Highbury Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager conducted appropriate investigations into incidents and complaints. Lessons were learned from safety related incidents which resulted to changes to reduce risk and improve care. People and relatives we spoke with knew how to raise concerns. Staff told us they felt confident to raise concerns and that they would be listened to and supported by the management team.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People had hospital passports containing key information about their needs and preferences which could be shared with other healthcare providers as needed. We spoke with healthcare professionals who worked alongside the service. They spoke positively about the good standard of communication with the staff team. Referrals were made to external health providers in line with people’s needs and wishes to improve their health and wellbeing.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff understood how to identify and act upon any signs of possible abuse or neglect. For example, when a person had an unidentified bruise, staff recorded this and reported it. The registered manager investigated what could have caused the bruise and looked for any signs of abuse and neglect. Unexplained bruises were reported to the local authority safeguarding team. This invited the scrutiny of external agencies to review what action the manager and team had taken to ensure people were safe.

People we spoke with told us they felt safe. One family told us they had had safeguarding concerns about their loved one. The registered manager had shared concerns raised appropriately with external agencies and conducted investigations. The other relatives we spoke with told us they felt their loved ones were receiving safe care and treatment.

Some of the people living at the home were subject to Deprivation of Liberty Safeguards (DoLS) authorisations. This was because they needed care and were unable to make the informed decisions needed to consent to some of the restrictions living in a care home can create. There was a system in place to ensure people who needed DoLS authorisations had been requested for those who needed them. This system also recorded any conditions imposed on the authorisation and ensured that the conditions were met

Overall, the provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found one example of staff not always making a clear record of circumstances leading to the need for a person to be given sedative medication. We spoke to the registered manager about this. They explained that they had sought advice and support from a medical professional and as a team were working hard to support a person who could frequently become distressed. The manager agreed that completing ‘ABC’ (Antecedent, Behaviour and Consequence) records was the agreed policy and procedure and would speak to staff to ensure records were consistently recorded.

Staff we spoke with knew about the person’s concerns and what could lead to them feeling very distressed. We saw very good examples of caring and compassionate interventions from staff which led to the person feeling eased without the need for medication. We did not have concerns that the person was being unnecessarily restricted.

People’s care documentation detailed risks specific to their needs and wellbeing. We saw clear and personalised guidance for staff regarding people’s specific health conditions. Staff we spoke with knew about people’s risks and how to support them. For example, staff knew who required modified diets to protect them from the risk of choking. Systems were in place to make it easy for staff to check this information and be reminded if needed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager conducted daily checks of the home environment to look for any changes or new risks to people. Facilities and equipment around the home had been well maintained to ensure they remained safe for people to use. Fire safety arrangements were in place to ensure people would be supported safely in the event of a fire emergency. The home was uncluttered and any products which could pose a risk to people such as cleaning supplies, were stored away safely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives we spoke with told us they felt they were supported by adequate numbers of staff. During our assessment we saw staff were always present in lounge areas to monitor people’s safety. Recruitment systems were in place to ensure staff were safe and suitable to provide care to people. Staff spoke positively about the training they received and told us they felt well supported and prepared to do their jobs well. Tasks and responsibilities were assigned to staff on each shift to ensure effective deployment. The home had recently experienced ongoing difficulties with repairs to the lift. Temporary lounge areas had been created on each upper floor and plans were made to ensure dedicated staffing for each area.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

At the time of our assessment, we found the home to be clean, and efforts had been made to update the décor particularly in people’s bedrooms. People we spoke with told us they were happy with the cleanliness of the home. Staff told us they were supported to maintain good levels of cleanliness with regular training and supplies of personal protective equipment (PPE).

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they were happy with the support they received to take their medicines safely. Systems were in place to ensure medicines were stored safely and administered when people needed them. Medications were ordered in a timely way to ensure people did not run out of what they needed. People’s medicines were reviewed regularly to ensure they remained appropriate for their needs. ‘As needed’ medicines were accompanied with guidance to ensure staff understood how and when to administer them.