Highbury House Nursing Home

Highbury House Nursing Home is a residential care home providing personal and nursing care to up to 30 people in an adapted and extended property. The service provides nursing and support to people with varying care needs over the age of 65. Some people had complex care needs, including end of life care. Other people were more independent, and some were living with memory loss. At the time of our inspection there were 24 people using the service.

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

The providers’ governance and quality monitoring systems had not been effective in all areas and had not identified a number of risks and lack of accurate records. This included the safe management of medicines, environmental risks, risks related to care, emergency evacuation and infection control practice.

Systems followed had not ensured all medicines were handled safely and did not ensure people received their prescribed medicines safely and appropriately. Medicines given ‘as required’ did not always have guidelines in place to support staff to give these in a consistent safe way. Records did not support people’s identification as photographs were not in place.

We were somewhat assured that the provider was using PPE effectively, and promoting safety through the layout and hygiene practices. This was because some staff were not wearing masks correctly, the laundry facilities and sluice rooms were not promoting good infection control practice.

Not all systems to monitor and check the safety of the environment were effective. The hot water supply was not checked in all areas and window safety was not routinely checked. The provider was unable to supply the safety certificate for the passenger lift.

The staffing arrangements allowed for people’s needs to be attended to in a safe way. Feedback received confirmed staff had time to spend quality time with people. Staff were recruited safely. People were protected from the risks of harm, abuse or discrimination because staff knew how to recognise any potential abuse and knew what actions to take if they identified any concerns. Routine individual risk assessments identified health and wellbeing risks that were responded to.

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.

There was a positive culture in the service with a focus on team working. Feedback from staff told us they felt valued and part of a supportive team. The managers were available and accessible to staff, people and relatives. The registered manager had established an open and honest culture where staff and people felt able to share their views. The registered and deputy manager worked with families and health professionals to provide the best care and support possible for people.

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 requires improvement (published 14 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This enabled us to review the previous ratings. We undertook a focused inspection to include the safe and well-led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 overall rating for the service has remained Requires Improvement this is the second time this service has been rated Requires improvement. We have found evidence that the provider needs to make improvements.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, infection control practice, the management of some environmental risks and the effective use of governance systems in the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Highbury House Nursing Home provides accommodation, nursing and support for up to 30 people aged 65 and over at the time of the inspection. At the time of our visit 26 people were living at the service.

Accommodation was provided over two floors in one adapted building. There were communal areas, including a lounge, a family meeting room, a dining room and an activities room. People had their own rooms. People had access to gardens at the rear of the home.

We received mixed feedback about staffing levels and people gave us mixed feedback about how responsive staff were to call bells. At the time of the inspection, the provider used agency nurses and carers to make up the numbers for staff to ensure safe staffing levels. The provider demonstrated in action plans and resident and relative meeting minutes that they were aware of the need to have a permanent staffing. People, relatives and staff told us they felt confident that recruitment is ongoing and that the provider was aware of the staffing issues. Following the inspection, the provider told us that recruitment continued to be carried out with the majority of posts filled by permanent staff.

The manager was newly in post and was well regarded by people and staff. Staff told us they had already made improvements to the way the service was run. The home manager told us that during the transition the group manager continued to have a regular presence at the home to support them.

We saw that formal complaints were recorded and investigated. People and relatives told us they knew how to raise a complaint. Despite this, we received mixed feedback about whether complaints resulted in consistent and sustained action or improvement.

The premises were clean and well presented. People were able to move freely around the home and enjoyed using the garden. People were protected from infection by staff that kept the premises clean and used appropriate protective equipment when needed.

Staff were knowledgeable and experienced to deliver care. New staff completed an induction with mandatory training and continued to have access to training and continued professional development opportunities.

Care plans did not always reflect people’s current needs and the food people received did not always meet their dietary needs. We told the provider about this and they agreed to take immediate action to address these issues identified on inspection.

Staff gave people choices and supported people to make decisions about their care. We observed positive interactions between staff and people. People's equality and diversity was respected. Staff knew how to meet people's religious, spiritual and cultural needs and preferences.

Staff supported people to maintain their privacy, dignity and independence.

A structured activities programme was available for people to take part in. A person told us, “I enjoy the activities and I take part in all of them.”

Visitors continued to be welcomed and interactions between staff and visitors were warm and friendly.

People were supported to access health and social care professionals when needed. A GP told us, “Over the past few years I would be able to say that in my experience the service is safe and effective with a caring ethos.”

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

The service met the characteristics of Requires Improvement in three key question and Good in two key questions. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: The last rating for this service was Good (published 19 October 2016).

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services. If any concerning information is received, we may inspect sooner.

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

People told us that they were happy with the support they received with their medicines. One person told us, “The nurses here give me my tablets. Everything runs just as it should.” Systems in place ensured that medicines were managed and recorded appropriately. However, not all nurses had completed an annual competency assessment. We have identified this as an area that needs improvement.

Risks associated with the fire safety of the environment were not always identified or managed appropriately. Staff had not received appropriate fire drill training. We have identified this as an area of practice that needs improvement.

