We carried out a review of the data available to us about Highfield (Stockton) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Highfield (Stockton), you can give feedback on this service.
Highfield (Stockton) is a residential care home providing personal care for up to 40 people in one purpose-built building. The service provides support to older people and people living with dementia. At the time of our inspection there were 27 people using the service.
People’s experience of using this service and what we found
Medicines were managed safely. Infection prevention and control processes protected people from the risk of infections. There were safe systems of recruitment in place. Staff received safeguarding training and knew what to do if they thought someone was at risk. Risks to people and the environment were identified and well managed. Plans were in place for a refurbishment of the home.
Systems and processes were in place to monitor the quality of the service being delivered. The culture of the service was positive, and people and staff were complementary of the management team. Staff felt well informed and supported to undertake their roles.
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 CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was good (published 9 October 2018).
Why we inspected
We received concerns in relation to the environment and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service is good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highfield (Stockton) on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
• Systems were in place to allow safe visiting, including screening visitors before they entered the building.
• Social distancing was encouraged and changes had been made to communal areas to promote this.
• Staff wore personal protective equipment (PPE). Training in infection prevention and control measures and the appropriate use of PPE had taken place.
• Systems were in place to admit people safely into the home.
• Regular Covid testing was taking place.
Further information is in the detailed findings below.
We last inspected the service in June 2017 and at that time identified breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to staffing, dignity and respect and good governance.
During this inspection we found improvements had been made and the matters we identified at the previous inspection had been addressed. As a consequence of these improvements the service was no longer in breach of regulations.
Highfield (Stockton) is a ‘care home’. 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.
Highfield (Stockton) can accommodate up to 40 people in one purpose built building. At the time of our inspection there were 37 people using the service.
The service had a registered manager 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.
At the last inspection we found that staff were not up to date with all training. At this inspection we found more than 90% of staff were now fully up to date with training, with other staff booked on to upcoming courses. People we spoke with were confident that staff had the skills to meet their needs and staff told us they were happy with the training they received.
The environment was now more suitable for people living with dementia. Clear signage had been put up around the building to help people find their way around. Corridors and communal areas had been newly decorated and people had photographs on their bedroom doors.
A more effective system of audits was now taking place. Although they had not identified every issue we found the registered manager was very responsive and made changes in light of our feedback, both during and immediately after the inspection. The audit system was still improving with more changes having been recently introduced.
People who used the service felt safe living at Highfield (Stockton). People’s relatives also told us they felt their loved ones were cared for safely.
Safeguarding incidents were correctly investigated. Staff had received safeguarding training and knew how to report any concerns.
The provider recognised people’s human rights and had policies in place to ensure people were protected from discrimination.
Falls, accidents and incidents were recorded and analysed to ensure lessons were learned and actions taken to minimise the risk of future incidents.
People had individual risk assessments on their care files but they did not always contain the most up to date information. We received confirmation after our visit that risk assessments had been updated.
Staffing levels were sufficient to meet people’s care needs. Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken to prevent unsuitable people from being employed.
Regular maintenance and safety checks of the premises and equipment were carried out and plans were in place to support people in emergency situations.
People received their medicines safely. Records confirmed medicines were received, disposed of, and administered correctly.
People and their relatives were happy with the cleanliness of the service however there were some areas of the home which had an unpleasant smell. There was an issue with the flooring in one of the communal toilets and some areas within bathrooms and toilets required redecoration and repair. We received confirmation after our visit that all areas had undergone a deep clean whilst awaiting refurbishment.
Staff received support at regular supervision meetings. Annual appraisals were overdue at the time of the inspection but have now been completed.
People were supported to eat a healthy balanced diet and mealtimes were calm and relaxed.
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.
People were supported to maintain their health and wellbeing. People's care records contained evidence of visits and advice from a variety of health professionals.
People who used the service and their relatives were very happy with the care their loved ones received. Staff treated people with dignity and respect and promoted independence.
Some care plans contained more information on people’s likes and dislikes than others. These details help staff support people in a way that suits them best. We discussed this with the registered manager and work began immediately to make improvements to all care plans.
There was a complaints procedure in place and people knew how to make a complaint if necessary.
There was a varied timetable of activities and events each day that aimed to offer something suitable for everyone. People also had the opportunity to go out on the mini-bus.
Records did not always contain up to date information relating to people’s care needs. We received confirmation following our visit that all care files within the home had been audited to ensure that any old information was removed.
Staff meetings took place daily with longer meetings taking place every month. Staff felt able to discuss any issues with the manager.
Staff, relatives and people using the service all spoke highly of the registered manager. The service also had a good relationship with healthcare professionals who gave positive feedback regarding the knowledge and co-operation of management and staff.
Feedback was sought from people using the service and relatives in a variety of ways via surveys and regular conversations. A ‘you said, we did’ notice board detailed actions taken in light of people’s feedback.
Highfield (Stockton) is a purpose built care home located on the outskirts of Yarm. At the time of our inspection the location was registered to provide accommodation to 40 people.
The home had a registered manager in place. 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.
We found that staff training was not up to date. The provider’s target for training was a minimum of 85% of staff training to be current. We found the average percentage of staff who had current training across all courses was 73.2%. Less that 50% of staff had current dementia training despite a high number of people who used the service living with some form of dementia.
