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CQC report explained · a residential care home, run by The Avenues Trust

Highfield

1-3 Emily Jackson Close, Eardley Road, Sevenoaks, TN13 1XH

Requires improvementpublished 12 January 2024, 2 years ago

Rated Requires improvement: inspectors found the service was not performing as well as it should and told it what to change.

The five questions inspectors ask
Safe?
Requires improvement
Staff understood people's risks and how to protect them, and there were enough staff. However, some risk assessments and positive behaviour support plans lacked enough guidance, and accident and incident records varied in detail.
Effective?
Good
People had personalised care plans, relevant staff training and access to health services. Staff supported people to make choices, eat and drink safely and develop daily living skills.
Caring?
Good
People were treated with kindness, dignity and respect. Staff supported privacy, listened to people's communication methods and involved people in decisions about their care and home.
Responsive?
Good
Support was personalised and adapted to people's needs, communication and interests. People were supported to maintain relationships, take part in activities and raise complaints.
Well-led?
Requires improvement
Leadership and staff support had improved, but governance systems were not yet robust enough. The provider remained in breach of Regulation 17 because records and checks did not always show that risks and incidents were managed effectively.
The latest report, explained

What inspectors found, January 2024

Rated Requires Improvement; safety and leadership need further improvement, but the home is no longer in special measures.

This was an unannounced follow-up inspection. Two inspectors visited on 29 November 2023 and reviewed information, care plans, medicines records, audits and staff files. They spoke with two people, five relatives and nine staff.

The home had improved since its previous inadequate rating. Inspectors rated Effective, Caring and Responsive as Good. They found kind, person-centred support, enough staff, good communication and support for people's independence, health and activities.

Safety and leadership were rated Requires Improvement. Some risk assessments, positive behaviour support plans and accident records were not detailed enough. The provider remained in breach of Regulation 17 on good governance. The home is no longer in special measures, but CQC will monitor an action plan and progress.

What inspectors praised

  • Enough staff

    Inspectors found enough staff to provide planned support, including one-to-one support for activities and visits. Relatives also said staffing was more stable.

    “There were enough staff to provide the support people needed.” from the report

  • Kind and respectful care

    Staff supported people's dignity, privacy and choices. Inspectors saw calm, patient interactions and people appeared comfortable with staff.

    “People were spoken with in a kind and considerate way.” from the report

  • Communication support

    Staff understood different communication methods and used easy-read information, pictures and individual communication plans.

    “Staff knew people's different communication needs well.” from the report

  • Medicines management

    Medicines records and counts were accurate during the inspection. Staff had medicines training and audits were used to address problems found.

    “Medicines administration records were accurately completed, and the medicine counts had been completed correctly.” from the report

  • Support for independence

    Staff helped people work towards goals and learn everyday skills, such as preparing drinks, doing laundry and taking part in activities.

    “Staff focused on people's strengths and promoted people's independence.” from the report
What inspectors were concerned about

  • Incomplete risk guidance

    needs fixing

    Some risk assessments did not give staff enough information to keep people safe. One type of risk assessment was missing in some bungalows and was completed after the inspection.

    “However, some risk assessments did not have enough guidance for staff to ensure people were as safe as possible.” from the report

  • Behaviour support plans still being updated

    needs fixing

    Positive behaviour support plans were still under review. Inspectors said missing information could lead to people receiving support inconsistently.

    “Without robust plans and information there was a risk people were not supported in a consistent way.” from the report

  • Governance breach

    serious

    The provider's checks and audits did not identify all the shortfalls around risk assessments and incidents. CQC found that governance systems were still not effective and robust enough.

    “The provider had failed to ensure effective and robust governance systems were in place to ensure the health and wellbeing of people who use the service.” from the report
Questions to ask them, based on this report
  1. 01Which risk assessments are still being updated, and when will all staff have access to the completed guidance?
  2. 02How are positive behaviour support plans being reviewed, and how will you check that staff follow them consistently?
  3. 03What changes have been made to the recording and review of accidents, incidents and near misses?
  4. 04How will the provider show that its governance checks are now identifying and correcting all safety shortfalls?
  5. 05What is the progress of the new manager's application to become registered?

This was an unannounced follow-up inspection after the previous inadequate rating, with particular findings about Safe and Well-led; the report also gives updated ratings for all five key questions. This explanation was written from the published report of 12 January 2024 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.

An earlier report, explained

What inspectors found, October 2023

Highfield is rated Inadequate and in special measures; inspectors found serious safety, staffing and management failures.