There were sufficient numbers of staff to ensure that people’s needs were met and that they received care and treatment promptly. People commented they felt safe living at Highbury House Nursing Home. One person told us, “Staff are quick to respond to the call bell and we can always find staff around.” Staff were aware of what actions they needed to take to raise a safeguarding concern. A staff member said, “By being a friendly home, I think people have trust in you as staff and raising any concerns becomes so much easier. I have done the safeguarding training and we have talked it over in meetings and I can assure you that I would report anything straight away, but it’s never come up.” Policies and procedures were in place to safeguard people. Essential training, as well as additional training to meet people’s specific needs, had been undertaken. Staff were encouraged to take further qualifications to develop their careers.

Care and treatment focused on the needs of the person and acknowledged their individuality and identity. There was a focus on meaningful activities to ensure people’s social and emotional well-being was fully promoted. There was an activity coordinator in post who led on the provision of meaningful activities. The importance of sharing this responsibility was understood by staff. One member of staff said, “We all have a role in the activities. So for example, I know that people like to get out and about so we go to Rudyard Kipling garden in the village or down to the seafront, anywhere they want to go.”

People spoke highly of the food. One relative said, “The food is absolutely delicious. Mum enjoys a lovely tart made with goats cheese. She let me taste it and it was good.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. A relative told us, “[My relative] wasn’t eating very well when she first arrived. The cook made a point of coming over and introducing themselves and said, ‘If there’s anything you like I will make it.’ They send out an extra jug of gravy or cream out with the meals, as my relative doesn’t like their food too dry.” Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

People told us they were happy living at Highbury House Nursing Home. One person told us, “It’s nice and homely here. It suits me very well.” People’s privacy and dignity was respected. Staff had a good understanding of people’s needs. They treated people with respect and protected their dignity when supporting them with personal care. One person said, “Staff here have love, care and compassion in abundance.” Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

Care plans and risk assessments for people were in place and reflected people’s individual health and social care needs. Staff knew people well and were knowledgeable about their care needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff understood and could demonstrate application of their responsibilities and processes of the Mental Capacity Act 2005 and DoLS. People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. The registered manager was aware of the legal requirements with regards to ensuring people who lacked capacity had mental capacity assessments and that they were not deprived of their liberty unlawfully.

People’s healthcare needs were met. People were able to have access to healthcare professionals when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services. A healthcare professional told us, “I am impressed with the care offered at Highbury House. The home has a loyal and committed staff team. The manager has embraced the support we can offer and works proactively with us.”

The registered manager was described as approachable and supportive. A relative told us, “The registered manager] has been very helpful. Take finances. It has always been a concern but [the registered manager] has kept the accountants at bay. They have been wonderful.” They were visible and proactive and this had helped to create an open culture at the home. Residents meetings provided an opportunity to discuss issues with other relatives and staff. Handover of care meetings were held to discuss people’s changing needs and plan how staff could meet these. Management, departmental and whole staff team meetings were held. Participants were able to contribute to the meetings and make suggestions to improve practice.

Audits were undertaken regularly and included care plans, medicines and health and safety. There was a record for the monitoring and maintenance of the environment and equipment used in the home such as hoists and the lift. Policies and procedures had been reviewed and updated and were available for staff to refer to, as required. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with five people who used the service, two relatives and one visitor. We also spoke with the provider and five members of staff, including the registered manager, two nurses and two care workers.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "It's reassuring to know that (name) is safe and so well cared for here."

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had updated policies and procedures in relation to safeguarding adults at risk, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We were shown documentary evidence of a recent application that had been submitted, including details of the subsequent assessment and authorisation. Staff had received relevant training to understand and recognise abuse and knew the process for reporting any incidence of such abuse. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had the opportunity to be involved in reviewing care plans and they reflected current needs.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. One relative told us 'We were always made to feel so welcome when we came to visit mum, nothing was too much trouble. It was very comforting for us to know she was safe here and the care she received was just wonderful.'

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person using the service told us "The care is excellent. I'm very happy here and I tell people it's the best care home in East Sussex.' One relative told us 'Although she was obviously very ill, she always looked clean, comfortable and so well cared for.'

We saw that the staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of social and recreational activities, reflecting their interests and preferences, both in and outside the service. An activities coordinator was employed and we saw an information board in the dining area which provided people with details of 'What's on for the month of July'.

People's needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people's individual needs.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people using the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they frequently carried out a range of internal audits, including care planning, medication and staff training. The manger also told us that they operated an 'open door policy' so people who used the service and visitors to the home could discuss any issues they may have.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

We also took information from other sources to help us understand the views of people who used the service, which included resident meeting minutes and a residents' survey.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, 'Excellent staff and excellent food. Everything is excellent.' Another person commented, 'The staff are lovely. They look after me all the time.'

The people who used the service were supported to have adequate nutrition and hydration. People were given choices of food and drink that met their diverse needs. One person who used the service told us, 'I'm really happy with the food. I always get a choice and there is plenty of it.'

The people who used the service were in safe and secure premises that promoted their wellbeing.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who used the service.

We also saw that care plans, staff records and other records relevant to the management of the home were accurate, fit for purpose and held securely.

We saw that people had been involved in making decisions about their care and treatment. They had the opportunity to voice their opinions and they were listened to. Records showed that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. People told us they were happy living at the service. They told us they could be independent and that staff respected their choices. One person commented, 'They (the staff) don't stop you from doing anything. They give you help if you want them to and you can be independent'.

Medication was managed safely and people received their medication at the correct time. People who use the service were protected from the risk of abuse and told us that they felt safe at the service. People were protected by the service's recruitment procedures. There were systems in place to identify, assess and manage risks to people who used the service.