This was an unannounced inspection carried out on 30 June 2016. Highland House is a large detached property, set in large, well-maintained grounds, just outside Canterbury. It is a privately owned, family run service and provides accommodation and personal care for up to 30 older people, some of whom may be living with dementia. On the day of the inspection there were 27 people living at the service. The provider is a limited company with four directors. The service is run by two of the directors, one of whom is a registered manager. They were both present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had not consistently submitted notifications to CQC in line with Regulations.
People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the registered manager or to other organisations if they had any concerns and were confident that the appropriate action would be taken.
Risks to people’s safety were identified, assessed, monitored and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.
Robust recruitment processes were in place to check that staff were of good character and safe to work with people. Information had been requested about staff’s employment history, including gaps in employment. There was a comprehensive training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff who knew them well.
People received their medicines safely and told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager had submitted applications to the local authority in line with guidance.
People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the principles of the MCA and how it impacted on the people they supported. They put this into practice effectively, and ensured that people’s human and legal rights were protected.
The building and grounds were very well maintained. Regular environmental and health and safety checks were completed to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire or a flood, the staff knew what to do.
People were provided with a choice of healthy food that they told us they liked. Meal times were social occasions and were very relaxed with people and staff chatting with each other. People were supported to maintain good health and had access to health care professionals when needed. Staff had strong working relationships with health professionals, such as, GPs and the community nursing team.
People were involved with the planning of their care. Care was planned in line with people’s individual care needs. People spoke positively about staff and told us they were kind and caring. People were happy with the care and support they received. Staff knew people well and were familiar with people’s life stories. They were knowledgeable about people’s likes, dislikes and preferences.
People’s privacy was respected and people were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People, their relatives, staff and visiting health professionals were encouraged to provide feedback to the registered manager about the quality of the service. People said their views were taken seriously and any issues they raised were dealt with quickly. They told us they did not have any complaints about the service or the support they received from the staff.
Staff offered people a range of different activities each day. People made suggestions of new activities they would like to do. People, staff and visiting health professionals told us the service was well-led. Staff said they felt supported and valued by the management team.
The registered manager mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities. Some records were not consistently updated.
We have made a recommendation about using signage that might help people living with dementia to find their way around the service.
We found a breach 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 this report.