CQC report explained · a nursing home
What the CQC found at Highfield House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, February 2023
Rated Good; a focused inspection found safe, well-led care, but checks on agency staff competence needed improvement.
The inspection was unannounced and took place on 11 January 2023. Inspectors reviewed care, medicines, staffing, training, recruitment, audits and other records. They spoke with people, relatives and staff.
The inspection was prompted by concerns about safe care, risk management and staffing. Inspectors found no evidence that people were at risk of harm from these concerns. Safe staffing was in place, recruitment had increased and reliance on agency staff had reduced.
Inspectors found that staff understood people's needs and used equipment safely. The home worked with physiotherapists and other healthcare professionals. Medicines systems, infection control and safeguarding arrangements were also found to be effective.
The overall rating stayed Good, as did Safe and Well-led. This was a focused inspection of Safe and Well-led only. The other areas were not inspected during this visit and their previous ratings were used for the overall rating.
Safe care and equipment
Staff understood people's needs and received tailored training to use specialist equipment safely. The home worked with specialist healthcare professionals and its physiotherapy team.
“Staff were knowledgeable of the needs of the people using the service and how to support them in line with best practice guidance.” from the report
Improved staffing
Recruitment had increased the staff team and reduced the use of agency staff. The home continued to limit its bed numbers until it had enough staff to open them safely.
“The use of agency staff had reduced by 500hrs between November and December 2022.” from the report
Stronger leadership
The management structure had been reorganised, with clearer responsibilities and more senior clinical roles. Staff received leadership training and took part in governance meetings.
“The reorganisation had also made staff's roles and responsibilities clearer so they knew what to focus on, who to go to for support and when they needed to escalate concerns.” from the report
Learning and training
The home had regular training opportunities and had improved its induction for new staff. Mandatory training compliance had risen to 88%.
“New staff completed additional clinical training as part of their induction process which meant they had greater knowledge when they started providing support to people.” from the report
Agency staff checks
seriousThe provider had not carried out competency checks on agency staff. Inspectors were concerned about the risks, particularly when agency staff supported people with PEG feeding tubes.
“However, we had concerns that competency checks were not undertaken by the provider on agency staff and we had concerns about the risks associated with this,” from the report
Care records follow-up
needs fixingAudits showed that care records needed improvement. Actions were underway, but the system for checking that actions were completed promptly could be better.
“The latest audit findings showed improvements in care records were required.” from the report
Tracheostomy tube cleaning
minorInspectors identified minor improvements needed in the way tracheostomy tubes were cleaned. The provider accepted the advice and said practices would change.
“However, we identified some minor improvements required regarding the practices around cleaning of tracheostomy tubes.” from the report
- 01How do you now check that agency staff are competent for every task they are asked to carry out?
- 02What safeguards are in place when agency staff support people who have PEG feeding tubes?
- 03Have the improvements to care records been completed, and who checks that actions are followed up on time?
- 04What changes have been made to the cleaning of tracheostomy tubes since the inspection?
- 05How will you maintain staffing levels and clinical oversight if more beds are opened?
This was an unannounced focused inspection of Safe and Well-led only; the other key question ratings were not inspected during this visit and the previous ratings were used for the overall rating. This explanation was written from the published report of 3 February 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, August 2022
Highfield House is rated Good; inspectors found safe, kind and coordinated care, but records and staffing still need attention.
Inspectors visited without notice on 13 and 26 July 2022. They spoke with people, a relative, staff and visiting professionals. They reviewed care records, medicines records, recruitment and training records, and watched care and mealtimes.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were protected from avoidable harm, received their medicines safely, and were supported by staff who worked with health professionals.
Inspectors found some areas to improve. There was a high reliance on agency staff, rehabilitation sessions were affected by physiotherapy vacancies, and care records did not always include people's interests or communication methods.
The overall rating fell from Outstanding at the previous inspection in 2018 to Good. The report says the service had recognised areas affected by the COVID-19 pandemic and had plans to improve training, recruitment and electronic care records.
Safe care and medicines
Inspectors found regular risk checks and safe systems for storing, giving and recording medicines. Staff responded quickly when people's health or equipment needs changed.
“People received their medicines as prescribed and there were safe practices around the storage, administration, recording and disposal of medicines.” from the report
Kind and respectful staff
People were treated with dignity and supported to make choices. Staff also helped people maintain independence and provided emotional support.
“People were treated well, and with dignity and respect.” from the report
Coordinated health support
The home worked closely with nurses, therapists, doctors, hospitals and other professionals. This helped staff respond to changes in people's health and support rehabilitation.
“Staff worked closely with healthcare professionals to ensure people's health needs were met and people received effective, coordinated care.” from the report
Involvement of families
People and relatives were encouraged to share their views. Families could be involved in care reviews and decisions, including medicine reviews and advance care planning.
“This gave families the opportunity to have their views included in medicine reviews and the development of care plans, including advanced care decisions.” from the report
Learning and improvement
The home reviewed incidents and shared safety alerts so lessons could be learned. Leaders had improvement plans for recruitment, training and care records.
“There was an ethos within the service to learn from mistakes and when things went wrong.” from the report
Reliance on agency staff
needs fixingThere were enough staff to keep people safe, but the home was relying heavily on agency workers. This could make it important to ask how new or temporary staff learn about each person's needs.
“At the time of our inspection there was a reliance on the use of agency staff.” from the report
Physiotherapy delays
needs fixingPhysiotherapy vacancies meant some people were not assessed as quickly as they should have been or did not receive the planned number of sessions for rehabilitation.
“This meant people were not being assessed as quickly as they should or receiving the number of physio sessions needed to help with their rehabilitation.” from the report
Personal information missing from records
needs fixingCare records focused mainly on clinical needs and did not always record what people liked or were interested in. The home had started one-page profiles but had not yet rolled them out to everyone.
“The focus was more on their clinical needs rather than them as a person.” from the report
Communication details not always recorded
needs fixingStaff knew different ways people communicated, including non-verbal methods, but this information was not always in care records. The report says this could affect interactions with agency and newly recruited staff.
“This information was not always included in people's care records and therefore may impact on the quality of communication and interactions from agency staff and new staff who did not know people as well.” from the report
- 01How many agency staff are currently working here, and how do you make sure they know each resident's needs and communication methods?
- 02Have the physiotherapy vacancies been filled, and are residents now receiving the assessments and sessions set out in their plans?
- 03How do you record each resident's preferred name, interests and personal routines so all staff can use this information?
- 04How are people's verbal and non-verbal communication methods recorded and shared with new and agency staff?
- 05What progress has been made with the training programme and the new electronic care records since this inspection?
This was an unannounced inspection covering all five key questions and infection prevention and control; the Safe and Caring ratings stayed Good, while Effective, Responsive and Well-led fell from Outstanding to Good since 2018. This explanation was written from the published report of 10 August 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 House
4 rated inspections over 7 years: the service has held its Good rating throughout.
- February 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2022Gooddown from OutstandingSafe: GoodWell-led: Good
- February 2018Outstandingup from GoodSafe: GoodEffective: OutstandingCaring: GoodResponsive: OutstandingWell-led: Outstanding
- November 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- September 2011
Registered with the Care Quality Commission on 8 September 2011.
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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