Higher Bank

At the last rated inspection in 2018 the home was rated good. At this inspection we found standards had declined and the home was now in breach of legal regulations for safe care and treatment, safeguarding, staffing and governance.

The service needed to improve their learning culture. Work was needed to ensure peoples risks were always being appropriately managed. The facilities and equipment were not always well maintained which in turn did not always mitigate risk. It was difficult to determine if enough staff were in place due to the registered managers being included within staffing numbers and no dependency tool being in place. Staff training was not up to date. Medicines were not managed safely; audits of medicines were not robust and records relating to medicines were not always as concise as they should be. Though people could raise concerns, further work was required to ensure people were protected and kept safe. A registered manager told us they were on with the necessary works to improve safety.

It was not always clear if people and their loved ones were involved in assessments of people’s needs. Staff reviewed assessments though these reviews did not always identify the issues we found during our assessment. People had enough to eat and drink to stay healthy, though nutritional good practice was not being followed. The provider did not always work with all agencies who needed to be involved in people’s care for the best outcomes. They monitored people’s health to support healthy living, though how this information was used was not always clear. Staff needed to consider consent more when supporting people, specifically around eating.

People were generally treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People had choice in their care and were encouraged to maintain relationships with family and friends. Staff did not always respond to people in a timely way. The service supported staff wellbeing.

The service provided information in a way people could understand. People knew how to give feedback and were confident the service would take it seriously and act on it. Some further work could be done to ensure people were consistently involved in decisions about their care. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service needed to ensure they always involved appropriate professionals in people’s care. People were involved in discussions about future planning.

It was not easy to determine the culture within the home. Governance needed to be significantly improved within the home. Further work was needed to ensure managers better worked with the local community to deliver the best possible care, and work was needed to ensure they were receptive to new ideas. Improvements were needed to ensure there was a culture of continuous improvement. Although leaders were visible, they did not always present as knowledgeable as they should be in all areas. Staff felt able to speak up, but processes and procedures needed to have appropriate oversight. Staff felt supported and were treated equally, free from bullying or harassment.

This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and or appeals have been concluded. We have also asked the provider for an action plan in response to some of the concerns found at this assessment.