The environment was not dementia friendly. There were not contrasting colours between walls and handrails and there was insufficient signage to help people navigate around the building independently. Following our inspection signage was put in place but further work was needed to improve the environment for people living with dementia.
Although staff were observed administering medication safely, records were not always correct. We have made a recommendation about medicines management and records.
There were systems in place to monitor and improve the quality of the service provided. People’s views were sought via regular meetings and an annual survey. We saw there were a range of audits carried out both by the manager and senior staff within the organisation. However these checks were not effective as they had not picked up the issues we found during the inspection.
There were systems and processes in place to protect people from the risk of harm. Risks to people’s safety had been assessed by staff and records of these assessments had been regularly reviewed. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe the organisation’s whistle blowing and safeguarding procedures and told us they would be confident to report any concerns.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.
People and staff told us there were enough staff on duty to meet people’s needs. A dependency tool had been completed to calculate safe staffing levels and rotas we looked at indicated showed the service was staffed in line with these figures.
We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.
We saw staff had received supervision on a regular basis and an annual appraisal.
We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. The dining experience was relaxed and unhurried with people being given a choice of food and drinks and the support they required to enjoy their meal in a dignified way.
People were supported to maintain good health and had access to healthcare professionals and services.
There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they were attentive, respectful, patient and interacted well with people. In conversation staff demonstrated a good knowledge of the people they cared for. People and their relatives were happy with the care being delivered.
We saw people’s care plans were person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated.
People were encouraged to participate in a variety of activities by enthusiastic activities staff. A number of people chose to remain in their rooms and the manager told us they had made efforts to address this. Staff supported people to access activities within the community such as trips to the seaside.
The registered provider had a system in place for responding to people’s concerns and complaints. This was clearly displayed in communal areas. People said they would talk to the manager or staff if they were unhappy or had any concerns. We saw that complaints had been addressed in line with the provider’s policy but outcomes were not being recorded.
Three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.
The inspection visit took place on the 9 April 2015 and was unannounced which meant the staff and provider did not know we were visiting.
Highfield Stockton is a 40 bedded purpose built care home located on the outskirts of Yarm, providing people with accommodation and personal care. Although registered for three regulated activities, it is not currently providing nursing care or treatment of disease, disorder or injury or diagnostics and screening procedures.
We last inspected the service on 28 November 2013 and found the service was compliant with regulations at that time.
There was a registered manager in post who was on duty at the time of the inspection. 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 were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know when an application should be made and how to submit one. The registered manager also ensured that capacity assessments were completed and ‘best interest’ decisions were made in line with the MCA code of practice. This meant people were safeguarded.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
All people told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. The staff team were supportive of the registered manager and each other and feedback from visiting professionals on the day were very positive about the service at Highfield.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.
There was a regular programme of staff supervision in place and records of these were detailed and showed the service worked with staff to identify their personal and professional development. We fed back to the registered manager and deputy that the quality of recording around supervisions and appraisals was good. We spoke with kitchen staff who had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. They also told us that they received any equipment and supplies that they requested promptly.
We saw people’s care plans were personalised and had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved, when they were able, the person. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.
The service encouraged people to maintain their independence and the activities co-ordinator ran a full programme of events which included accessing the community with people. We saw people popping in and out of the manager’s office to chat and spend time with them and it was evident that everyone knew the manager well and were comfortable to speak with them at any time.
We observed that all staff and the registered manager were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members and there was a lovely warm and caring atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.
The service undertook regular questionnaires, not only with people who lived at the home and their family, but also with visiting professionals and staff members. We also saw a regular programme of staff and resident meetings where issues where shared and raised. The service had an accessible complaints procedure and people told us they knew how to raise a complaint if they needed to. We saw that complaints were responded to and lessons learnt from them. This showed the service listened to the views of people.
Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.
The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Highfield and actions plans and lessons learnt were part of their on-going quality review of the service.
We saw that people looked clean and well cared for. Communal areas of the building had been refurbished, the home was welcoming and staff were friendly. We observed positive interactions between staff and people living in the home and we saw that people were treated kindly and with respect by staff. One person who lived in the home told us, " They're all kind here and patient with you all the time".
We found that medication was administered in line with the policy and procedures by trained staff and processes were in place to monitor the administration of drugs and minimise the risk of error.
We talked with staff during the visit and looked at training records. We found that staff were supported to attend training, had regular supervision and annual appraisals to enable them to develop and maintain their skills.
We saw that the home had a range of different mechanisms in place to gather feedback on the quality of the service provided and we found that the manager responded positively to issues raised through surveys, audits, complaints and comments from people who used the service and their relatives.
We observed people being offered a range of choices, such as options to remain in their own rooms or spend time in the communal lounges, choice of meals at lunchtime and choice of hot drinks. One person we spoke with said, "I make my own decisions, I decide where I want to spend my time, visitors are able to come at any time, we always have choices, if you want anything you just have to ask."
We saw that people had been consulted about their care and support needs and care records contained a good level of person centred information. We spoke with three people about the care and support they received. They were all satisfied with the care and service provided at the home. One person said, "I believe that the staff know me as an individual and know what my care needs are."
From the records we looked at, we saw that there were good systems in place for ensuring the environment was safe. We did note that there was the need for redecoration and refurbishment, however there are plans underway for this.