High Lea House

The provider was in breach of the legal regulation relating to Safe care and treatment, governance and meeting responsibilities in sharing safeguarding information. The provider was previously in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation. In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

This assessment was completed due to concerns raised by the local authority around the quality of care and leadership.

This inspection identified significant and widespread concerns in relation to the safety, governance and management of the service. People were not consistently protected from risks, and there was a lack of effective systems to monitor, assess and respond to safety concerns. The provider had not ensured there was appropriate leadership and oversight, and this had resulted in a deterioration in meeting standards of care.

The service had been without a registered manager for over 12 months. During this period, arrangements to monitor quality, manage risks and ensure compliance with regulations were ineffective. The nominated individual, who was acting in a management role at the time of inspection, did not demonstrate sufficient knowledge of regulatory requirements or an understanding of their legal responsibilities. This significantly limited the provider’s ability to identify concerns promptly and take appropriate action.

The provider placed people at risk of not having their hydration needs met because there was no system in place to oversee or escalate concerns when recorded fluid intake was low.

Medicines management practices did not safely protect people. We identified concerns with storage of medicines. Records to guide staff on how to administer medicine lacked detail.

There was no effective system to review incidents or identify patterns and trends. Where people experienced repeated falls, this was not escalated or reviewed to identify changes in health or support needs.

Safeguarding systems were ineffective. Injuries, including bruising and deaths, were not consistently shared with CQC, and required notifications were not submitted by the provider.

Records relating to mental capacity were conflicting for some people, creating uncertainty about decision-making.

Personal Emergency Evacuation Plans (PEEPs) did not provide clear guidance to staff regarding the safe evacuation of people who used the stair lift. There was no risk assessment relating to the stair lift, despite confirmation from the fire service that it should not be used in the event of a fire.

People shared mixed experiences of living at High Lea House. Some people told us they felt restricted in their independence, including limited use of the stair lift, not going out with staff, and a lack of opportunities to attend community or faith activities such as church. One person told us, “The lift broke down, was replaced with stair lift, we’re restricted by this now as the provider likes a member of staff to be with you”.

The environment was an old-style building. People we spoke with commented on the building. One person told us, “Downstairs bedroom, bit small and cramped. Would like a larger room”.

People said they would like more activities, greater access to books, and improved food choices, particularly at breakfast. One person told us, “Don’t do a lot unfortunately, lack of facilities, hairdresser is good - bingo and extra activities. A few more activities would be good, this might be a lack of resources.” Some people also commented on their living environment, including wishing for larger rooms. We did receive positive feedback regarding some of the activities, 1 person told us, “When we’re asked by activities what we want - make fruit skewers. Made biscuits/ decorated biscuits. Flower arranging. Communion - 1st Tuesday of each month. Service last Wednesday of each month”.

Relatives raised concerns about cleanliness and oversight. We were told there was no cleaner present on Sundays. One relative told us, “Cleaning isn’t great”.

During lunchtime observations, people were seen eating independently, which was positive. However, staff interaction was limited. One staff member was observed serving very hot plates with minimal communication with people. This lack of communication increased the potential risk of causing harm to people through scalding. People who required supervision in the dining room had staff present to observe them while they ate.

Some people told us their needs were met and they were happy living at High Lea House. However, there were missed opportunities to promote choice, engagement, reassurance, and positive experiences for people and their relatives. One person told us, “Very good staff, do what they can and work hard. [Owner] will be leaving eventually. I like the lady very much. I’ll cry when she leaves, her personality, her warmth and caring. Ability to put residents first”.