CQC report explained · a residential care home
What the CQC found at The Highviews
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2023
Requires Improvement; the home is no longer in special measures after progress from an inadequate rating, but some safety, responsiveness and leadership improvements were not yet embedded.
This was a focused inspection on 25 July 2023. One inspector spoke with five people, observed care, spoke with managers and staff, and checked care and management records. The inspection focused on Safe, Responsive and Well-led.
Inspectors found clear improvements since the previous inspection. Staffing was better, people had more opportunities to go out, care was more personalised, and new systems for risks, incidents and management checks were in place.
The improvements were still new and had not been fully sustained. Some night staff were not trained to give as-needed medicines, recruitment still needed attention, and records and care planning needed further development. The overall rating changed from Inadequate to Requires Improvement, and the home left special measures.
Improved staffing
The home had enough staff, including one-to-one support for activities and community visits. People and staff said the extra staffing had improved quality of life.
“The service had enough staff, including one-to-one support for people to take part in activities and visits out in the community.” from the report
More community activities
People had more chances to go out and take part in activities they chose, including arts and crafts and local trips.
“We observed people were being supported with activities they had chosen including arts and crafts as well as being supported with trips out in the local community.” from the report
Better risk management
Risk assessments and care plans had improved. Staff followed advice about eating and drinking risks, and environmental safety arrangements had also improved.
“Risks to people were identified and assessed. Care and support plans provided guidance for staff in how to support people safely to mitigate risks.” from the report
People involved in decisions
People were involved in service meetings and decisions about activities and the home. A concern about the lounge television was acted on.
“Notes from meetings showed how people were engaged. For example, people were encouraged to take turns to chair the meetings.” from the report
Night-time medicines training
seriousNot all night staff had been trained and assessed as competent to administer as-needed medicines. A temporary arrangement was being used while new staff were trained.
“Staff who worked at night had not all been trained and assessed as competent in administering medicines.” from the report
Improvements not yet lasting
needs fixingThe new systems and changes had not yet been shown to be fully embedded and sustained. This affected safety, personalised care and management oversight.
“Systems for assessing and managing risks were not yet fully embedded and sustained.” from the report
Recruitment still needs attention
needs fixingAlthough staffing levels had improved, the provider was still recruiting to make sure suitable staffing levels could be maintained over time.
“The provider continued to recruit new staff. This remains an area of practice that needs to improve to ensure that suitable staffing levels are sustained over time.” from the report
End-of-life planning unfinished
minorSome people had information about their wishes, but the manager described improvements to end-of-life care plans as work in progress.
“The registered manager described this as work in progress and plans to improve end of life care plans were included on the service improvement plan.” from the report
- 01Have all night staff now been trained and assessed as competent to administer as-needed medicines?
- 02How are you checking that staffing levels remain safe when staff leave or recruitment takes time?
- 03How will you show that the new risk, care planning and management systems are fully embedded and sustained?
- 04What changes have been made to people's end-of-life care plans since the inspection?
- 05What opportunities will my relative have to choose activities and go out into the local community?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used in calculating the overall rating. This explanation was written from the published report of 31 August 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, June 2023
Rated Inadequate and placed in special measures; inspectors found serious safety, staffing and leadership failures despite kind relationships with residents.
This was an unannounced inspection on 14 March 2023. Inspectors spoke with all six residents, relatives, staff and the manager. They observed care and checked care, medicine, staffing and management records.
The home did not have enough suitable staff. This left people at risk, including when someone who needed supervision while eating was left alone. Risk assessments were missing or not followed, medicines were not always managed safely, and fire and other environmental risks had not been properly dealt with.
People were generally treated with kindness and dignity by staff who knew them well. However, care plans did not give staff enough guidance, and limited staffing meant people had few opportunities to go out, see friends, develop skills or make everyday choices.
The overall rating was Inadequate. Safe and well-led were rated Inadequate, while Effective, Caring and Responsive were rated Requires Improvement. This was the first inspection of the newly registered service, although the previous provider had been rated Good in 2019.
Kind relationships
Residents and relatives described staff as caring. Inspectors saw warmth, respect and a calm atmosphere, and staff knew residents' needs and preferences well.
“People had developed positive and enduring relationships with the staff.” from the report
Privacy and dignity
Staff respected residents' privacy and dignity during personal care and when residents wanted time alone.
“Staff protected people's privacy and dignity.” from the report
Health support
Residents were supported to attend appointments with GPs and other health professionals, and staff worked with outside services.
“Health needs were assessed, and records showed that people were supported to attend appointments including for annual health care checks with the GP, specialist professionals, dentist, opticians and an occupational therapist.” from the report
Infection control
Inspectors were assured about most infection prevention arrangements, including the use of protective equipment and managing infection risks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Unsafe staffing levels
seriousThere were not enough suitable staff to meet residents' needs. At times only one staff member was on duty, including at night, and one person at risk of choking was left without the required supervision.
“There were not enough suitable staff deployed to meet people's needs.” from the report
Risks and medicines
seriousRisks were not consistently assessed or managed. A prescribed epilepsy medicine had run out, medicine records were unclear, and not all night staff could give medicines.
“The lack of risk assessments, failure to manage risks to people, failure to monitor incidents and failures in systems for managing medicines safely meant that people were at risk of avoidable harm.” from the report
Limited activities and choice
needs fixingResidents had few opportunities to go out, see friends, attend interests or build independence because staffing did not support these activities.
“There was little opportunity for people to go out and take part in activities within the local community.” from the report
Weak management checks
seriousThe home had no effective audits for risks, medicines or incidents, and records were incomplete. This meant problems were not reliably identified, investigated or learned from.
“There was a lack of effective systems for oversight and governance, this meant the provider could not be assured of the quality and safety of the service.” from the report
- 01How many staff are now on duty at different times, including overnight, and how does this match each resident's moving, eating and personal care needs?
- 02What has been done to ensure choking guidance is followed and that residents receive and have accurate records of all prescribed medicines?
- 03Which risk assessments and care plans have been rewritten, and how do you check that staff follow them?
- 04What changes have been completed to give residents regular opportunities to go out, see friends and take part in activities?
- 05What progress has been made with the service improvement plan and the manager's registration?
This was an unannounced comprehensive inspection covering all five key questions, the premises and care provided, including infection prevention and control. This explanation was written from the published report of 6 June 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.
Every inspection of The Highviews
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2023Inadequatedown from GoodSafe: InadequateResponsive: Requires improvementWell-led: Inadequate
- July 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2021
Registered with the Care Quality Commission on 2 December 2021.
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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