About the service:

Highgrove is a residential care home that was providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. Accommodation is provided across three floors, each with separate facilities.

People’s experience of using this service:

Staff spoke warmly about people and were involved in their emotional well-being. Staff treated people with respect and dignity. People were overwhelmingly positive when describing how staff supported and cared for them.

Care plans were personalised and individual to each person describing people’s care needs from the person’s perspective. Concerns and complaints were responded to and actions taken to improve the quality of care where appropriate. People were consulted in their end of life care plans and well-supported during their end of life.

The service had a clear vision to provide the best quality care for people living at the home; and staff understood this. Regular surveys and communication took place with people, relatives and staff; actions from these were discussed and implemented. The home was innovative and worked in partnership with other organisations to improve the quality of care in the home and involve people in the community and the wider world.

People’s needs and choices were assessed and care and support delivered in line with these assessments. Outcomes were identified and records showed how these were met. People’s weight was monitored and they were supported and encouraged to eat and drink to maintain a balanced diet. There were good methods of communication evident to ensure staff worked well together across the home and with external organisations to ensure effective care and support. Staff were vigilant about people’s health needs and records showed how health professionals were involved when needed. People were involved in the running of the home; they provided questions for recruitment, ran activity sessions and were consulted about changes to the home through regular meetings. People had consented to their care and support where they were able to do so, and where not appropriate legal documentation was in place.

Good practices were evident to keep people safe from abuse. Risks were assessed and people were supported safely according to assessments which supported people’s freedom. Medicines were administered safely and using up-to-date guidelines. Infection control procedures were in place and stocks of PPE and cleaning products were readily available. Staff were diligent about following these processes. Accidents, incidents, complaints and concerns were monitored and analysed and required actions put in place.

Rating at last inspection:

At our last inspection we rated the service as requires improvement (29 May 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any information of concern is received we may inspect sooner.

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

Our inspection took place on 18 December 2017 and was unannounced. We had inspected the service before, however this was the first inspection whilst being registered under Crown Care IV Ltd.

Highgrove 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. Highgrove is a care home registered to provide accommodation and nursing care for up to 67 people who may have dementia care needs. The home was built in 2009, is purpose built and provides all single bedrooms with en-suite facilities. On the day of our inspection, there were 62 people living at the home.

There was a registered manager in post when we inspected. 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 told us they felt safe at Highgrove. We saw risks associated with care and support were assessed, but found inconsistencies in the quality of information in care plans.

We found processes to recruit staff were safe, and staff were deployed in sufficient numbers to respond to people’s needs. Staff understood how to recognise and respond to concerns about potential abuse. People received their medicines safely.

We received good feedback about the staff’s skills and knowledge, and we saw staff received regular training and support from management.

People gave positive feedback about the food in the home, however we found risks associated with people’s nutritional health were not always well managed. Adapted equipment was available to enable people to remain as independent as possible with eating, and we saw people received assistance when this was needed.

The provider recognised when they needed to apply for Deprivation of Liberty Safeguard (DoLS) authorisation, however we found documentation relating to people’s capacity was not always effective. We saw the provider had recognised this, and we made a recommendation about reviewing and updating this information in people’s care plans.

People told us the staff were caring, and our observations confirmed this. People’s privacy, dignity and independence were well supported. There was a good approach to equality and diversity principles which ensured people did not experience discrimination.

We found information in people’s care plans was not always kept up to date with changes in their needs, although staff practice reflected knowledge of these.

Care plans were available in alternative formats such as larger print or braille if people required these, and arrangements were in place to ensure there was equality of access to activities. We received good feedback about the activities provided at Highgrove.

We saw complaints and concerns were resolved appropriately, and saw evidence the home received compliments from people and their relatives about their experiences of care.

We received positive feedback about leadership in the home. There was a clear vision for how the service provided care for people.

Although there was a programme of audit in place, the provider acknowledged they had identified improvement was required in this area.

People, their relatives and staff were consulted in the running of the home, and we saw a high level of satisfaction reported through survey activity.

We identified two breaches of regulation during this inspection relating to safe care and treatment and good governance. You can see what action we have told the provider to take at the back of the full version of the report.