CQC report explained · a residential care home
What the CQC found at Highfield
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some risks were not dealt with quickly, people could go for up to two hours without checks, and records did not always show that repositioning, food and drink support had happened. Some communal and bedroom areas were dirty, although medicines were managed safely and staff were recruited safely.
- Effective?
- Requires improvement
- Staff did not always have certified or documented competence for specific needs such as catheter care. Food and fluid records had gaps, and kitchen information did not always explain people's dietary support clearly.
- Caring?
- Requires improvement
- People were not always treated with dignity or responded to when asking for drinks, and staff did not always knock before entering bedrooms. Inspectors also saw kind and calm interactions, and staff supported some people to remain independent.
- Responsive?
- Requires improvement
- People could go for long periods without conversation, activities or support to follow their interests. Communication methods such as pictures or photographs were not always available, although care plans were personalised and complaints were handled promptly.
- Well-led?
- Requires improvement
- Audits did not identify or drive improvement in several areas, including cleanliness, staffing deployment, records and social isolation. The management team accepted feedback and began taking action, but progress had been slow.
What inspectors found, November 2023
Rated Requires Improvement; inspectors found risks, gaps in person-centred care and weak quality checks, despite kind staff and safe medicines support.
This was an unannounced inspection on 7 and 14 November 2023. Inspectors spoke with 13 people, 7 relatives and 15 staff. They reviewed care, medicines, recruitment and management records.
All five areas were rated Requires Improvement. Inspectors found risks that were not dealt with quickly, unclear records about people's care, cleaning problems and staff deployment that left some people without enough interaction. Some staff also lacked formal training for specific care needs.
People were not always treated with dignity or supported to follow their interests. People who did not communicate verbally were not always offered choices in other ways. The home had an activities coordinator and some improvements began during the inspection.
There was no evidence that people had been harmed. However, the report says there was limited assurance about safety and an increased risk that people could be harmed. The previous overall rating was Good in 2018, while a targeted infection control inspection in 2022 found no concerns.
Safe medicines support
Inspectors found that medicines were administered by trained staff whose competence was checked regularly. Protocols were in place for medicines given when needed.
“People were supported safely with their medicines. Staff were trained to administer medicines and had their competency to do so checked regularly.” from the report
Health support
People were supported to contact health professionals when needed. Professionals said staff listened to and followed their advice.
“Professionals who worked with staff spoke positively about how their advice was listened to and followed closely to help support people.” from the report
Kind interactions
Although care was not consistently caring, inspectors saw staff speak calmly and kindly with people. People appeared happy and relaxed during these interactions.
“People were visibly happy and relaxed when being supported by staff and smiled and laughed with them.” from the report
Personalised care plans
Care plans gave a detailed overview of people's likes, dislikes and preferences. People and relatives were involved in discussions about care.
“People's care plans were personalised and detailed and gave a good overview of people's likes, dislikes, and preferences.” from the report
Complaints and end-of-life care
Complaints were responded to promptly and their outcomes were recorded. Inspectors also found that end-of-life plans were detailed and respected people's preferences.
“The registered manager responded in a timely manner to complaints and recorded the outcomes of these for future learning.” from the report
Unresolved safety risks
seriousSome risks were not assessed or dealt with promptly. People could go for long periods without checks, and unclear records made it difficult to confirm that important care had happened.
“Some people were at risk because not all risks had been assessed in a timely manner.” from the report
Cleanliness and infection risk
seriousCommunal bathrooms and some bedrooms were visibly dirty. Inspectors said infection prevention and control measures were not effective.
“Several areas of the home were not clean and posed an infection risk to people and staff.” from the report
Limited daily interaction
seriousStaff deployment meant people could be left without conversation or meaningful activity for extended periods. This increased the risk of loneliness and boredom.
“People were not always supported in a person-centred way. Staff deployment meant people went for extended periods of time without interaction, increasing the risk of social isolation.” from the report
Gaps in staff training
needs fixingStaff supporting people with specific needs, including catheter care, did not always have certified or documented competence. Inspectors recommended that training and competence be reviewed.
