and protecting them from harm.

There were comprehensive risk specific assessments in place, which showed the risk and the measures which needed to be taken to minimise the risk. Personal emergency evacuation plans were in place for each person and described the assistance they would need to safely exit the building should there be an emergency.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

There were sufficient staff to keep people safe and their needs were met in a timely manner.

Staff had undertaken training to ensure they had the skills and knowledge needed to carry out their roles. Staff were supported by the management team and received supervision and appraisal meetings to discuss and monitor their performance.

The recruitment processes which were in place were robust and pre-employment checks were carried out to ensure staff were of good character and were suitable to work with vulnerable adults.

There was a good supply of drinks and snacks available at all times. There was a good choice of meals and alternatives were always on offer. People told us they enjoyed their meals.

There had been an extensive programme of improvements undertaken since our last inspection to the environment and décor which resulted in a welcoming and homely atmosphere. There had been thought given to the needs of people living with dementia, and dementia friendly adaptations made, such as coloured doors and reminiscence boxes outside bedroom doors.

There had been thorough assessments carried out in line with the Mental Capacity Act 2005, and where a person had been deemed not to have capacity there had been Deprivation of Liberty Safeguards (DoLS) applied for to ensure people were only deprived of their liberty where this was lawful to do so.

Staff were kind, caring, sympathetic and patient. Staff knew people well and there were positive relationships between people and all members of the staff team. People were treated with dignity and respect and staff were mindful to protect people’s privacy.

Care plans were detailed and person-centred. The care plans we reviewed were all up to date and contained a high degree of information about the person, including their personal history, medical conditions and preferences.

There was an extensive programme of activities. These were varied and people told us they enjoyed the activities they participated in. There had been trips out shopping and to a football match, as well as activities in the home.

Complaints were recorded, investigated, resolved and responded to in line with the organisation’s policy. People told us the manager dealt with concerns very quickly.

There was clear leadership in the service. The new management team was respected and valued by the people, their relatives, the staff team and health professionals who regularly visit and work with people in the home.

There were robust procedures in place to monitor all aspects of the home and the service provided to people who lived there. The registered provider carried out regular monitoring visits to ensure standards were good and they had oversight of the quality and safety of the home.

Highstone Mews is a care home registered to provide accommodation and residential or nursing care for up to 60 older people, some of who are living with dementia. The ground floor of the home is configured to provide personal care for up to 30 people. The first floor provides nursing care for up to 30 people and both floors support people who have a diagnosis of dementia. The registered provider told us they were planning to split the home into four smaller units to meet people’s needs more efficiently.

There was no registered manager in place at the time of our inspection; however there was a newly appointed manager and deputy 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.

People we spoke with gave mixed views about whether they were safely cared for in the home on the first day of the inspection, however people were feeling more positive about the level of safety on the second day.

Risk assessments were in place for all aspects of people’s care, however we found that whilst a lot of work had been carried out between the first and second days there was still conflicting and inconsistent information present.

We found some concerns about the maintenance of the building, and there were some areas which had not been maintained as frequently as they needed to be.

There were personal emergency evacuation plans in place, however these did not contain key information about people’s needs and there was no instruction to tell staff how to assist people from the building in the case of an emergency.

There had been concerns raised prior to the inspection that there were not enough staff to meet people’s needs. We found there were staff from other services on the first day who did not know people or how to meet their needs. There had been an increase of regular staff when we returned on the second day which had led to an improvement in the level of care and support people were receiving.

There were multiple concerns about the management of medicines in the home. These included incorrect use of medicines, unsafe storage (due to temperature) and medicines being out of stock and unavailable to people.

The recruitment process in place was robust and all appropriate checks were made to ensure staff were of good character.

The service had not ensured there were appropriate Deprivation of Liberty Safeguards in place for all the people who required these. We found there had been work carried out to rectify this between our visits however there was still more work which needed to be completed to ensure people’s rights were protected.

Staff training had been identified as an area of concern during an audit carried out prior to our inspection. We found there had been a programme of training planned and this was in progress to ensure staff had the relevant skills and knowledge to carry out their roles effectively.

We had received information of concern in relation to the amount and choice of food available to people, and concerns about people who had lost weight prior to our inspection. We found there were no concerns about the availability of food, however there had been some people who had suffered weight loss. The management team were taking action to ensure people were receiving the correct support to maintain a healthy diet and weight.

People had access to a range of healthcare professionals, including GPs, district nurses, opticians and chiropodists. We did find however that people who were living with some conditions were not being adequately monitored to ensure their conditions were stable.

Staff were kind, caring and sympathetic when supporting people and we saw there were some positive relationships within the home. We saw on the first day that some people appeared unkempt; however this had greatly improved when we returned for the second day.

We saw there were some occasions where people’s dignity was not well protected and this was not always recognised by staff, for instance when people were in bed and became uncovered.

There was very little evidence that people had been encouraged to discuss their wishes for the end of their lives, to ensure this information was recorded whilst people had capacity to share their preferences.

We saw there were activities taking place in the home, and there were some outings which took place. We also found there were a significant number of people who remained in their rooms and were at risk of social isolation. This has been identified and there was planning taking place to ensure people had one to one activities in their rooms to lessen this risk, if they could not be encouraged to leave their rooms.

On the first day of the inspection we found care plans were confusing and chaotic as they were being maintained in part on an electronic system and in part on paper. This had changed when we returned for the second day as all the information had been put into the electronic system and the paper records had been archived.

There was no evidence that people or their relatives had any opportunity to be involved in the creation or review of their care plans, which meant their wishes and preferences were not gained and included in these documents.

The home had been without a manager for a period of several weeks. The newly appointed manager and deputy manager had only been in post for 10 days when the inspection started.

The implementation of the electronic system had been poorly planned and this had led to confusion and an increased level of risk, however this was rectified between the first and second days of the inspection.

Staff were feeling more positive since the appointment of the manager and deputy manager; however they reported feeling unsettled by the recent changes and period where there was no manager.

There was some evidence of auditing and monitoring processes, which had been carried out by a supporting manager from another home, however there needed to be consistent checks carried out and actions plans created to ensure all actions had been carried out and in a timely manner.

We saw no evidence that there had been any senior manager or registered provider visits to check the quality and safety of the home, we were told these were planned to start the weekend following the inspection.

There had been little opportunity for people and their relatives to give their thoughts and views on the changes which were taking place in the home, and whilst some people felt they had been kept informed others felt they had not.

The provider was not meeting the requirements of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.