This unannounced inspection took place on 19 September 2018 and 08 October 2018. During our last comprehensive inspection on 02 August 2017 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to keeping people safe, personalised care and support, dignity and governance. We rated the service requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions, Safe, Effective, Caring, Responsive and Well-led to good. At this inspection we found that not all the areas we previously found not meeting the required standards were improved.

Highfield Care Home 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 Care Home is a purpose-built care home and is registered to provide accommodation and personal care for up 54 older people some of whom are living with dementia. At the time of our inspection 42 people were living at Highfield Care Home.

There was a recently employed manager in post, however they were not registered at the time 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 2008 and associated Regulations about how the service is run.

People we spoke with told us they felt safe in the home. Relatives told us they felt that the care people received was safe. However, we observed, during the inspection that staff did not always follow guidance given by health professionals for people who needed assistance with their meals because they were at risk of choking.

Risk assessments had been completed and were regularly reviewed. However, when staff completed risk assessment tools to ascertain the level of risk presented to people the scores were not added up correctly and were not consistently reflected in assessment of need care documents or care plans. This meant that there was a risk people did not have the appropriate measures in place to mitigate the identified risks.

People told us that there were less staff over weekends and on occasions they had to wait long period of times for staff to answer their call bells. This was confirmed by relatives who told us that at the weekends there was always a shortage of staff. Staff members we spoke with told us there were not enough staff deployed to meet people`s needs in a timely way. Our observations confirmed that staff were stretched and busy which led to some people`s support being carried out in a rush.

People told us staff were kind and caring and protected their dignity and privacy. Care plans were developed and were reflective of people`s likes, dislikes and preferences, however not all care plans we reviewed had been updated following a change in people`s needs. Care plans contained a high level of information that was not helpful for staff and it did not give sufficient guidance in how staff should meet people`s needs in a personalised way.

Where people were identified at risk of malnutrition or dehydration and required their food and fluid intake monitored, this had not been done effectively. Where people used their own mobility equipment risk assessments were not developed and assessments were not carried out by the provider to ensure the equipment was suitable and in good working order as well as used correctly by people.

Safe and effective recruitment practices were followed to ensure that staff working at the home were of good character and suitable for the roles they performed.

People received their medicines safely and had access to healthcare prof

This inspection took place on 02 August 2017 and was unannounced.

Highfield Care Home provides nursing and personal care for up to 49 older people, some of whom were living with dementia. At the time of the inspection there were 47 people living in the home.

The registered manager recently left the service. 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 2008 and associated Regulations about how the service is run. The provider had recently employed a manager who was not yet registered with CQC.

People and their relatives felt that the home and the care delivered met their needs. However we found that the care people received had not always promoted their safety regarding pressure care management and nutrition.

Care plans were not up to date and did not provide staff with sufficient guidance to meet people`s needs safely and effectively. People`s likes, dislikes and preferences regarding their care was not always captured in their care plan or considered by staff when delivering the care and support people needed. Care records were not always legible and easy to read.

People told us they felt staff protected their dignity and privacy, however we observed that some of the staff`s actions had a negative impact on people`s dignity.

Where potential risks to people’s health, well-being or safety had been identified, these were assessed however not regularly reviewed to take account of people’s changing needs and circumstances. Food and fluid monitoring charts were not completed effectively and for people who were losing significant amount of weight it was not clear what the staff were doing to promote good food and fluid intake.

People told us their call bells were answered in a timely way. The provider used a dependency tool to inform their staffing levels. However we observed that there were a high numbers of people with complex needs who may have benefitted from more time spent with them, however staff were not able to do this.

Safe and effective recruitment practices were followed to ensure that staff working at the home were of good character and suitable for the roles they performed.

People received their medicines safely and had access to healthcare professionals such as GP’s, dentists, opticians and chiropodists when required.

We found that staff obtained people’s consent before providing the day-to-day care they required however mental capacity assessments were not always carried out to establish if people had capacity to understand and take decisions regarding the care and support they received.

