Highbury Residential Care Home

Highbury Residential Care Home is a residential care home providing personal care to up to 8 people. The service provides support to people with learning disabilities and autism. At the time of our inspection there were 8 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People did not always receive safe care and support, and the environment was not always safe. People’s needs and preferences were not always met.

Risk assessments were not always in place to assess known risks. The environment was not made safe by the provider, with areas of the building that were under renovation, fully accessible to people.

Staffing levels at night did not reflect the level of need people had, should an emergency occur. We did not see evidence the building was safe in relation to fire hazards and checks within this area.

Medicines were not always appropriately documented or managed. Cleaning fluids were not always safely stored and were a known risk to people in the service.

People were not always supported to pursue their hobbies and interests. We did not see evidence people were engaged with regularly activities of their choice. Our observations were of people mostly watching television.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supported people to make decisions following best practice in decision-making.

Staff supported people to access health and social care services.

Right Care:

People did not receive care that was person-centred, and dignity, privacy and human rights were not always promoted.

Some staff communicated with people in a way that was not dignified or caring. Peoples’ privacy was not always respected as personal information was left accessible, and not kept securely.

Many staff had not received training in supporting people with learning disabilities and autism. Staff understood safeguarding procedures. Staff had training on how to recognise and report abuse and they knew how to apply it.

People's care plans reflected their needs and wishes and promoted their wellbeing.

Right Culture:

The ethos, values, attitudes and behaviours of the provider and manager did not always ensure people lead confident, inclusive and empowered lives.

Systems and processes were not effective in picking up and responding to any problems within the service. We saw no evidence the provider or managers knowledge within the field of learning disability and autism care and support, was up to date to ensure appropriate standards could be met.

The staff team were not always proactive in meeting people’s needs, and were reacting to people’s distress and boredom, rather than fostering an environment and atmosphere that would reduce the likelihood of any such distress happening.

People and those important to them, including social care professionals, were involved in planning their care.

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

Rating at last inspection

The last rating for this service was good (published 13 March 2020).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted due to concerns received around the provider’s ability to meet the standards required to safely and effectively provide support to people with learning disabilities and autism. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from Good to Inadequate 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highbury Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, dignity and respect, person centred care and good governance, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

Safe arrangements were in place for visitors to the service including professionals and others. This included information on infection control procedures displayed in the lobby, rapid COVID-19 testing, hand washing and PPE use.

Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home, as well as a recent lateral flow test. We saw records which showed that appropriate checks were made for people entering the home.

A programme of testing for COVID-19 was in place for all staff and people living at the service.

Stocks of PPE (personal protective equipment) were readily accessible to staff and visitors, and regular checks were made to ensure they were being used.

At the time of our inspection, nobody living at the service had COVID-19, however isolation plans were in place to manage the spread of infection should this occur. This meant people could self-isolate in their rooms when necessary.

Policies, procedures, risk assessments and guidance relating to COVID-19 were up to date, which supported staff to keep them and others safe. Management and staff regularly communicated to keep up to date with guidance.

Management conducted regular checks and audits to ensure the service was kept clean and tidy.

Staff were trained in infection prevention and control procedures, including the procedure for safely putting on and taking off PPE (donning and doffing).

Highbury residential care home is a care home providing personal care for adults of all ages with learning disabilities, autistic spectrum disorder, mental health conditions, dementia and/or physical disabilities. At the time of inspection, eight people were supported by the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. The service fitted in well within the residential area where it was located. There were no identifying signs at the front of the home to indicate it was a care home. Industrial bins at the side of the property were adequately concealed.

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

People received safe care, and staff understood safeguarding procedures and how to raise concerns. Risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Medicines were stored and administered safely, and records showed they were administered correctly.

Staffing support matched the level of assessed needs within the service and staff were trained to support people effectively.

People were supported to have their nutritional needs met. Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.

People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know them. Care plans reflected peoples’ likes, dislikes and preferences. An activities programme was in place, and people were supported to pursue holidays and activities they enjoyed with staff support.

A complaints system was in place and used effectively. The provider was keen to ensure people received good care and support and listened to feedback when provided. Investigations took place into accidents, incidents and any events that could be learnt from. Learning was shared with the team and improvements were made when required.

Staff felt supported by the provider and manager and received regular supervisions. The provider was accessible to everyone and was open to suggestion and feedback.

The service applied the underlying principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. Further improvements would include ensuring people are always given choices over all aspects of their care, including improved communication.

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

Rating at last inspection

The last rating for this service was Good (published 4 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. This inspection took place on the 18 July 2017 and we found the service remained Good.

During the previous inspection we found some areas of concern about the maintenance of the home and equipment. Improvements were required to ensure these were addressed. During this inspection we found that this work had been completed.

People continued to receive safe care. Staff had been trained to recognise signs of potential abuse and keep people safe. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks and balanced these against people's rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people's needs. Robust recruitment processes were in place and staff were not employed until satisfactory checks had been completed.

Safe systems were in place to ensure people received their medicines as prescribed.

Staff completed an induction programme when they first commenced work at the service. They were provided with on-going training to update their skills and knowledge to effectively support people with their care and support needs. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.

People were treated with compassion and kindness by staff. Each person was supported in a way that individual to them. People's privacy and dignity was maintained at all times.

People's needs were assessed and care records gave clear guidance on how people were to be supported. Staff were knowledgeable about how to meet people's needs and understood how people preferred to be supported. People were supported to follow their interests and join in meaningful activities of their choice.

There was an effective complaints system in place which was used to drive future improvement within the service.

There were effective management and leadership arrangements in place. Systems were in place to monitor the quality of the service provided to help further develop the service. The provider also submitted statutory notifications to the CQC when required.

We found that people who lived in the home were happy with how they were treated in the home. We saw some people were relaxing in one of the lounges, watching television and using some computer based activities with support from staff.

A family member told us, 'X has been there ten years and he's very happy.'

We were also told, 'Overall, I've got no complaints. They are very supportive.'

The files we looked at contained up-to-date information about the needs of the people who lived in the home and their care and support needs.

We looked at how the provider dealt with any safeguarding matters and saw that clear safeguarding policy and procedure was in place. We also reviewed how the Provider dealt with information and records of the people who lived at the home and of the staff members. We found that the Provider had clear policies and procedures in place. Information was used and stored appropriately.

Finally we saw that the Provider had a clear system in place for dealing with any concerns or complaints brought to their attention.