Highbury Nursing Home

Updated 20 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by an Inspector, an Assistant Inspector, and a Specialist Nurse.

Service and service type

Highbury Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Highbury Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

A new manager was in post and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who were living at Highbury Nursing Home about their experience and views of the service. We spoke with 9 relatives about their experience of care provided. We spoke with 13 staff including, the owner, the manager, the deputy manager, care home assistant practitioners, nursing staff, an activity coordinator, members of the domestic staff team, the maintenance operative and day and night carers. We reviewed a range of records. These included 6 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. We reviewed a variety of records relating to the management of the service, including policies and procedures. We also spoke with a professional who worked regularly with the service.

Updated 20 June 2023

About the service

Highbury Nursing Home is a residential care home providing personal and nursing care to up to 38 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 22 people using the service. The home was purpose built and contained communal lounge and dining areas. People had their own rooms. Some had en-suite facilities, and some did not. There was a shared garden area. At the time of the inspection rooms which could be used to accommodate 2 people sharing were not being accommodated by 2 people.

People’s experience of using this service and what we found

We found the provider had failed to consistently investigate incidents and accidents. This meant that some risks of abuse or neglect were not considered or shared with the local authorities safeguarding team. Some areas of the home still required maintenance and repair making them difficult to clean adequately.

Many care staff still required training in some key areas such as the Mental Capacity Act, Dementia and other health conditions for which some needed care. Care plans contained information about people’s medical needs but not much detail about their wishes and preferences. People were supported by a fully recruited staff team.

More guidance was needed for staff to ensure people were supported to be as independent as they could be. People and their relatives described the staff team as caring. Meetings had begun for people to talk about ways in which the service could improve.

Efforts to provide information to people in a way they could understand had improved. The provider had recruited more staff to support people with activities and interests. People and relatives provided positive feedback about improved access to activities.

Systems to monitor the quality and safety of the service had failed to enable the management team to identify some of the concerns we found on inspection. Risk monitoring systems had failed to highlight some risks to people around the home. This left people at possible risk.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was a person using the service who had a learning disability.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate in all key questions (published 22 February 2023). At the last inspection there were 9 breaches of regulation in relation to the following areas: People being treated with dignity and respect, the leadership and oversight of the service, the safety and well being of people living at the home, how people were protected from the risk of neglect and abuse, meeting people’s nutritional and hydration needs, providing care in the way people wanted it, the need to obtain consent from people, how staff were recruited and the training and support offered to staff. We carried out enforcement activity to place conditions on the provider's registration to support them to improve in this area. These conditions remain in place.

At this inspection we found sufficient improvement had not been made in some areas and the provider remained in breach of some regulations.

This service has been in Special Measures since 01 March 2023. During this inspection the provider demonstrated that improvements have been made in some areas. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highbury Nursing Home on our website at www.cqc.org.uk.

Enforcement

This inspection has identified continued breaches in relation to how people were protected from risks of abuse and neglect, how people’s safety and well-being were monitored, the training provided to staff and how effective the systems leadership had put in place to make sure people received good care. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to monitor and make improvements within the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will request reports to be sent to us monthly to monitor the planned improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.