Inspectors visited unannounced on 18 and 20 July 2023. They spoke with people, relatives and staff, and reviewed care plans, medicines records, staff files and management records.

The home was not safe. Inspectors found safeguarding incidents were not properly recorded or reported, medicines were not always managed safely, staffing was not always enough, and there were environmental and cleanliness risks. Care plans did not always reflect people's current health needs.

The other four areas also needed improvement. People were not always treated with dignity, involved in decisions or supported to do meaningful activities. Staff training and understanding were inconsistent, and leaders did not have effective systems to identify and correct problems.

The overall rating fell from Good at the previous inspection, published in December 2017, to Inadequate. The home was placed in special measures, which means CQC will keep it under review and normally re-inspect within six months unless it proposes to cancel the provider's registration.

What inspectors praised

  • Family visits

    Visiting was unrestricted during the inspection, and visitors were seen coming and going freely.

    “Visiting was unrestricted. We saw visitors coming and going freely during the inspection.” from the report

  • Access to healthcare

    People were supported to use health services, and the home worked with health and social care professionals.

    “People had been supported to access health care services such as physiotherapists and learning disability nurses.” from the report

  • Food and fluids

    Inspectors found that people received support with eating and drinking, and relatives described staff supporting fluid intake during hot weather.

    “People received support to eat and drink enough to maintain a balanced diet.” from the report

  • Some positive care

    Although feedback was mixed, some relatives praised the care and described it as loving and kind.

    “Cannot fault the care, he has never been surrounded by so much love and care.” from the report

  • Accessible bungalows

    The three bungalows were wheelchair accessible.

    “People lived in 3 separate bungalows which were all wheelchair accessible.” from the report
What inspectors were concerned about

  • Safeguarding failures

    serious

    Four potential safeguarding incidents were not recorded effectively or reported to the local safeguarding team. Staff training had not led to a reliable understanding of when incidents should be escalated.

    “We identified 4 potential safeguarding incidents that had not been recorded effectively for management review or reported to the local safeguarding team.” from the report

  • Unsafe medicines and health-risk support

    serious

    Inspectors found an expired medicine had been given, incomplete medicine records and unsafe storage of thickener. Guidance for epilepsy, choking and distress was also unclear or missing.

    “Staff had not ensured people received their medicines safely and in line manufacturing guidance.” from the report

  • Unsafe environment

    serious

    There was mould and rust on equipment, unlocked cleaning chemicals and hazardous areas, a broken mirror and loose electrical sockets. The provider took action on some issues after the inspection.

    “The provider failed to ensure people were free from risk of harm from the environment.” from the report

  • Not enough skilled staff

    serious

    Staffing was not always sufficient to meet people's needs during the day and night. Some staff were overdue training and no staff had completed positive behaviour support training.

    “There was not always enough staff to meet the identified needs of people in the service.” from the report

  • Dignity and respect

    serious

    Inspectors saw medicines being given without adequate privacy and people being moved without being asked or given an explanation. Some staff spoke about a person's health condition in a disrespectful way.

    “Staff did not always speak about people in a respectful way.” from the report

  • Weak management oversight

    serious

    Audits did not identify problems found during the inspection. Leaders did not have effective systems for incidents, risks, medicines, training or the quality of care.

    “Quality assurance audits were not always effective at identifying issues or errors.” from the report
Questions to ask them, based on this report
  1. 01What action has been taken to make sure safeguarding incidents are recorded, reviewed and reported to the local safeguarding team?
  2. 02How are you checking that medicines are stored safely, are in date and are recorded correctly?
  3. 03What staffing levels and skills are now in place during the day and night for each bungalow?
  4. 04How have care plans and risk guidance been updated for epilepsy, choking, eating and drinking, distress and communication needs?
  5. 05Who is currently responsible for managing the home, and how are audits now checking that improvements are working?

This was an unannounced inspection covering all five key questions and both the care and premises, with the ratings changing from Good at the 2017 inspection. This explanation was written from the published report of 20 October 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.

The story over the years

Every inspection of Highfield

5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.

  1. January 2024Requires improvementcurrent ratingup from Inadequate
    Safe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement

    Read what inspectors found at Highfield →

  2. October 2023Inadequatedown from Good
    Safe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate

    Read what inspectors found at Highfield →

  3. December 2017Goodstayed Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. April 2017Goodstayed Good
    Safe: Good

    Read this report on cqc.org.uk

  5. September 2015Good
    Safe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  6. April 2014

    Registered with the Care Quality Commission on 7 April 2014.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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