“Staff were supporting people with specific care needs such as catheter care and did not have certified training in this.” from the report
Dignity and communication
needs fixingInspectors saw examples of people not being responded to and staff entering bedrooms without knocking. Staff were also unsure how to offer choices to people who did not communicate verbally.
“Staff did not always respect people's privacy and dignity.” from the report
Weak quality checks
seriousAudits did not reliably identify problems with cleanliness, records, staffing, staff knowledge or people's social support. The report says the culture was not always positive.
“Systems and audits to monitor the quality of the service were not always effective and did not identify areas for improvements.” from the report
- 01What specific action has been completed to remove trip hazards and improve falls checks?
- 02How do you now make sure repositioning, food and drink support are recorded clearly every day?
- 03What formal training and competency checks do staff have for catheter care and other specific health needs?
- 04How do you make sure people receive regular interaction and can follow their own hobbies and interests?
- 05What changes have been made to cleaning checks and quality audits since this inspection?
This was an unannounced inspection covering all five CQC questions, including the premises and care provided; the previous full inspection rating was from 2018. This explanation was written from the published report of 29 November 2023 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.
What inspectors found, March 2022
Inspected but not rated; inspectors found good infection control in many areas, but noted cluttered bedrooms, hand-opened bins and crowded staff breaks.
This was an announced, targeted inspection on 17 February 2022. Inspectors checked infection prevention and control, visiting arrangements and whether staff pressures were affecting people.
The home had several positive measures. Visitors were checked for testing, vaccination and temperature. Staff used protective equipment correctly. People could have visits with arrangements based on their needs and preferences. Staff covered sickness and isolation without using unfamiliar agency workers.
Inspectors were only somewhat assured about some infection control arrangements. Some bedrooms were cluttered, some bins had no pedal and many staff took breaks together in the dining room. The service was inspected but not rated, so this report does not provide an overall quality rating.
Visitor infection checks
Visiting professionals had to show a negative lateral flow test and vaccination evidence, and have their temperature checked.
“Effective infection control measures were in place for visiting professionals to the service.” from the report
Protective equipment
Staff had training and used personal protective equipment correctly.
“Staff had training how to use Personal Protective Equipment (PPE) effectively and used this correctly.” from the report
Family visits
People had individual visiting arrangements based on their needs and preferences, helping them see family and friends safely.
“People had separate visiting risk assessments and arrangements depending on their support needs and preferences.” from the report
Consistent staff team
Staff covered vacant shifts caused by sickness or isolation, and the service did not use unfamiliar agency staff.
“This meant that people were supported by a consistent staff team who knew them well.” from the report
Clutter and bins
needs fixingSome bedrooms were cluttered, making deep cleaning difficult. Some bins had no pedal and had to be opened by hand, which increased infection risk.
“Some bins at the service did not have a pedal meaning that they needed to be opened by hand, increasing the risk of infections being spread.” from the report
Crowded staff breaks
needs fixingMany staff took their breaks together in the communal dining room. Although social distancing was maintained, inspectors said this increased the risk of airborne infection spreading.
“The number of people congregated at one point, increased the risk of infectious airborne diseases such as COVID-19 spreading.” from the report
- 01Have all cluttered bedrooms been cleared enough to allow effective deep cleaning?
- 02Have the bins without pedals been replaced, and when was this completed?
- 03How are staff breaks arranged now to reduce the risk of infection spreading?
- 04How will visiting arrangements be agreed around my relative's needs and preferences?
- 05What infection control checks are currently required for visitors and visiting professionals?
This was a targeted inspection of infection prevention and control, visiting arrangements and staffing pressures; it was not a full inspection and the service was inspected but not rated. This explanation was written from the published report of 3 March 2022 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 Highfield
5 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- November 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2022Inspected but not ratedSafe: Inspected but not rated
- May 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Requires improvementstayed Requires improvementSafe: Requires improvement
- March 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- February 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2014
Registered with the Care Quality Commission on 7 April 2014.
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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