CQC report explained · a residential care home
What the CQC found at High Street
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments sometimes contradicted care plans and did not give enough guidance about people's conditions or anxieties. There were also not enough staff to support people safely to live full and meaningful lives, although people said they felt safe and medicines were managed safely.
- Effective?
- Requires improvement
- Consent, mental capacity and best-interest decisions were not consistently recorded. Staff training was missing or out of date in some areas, and care plans did not always match what staff could provide.
- Caring?
- Requires improvement
- Most people said staff were kind, and inspectors saw respectful and patient care. However, people were not consistently involved in care reviews, and low staffing limited independence, activities and time for conversation.
- Responsive?
- Requires improvement
- People had limited opportunities to follow hobbies, go out or take part in the community. One person had not left the home for 25 days after an external activity provider cancelled, and no alternative had been arranged.
- Well-led?
- Requires improvement
- The provider and manager did not have effective checks to identify the problems found by inspectors. There was limited involvement of people, relatives and staff in improving the home, although staff and relatives described the manager positively.
What inspectors found, June 2020
Creative Support - High Street was Rated Requires Improvement; inspectors found kind staff and safe medicines, but staffing, consent and management systems put people at risk.
This was an unannounced inspection over three days. One inspector spoke with four people, five staff, a relative and health and social care professionals. Records about care, medicines, staffing and management were also checked.
People said they felt safe and were happy. Staff were generally kind and knew people well. Medicines, food, communication and access to health professionals were handled well in several areas.
However, there were not enough staff to support people to go out, take part in activities or avoid isolation. Records about risks, care, consent and people's choices were not always accurate or complete. The service did not have effective systems to find and fix these problems.
All five areas were rated Requires Improvement. This means the service was not consistently meeting people's needs and there was limited assurance about the quality and safety of care. The rating had fallen from Good at the previous inspection, published in February 2018.
People felt safe
People and relatives said they felt safe. Staff had a good understanding of safeguarding and how to keep people safe.
“People told us they felt safe at the service.” from the report
Medicines were handled safely
Staff understood people's medicine preferences and used up-to-date instructions for medicines given when needed. Inspectors saw that medicines were administered safely.
“Staff understood how people's medicines were managed safely and in line with guidance and people preferences.” from the report
Kind and respectful staff
Most people said staff treated them kindly. Inspectors saw staff speaking with people respectfully, patiently and compassionately.
“We observed staff speaking with people in ways that showed respect, compassion and patience.” from the report
Good knowledge of people's needs
Staff knew people's likes, dislikes and communication methods well. They understood how to support people who became anxious.
“Staff also knew people very well and had a good knowledge and understanding of what people liked and the best way to approach them.” from the report
Food and health support
People had a choice of food and drink and some helped prepare meals. Staff worked with health and social care professionals to support people's health.
“People told us they had plenty to eat and drink and they thought the food was lovely.” from the report
Too few staff
seriousStaffing levels did not give people enough chances to go out, take part in activities or spend meaningful time with staff. This created a risk of isolation and psychological harm.
“The provider did not deploy enough staff to ensure that people could live full and meaningful lives.” from the report
Consent and rights
seriousThe home could not consistently show how people's capacity, consent and best interests had been assessed. One person was distressed about their living arrangements and said they had harmed themselves as a result.
“Systems were either not in place or robust enough to demonstrate consent was effectively managed.” from the report
Limited activities and community access
seriousPeople generally went out for about four hours once a week with an external provider. The home did not arrange alternatives when those outings were cancelled.
“One person's daily records stated that the person had not left the house for 25 continuous days.” from the report
Weak management checks
seriousThe provider and manager had not used effective audits to identify concerns about care, staffing, activities and records. There was no effective improvement plan when inspectors visited.
“There were no effective systems in place for monitoring care and quality.” from the report
Inaccurate care records
needs fixingSome care records contradicted each other or did not reflect people's current needs, preferences or beliefs. This created a risk that staff could provide the wrong care.
“Care records were in the process of being transferred to the new provider's paperwork, this had meant that not all records were accurate and some information was contradictory.” from the report
Training and environmental shortfalls
needs fixingSome staff training was missing or not regularly refreshed. Inspectors also found rubbish, stored furniture, archived records and trip hazards around the home, although some items were removed during the inspection.
“There were no records of training for some of the specific conditions people were diagnosed with such as Autism spectrum disorder, Downs syndrome, mental health awareness and training to understand how to manage people's anxieties and behaviours proactively.” from the report
- 01What are the current staffing levels on each shift, and how do they support people to go out and take part in activities?
- 02How do you record and review people's consent, mental capacity and best-interest decisions, including any restrictions or DoLS arrangements?
- 03What activities and community opportunities are now available if the external outing service cancels?
- 04How are care records checked so that risks, preferences, beliefs and support plans are accurate and consistent?
- 05What audits and improvement checks are now in place, and can we see the action taken since this inspection?
This was an unannounced inspection of the care and premises covering all five key questions; the previous overall rating was Good, published on 28 February 2018. This explanation was written from the published report of 19 June 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of High Street
3 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- June 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2019
Registered with the Care Quality Commission on 29 April 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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