Highbury Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to seeking consent from people.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective. We found inconsistencies in the accuracy and quality of people’s care plans. Some were detailed and accurate, some were not accurate and lacked detail. There was also an inconsistent approach by the management team to the quality of reviews after incidents and accidents. This meant guidance for staff about people’s needs was not consistently up to date and detailed.

We identified 1 aspect of people’s care needs for which they had not been adequately assessed, and care records were insufficient. This meant people were at risk of delayed or inappropriate care. Following our feedback, the registered manager made changes to improve the guidance to make it much clearer and more specific to people’s needs.

Aside from this health need, we saw improvements in how people’s needs were assessed. We saw evidence that people contributed to the development of their care plans. However, we received mixed views from relatives. Some told us they were involved in reviews of their loved one’s care, other said they were not.

Staff we spoke with knew about people’s care needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People told us they enjoyed the food and drinks offered to them. One person said, “I like the food…. It is always piping hot.” Another told us, “I enjoy the meals. I always have a drink on my table.”

Staff recorded people’s drinks and meals accurately to monitor if they were eating and drinking enough to maintain their health. Records showed both what was offered to people and what was actually eaten and drunk. We saw people were offered good portion sizes for their meals and were encouraged to eat well. People who needed support to eat received this from staff who were patient and did not rush them. This enabled people to eat at their own pace and enjoy and their food. We did note during 1 day of our visit, the TV and music playing whilst people were eating. The sound from the TV and the music was loud enough to make enjoying either difficult. We discussed with the registered manager consideration of the environment during mealtimes to ensure people were not distracted by excess noise while they were eating. People were offered snacks and were provided with regular fresh fruit and vegetables.

Although the provider had systems to encourage teams to work together and share information to support people, they were not always fully effective.

A template designed to share handover information between different shift teams was in place. However, difficult to read handwriting made use of this information challenging at times. The information shared between teams was not checked and was not always accurate. This meant there was a risk people may not receive the care they needed at the right time.

We did see evidence that people received support from a variety of different services and health and social care professionals. Records showed people were benefitting from joined up care and support. For example, records for people who needed support from community healthcare professionals to heal from wounds were detailed and specific. This enabled staff to follow guidance and provide optimal care for people’s skin integrity.

Systems were in place to identify risk to people’s health and prevent this from deteriorating. However, improvements were needed to ensure these were fully effective and we found issues with monitoring and recording of information.

Inaccurate recording and monitoring information presented in handovers meant there was a risk of staff missing signs of deterioration in people’s health and wellbeing. People were encouraged to make healthy choices. People who were at risk of losing weight received fortified meals and supplements to help them gain weight and improve their appetite. People who had diabetes were offered low or no sugar options to help them manage their blood sugars well. People who were at risk of poor mental health from isolating in their rooms, were encouraged to mix with others if they felt able to.

A relative told us about the improvement in their loved one’s wellbeing since moving to the home and being encouraged to mix more with others.

The provider routinely monitored people’s care and treatment, but monitoring records required improvement to ensure accuracy. Inaccurate recording and monitoring information in handovers meant there was a risk of staff missing signs of deterioration. Inconsistent reporting to, and communication with, appropriate external bodies following incidents and accidents impacted the monitoring of these events and outcomes for the people involved.

The management team were working on a service improvement plan. This was designed to improve care and outcomes for everyone. It detailed a lot of work the management and staff teams had done to better manage risk and improve the living environment for people. However, it was not always clear how the provider’s own monitoring systems had contributed to this improvement plan. Most of the concerns identified and addressed had been identified by external agencies, for example commissioning bodies. Further work was needed to ensure the provider’s own monitoring systems could identify concerns effectively and enable improvements in care and safety for everyone.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

The provider had installed CCTV in shared areas of the home, without consulting with people or seeking their consent. CCTV cameras had been installed in the hallways, lounge and dining areas. There was no evidence permission had been sought from people who had the capacity to consent to the installation of cameras. There was no evidence best interests decisions had been made for those who could not consent to the installation of CCTV. This meant people’s privacy and human rights had not been respected. The provider told us they had switched off the CCTV following our discussion. The provider assured us the system would only be reactivated when they were confident a consultation had been conducted and people had consented.

Capacity assessments had been completed for everyone living at the home. However, each person only had 1 capacity assessment which considered multiple aspects of their lives and what they could consent to. This was not in line with the Mental Capacity Act 2005 which specifies capacity assessments need to be decision specific. Where best interests decisions had been recorded, they did not always fully detail and explore restrictions people were subject to.

The registered manager told us they had made changes to the electronic care recording system. This would enable people to have multiple capacity assessments recorded for them. Where people had been assessed as lacking capacity to make a specific decision, they would then have a best interests decision recorded. This work was commenced during our assessment of the service.

Staff we spoke with understood and told us about the importance of seeking consent from people before offering care. We also saw consent being sought during our observations at the home. Care staff we spoke with understood capacity was variable, and dependent upon the complexity of the decision. Care staff could tell us about choices people were able to make for themselves.