About the service Highview Lodge is a residential care home providing personal to up to 77 people. The service provides support to older people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 63 people using the service.
People’s experience of using this service and what we found
People’s safety was not always well managed. We saw there some examples where moving and handling needed to be reviewed and better management of dietary requirements were needed. People who had modified diets did not always have food provided in the correct way and records did not always reflect actual needs.
Medicines were not always managed safely. We found that not all records and quantities tallied and recording systems, such as daily reconciliation and stock quantities carried over from previous cycles, were used consistently. Protocols for medicines on an as needed basis were not in place for all medicines or did not always include enough information.
Most people had their care needs met. We noted three people who needed their full care needs to be attended to. We also found where care needed to be more person centred and delivered in a way that promoted people’s dignity.
People and staff said there was generally enough staff to meet people’s needs. Two people told us at times there were delays for care needs to be met. Agency staff were supporting the home, many having worked at the home often. However better management of new agency staff starting, particularly around their induction to the home, was needed to ensure this did not impact on people.
Infection control practices were in place and staff knew what they needed to do. Some carpets needed to be replaced as they were worn and had malodours.
The management systems in the home were in place, however had not been effective to address the shortfalls. However, people, relatives and staff were positive about the management and leadership in the home.
Lessons learned were recorded and actions implemented. The management team told us that there had been several areas to work on, but they were committed to making the improvements. We found that they had made improvements in the areas raised at previous inspections.
Following our feedback immediate action was taken to address all points raised. These actions, and supporting records provided, gave us reassurance that risks were mitigated.
We found the management team to be open and responsive to feedback. A visiting healthcare professional told us that the management team and staff worked well with them.
People told us that their needs were met, and staff were nice. They told us they felt safe. Relatives were confident about the standard of care and told us staff were friendly. Relatives felt the management team and staff were approachable and knew people well.
People had access to food, drink and call bells throughout our inspection. We saw that staff were friendly in their approach with people. There was a programme of refurbishment ongoing.
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.
Rating at last inspection
The last rating for this service was good (published 12 August 2021).
Why we inspected
The inspection was prompted in part due to concerns received about medicines, standards of care, infection control and staffing. A decision was made for us to inspect and examine those risks. 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 has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The registered manager and their team took immediate action to address the shortfalls found which helped mitigate risks to people. This included, audits, training, implementing additional checks and surveys.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highview Lodge on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and governance systems at this inspection.
Please see the action we have told the provider to take at the end of this report.
We recommend the provider develops a management plan to ensure that shifts are sufficiently covered during agency staff induction periods and break times.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.