Staff were caring and attentive to people’s needs and interacted with people in a warm and respectful manner. People were given choices in such areas as food, activities and where they wanted to spend their time.

There were a variety of activities available in the home however a high number of people were cared for in their bedrooms and more one to one activities were needed to meet people`s social needs. The provider was in the process to recruit an additional activity staff to meet people`s needs.

People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement.

The manager and the provider completed a range of quality audits to monitor the quality of the service provided however we found that these had not been effective in identifying the issues we found at this inspection.

When we inspected Highfield Care Home on 22 August 2013 we spoke with four people living there and looked at six care plans. We also spoke with the relatives of one person who were visiting that day and with three members of the care staff.

We found that people were asked for their consent about their care provision and that, where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People’s needs were assessed and care and treatment was planned and delivered to meet those individual needs. One person we spoke with told us, “I get everything I need here.” Another person said, “I need help all the time and the staff are really good.”

People who were at risk of developing pressure ulcers had appropriate care plans in place that were followed by the staff.

People's medicine was administered on time and according to their prescription. There were proper arrangements in place for storing and recording medicines.

There were enough staff on duty, including nursing staff, for each of the three shifts to meet people's needs.

Care plans and daily records were stored securely and could be readily accessed by staff. Care plans and records were fit for purpose and ensured people received safe and appropriate care.

When we visited Highfield Care Home on 6 September we talked with some of the people using the service who spoke highly of their experience of living there. We saw that people's rights and choices were respected, particularly in relation to what they ate and drank. One person said, “Yes, there is a choice, and they keep to it too – and when you get it, it’s very hot even after serving all these people”.

One person told us that they had specific dietary requirements and that the staff at the home provided them with a wide variety of food. The person also said that they needed particular supplements to support their diet and that they were given these without fail.

People told us that they were involved in decisions about daily life at the home. For instance, one person said,”The activities lady asks us what we want to do and invariably we get to do it."

People also spoke highly of the care staff at the home. One person said, “Everyone is kind here, I just cannot see how it can be better”. Another person told us, "The carers [care workers] are all very good and kind, day and night. It's nice to have someone to help you.”

People told us that they felt safe and protected from harm at this home. One person said, “You are safe day and night here”. Another person told us, "Yes, I feel comfortable and safe and protected here”.

This inspection took place on 5 and 6 February 2015 and was unannounced.

Highfield Care Home provides nursing and personal care for up to 49 older people, some of whom were living with dementia.

The service had a registered manager in post since September 2014. 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 2008 and associated Regulations about how the service is run. The provider had appointed an interim manager to manage this service with support from a senior management team until a permanent manager is recruited to post.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that not all applications had been made to the local authority in relation to people who lived at Highfield Care Home however these were later completed subsequent to our inspection.

People said they felt happy and safe at the home and staff treated them with kindness, dignity and respect. Relatives were also positive about the care and support provided.

People and their relatives gave mixed opinions about staffing levels particularly during the busier times of the day.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs.

People received their medicines safely and had access to healthcare professionals such as GP’s, dentists and chiropodists when required.

People were supported to take their medicines as prescribed and were supported where possible to administer these themselves.

We found that staff obtained people’s consent before providing the day-to-day care they required. However, we found that people’s consent had not been obtained in line with the MCA 2005 in all cases.

Staff were caring and attentive to people’s needs and interacted with people in a warm and respectful manner. People were given choices in such areas as food, activities and where they wanted to spend their time. Staff respected people’s privacy and their visitors were always welcomed at the home.

People were involved in planning their own care and staff were responsive to their needs.

People’s care needs were reviewed regularly to ensure the agreed plan of care continued to meet their needs.

There were a variety of activities available in the home however not all people were able to access these.

People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement.

The manager completed a range of quality audits to monitor the quality of the service provided, however people’s care records were not always legible and easy to read.