The Care Quality Commission
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Archived: Highbury House Care Home

Overall: Requires improvement read more about inspection ratings

580-582 Lytham Road, Blackpool, Lancashire, FY4 1RB (01253) 344401

Provided and run by:
Mr David Moseley & Mrs Barbara Selina Moseley

All Inspections

25 April 2016

During a routine inspection

This inspection took place on 25 April and 3 May 2016 and was unannounced.

At the last inspection in October 2015 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and was rated as ‘Inadequate’.

During the last inspection, we found multiple breaches of legal requirements. This was in relation to safeguarding people from unsafe care, abuse and improper treatment, dignity and respect; premises and equipment; infection control; staff recruitment; staffing; record keeping; consent and capacity; governance of the home and notifications to the Care Quality Commission (CQC).

As a result of our findings the service was placed in ‘special measures’ by CQC. This report only covers our findings in relation to the latest inspection. You can read the report from our last inspections in October 2015, by selecting the 'all reports' link for Highbury House on our website at: www.cqc.org.uk.

During this inspection on 25 April and 03 May 2016, we found the provider had made improvements and was meeting the fundamental standards inspected with the exception of Regulation 19 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Fit and proper persons employed.

You can see what action we told the provider to take at the back of the full version of the report.

During this inspection the service had demonstrated improvements and is no longer rated as inadequate for any of the five key questions. As a result of the improvements made, the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in future inspections.

Highbury House is located in South Shore, Blackpool. The home is registered to accommodate up to 28 people who require assistance with personal care. The property is a large detached house with accommodation over two floors. There is a passenger lift for ease of access and the home is wheelchair accessible. The majority of the bedrooms are single occupancy and en-suite. There are private parking facilities at the front of the building and garden areas at the rear. During this inspection there were 24 people living at Highbury House.

There was not a registered manager in place. The previous registered manager left the service after the last inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new manager had been appointed in February 2016. She was in the process of applying to be registered with CQC.

People told us they felt safe at Highbury House. Procedures were in place and risk assessments completed to reduce the risks of abuse and unsafe care. However recruitment and selection practices were not always carried out safely which put people at risk of being cared for by unsuitable staff.

People said there were enough staff to support them well and give them help when they wanted this. Staff had been trained and had the skills and knowledge to provide support to people they cared for. They received regular support and supervision from senior staff.

We looked at how medicines were managed and found appropriate arrangements for their recording and safe administration. People were given their medicines as prescribed and they were stored safely.

Records were available confirming gas appliances and electrical facilities and equipment complied with statutory requirements and were safe to use. The environment was well maintained, clean and hygienic. There were no unpleasant odours. People told us the home was much cleaner than previously.

We saw the manager and management team had improved the care provided to people in the home, particularly people living with dementia.

Most of the people we spoke with were positive about the meals but three people felt there was a lack of choice. We observed staff interaction and support given to people during the lunchtime meal. Only two staff were on hand to serve meals, assist people with their lunch and try to calm one person exhibiting behaviour that challenged.

People we spoke with told us staff were caring and helpful. They told us they were treated with respect and valued. We saw staff behaving in a respectful way.

We looked at activities to encourage people to interact and socialise. We saw steps had been taken to develop activities, although these were still limited. We asked what people did during the day. One person said “word search/puzzles, I like reading.” Another person told us “Sometimes my [relative] takes me shopping, otherwise just sitting here watching the traffic.”

We recommended the registered provider continued to develop suitable person-centred activities within the service and in the community.

People said they knew how to complain. However four relatives told us complaints were not always resolved to their satisfaction. They said they found it difficult to get answers to concerns and did not get a positive response if they expressed concerns.

We recommended the registered provider and management team developed a responsive and reflective complaints practice.

People told us the manager was approachable and supportive and listened to their views. Although undated we saw that surveys were sent to people who lived at the home, relatives and staff.

The manager showed us the quality assurance audits the management team had completed. We saw a number of improvements had been made as a result of these. However we needed to see these were established to be confident the service was well-led.

21, 23 & 30 October 2015

During a routine inspection

This inspection took place on 21 & 23 October 2015 with feedback on 30 October 2015 and was an unannounced inspection. The service was last inspected in August 2014. They met the requirements of the regulations that were inspected at that time.

Highbury House is located in South Shore, Blackpool. The home is registered to accommodate up to 28 people who require assistance with personal care. The property is a large detached house with accommodation over two floors. There is a passenger lift for ease of access and the home is wheelchair accessible. The majority of the bedrooms are single occupancy and en-suite. There are private parking facilities at the front of the building and garden areas at the rear. During this inspection there were 28 people living at Highbury House.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Through our observation and discussions with people we noted that a number of systems to keep people safe had failed. There were numerous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which meant the service was not safe, effective, caring, responsive or well-led. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home but people were not protected from risks of harm. Although risk assessments were in place about nutrition, falls and pressure area care, they were not in place for risks related to excessively hot water, a person leaving the home unescorted or a person drinking alcohol to excess. Actions to manage risk were not identified to guide and support staff in keeping people safe.

Staff did not manage behaviours that challenged the service appropriately to keep people safe. We were told physical intervention was being used with one person but this had not been agreed or authorised.

We had significant concerns about people’s environmental safety. These included excessively hot water, first floor windows without restrictors, the gas certificate was out of date and legionella checks were not carried out. The registered provider made sure the water temperatures were reduced and window restrictors replaced within 48 hours so people were not at immediate or significant risk.

Staff did not follow the code of practice in relation to healthcare associated infection. Infection control was poor, with an unpleasant odour in the home during the inspection and unclean and unhygienic equipment in a bathroom and bedroom. This was rectified after the inspection.

We saw medicines were managed safely. They were ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly.

Staff recruitment was unsafe and the necessary checks were not made before staff started working in the home.

Staffing levels were unsafe and put people at risk. People who had high care needs were left unsupervised, with little stimulation or attention for long periods of time. We also saw two people living with dementia had left the home unaccompanied and unnoticed. The registered provider told us following the inspection that an additional member of staff was being recruited for the evening shift.

Staff failed to work within the Mental Capacity Act. We observed people were deprived of their liberty without authorisation. There was no documentation that best interests, consent, risk assessment and mental capacity assessments had been undertaken in relation to deprivation of liberty. Staff we spoke with did not have sufficient knowledge in this area.

Care files sampled showed no evidence people or their relatives were involved in planning and updating care. Consent to care was not recorded.

We observed poor care practices around supporting people to take drinks, with moving and handling of people and with supporting people with behaviour that challenged. However we also saw pockets of good practice with staff talking quietly with people and encouraging them in tasks.

Care was not person centred and choices of when to receive personal care and support were limited by the staff routines. We saw there were few social and leisure activities in place and no meaningful activity aimed at people living with dementia. People’s privacy and dignity was usually but not always maintained.

The management team had started developing the environment to assist in supporting people living with dementia. We saw measures to improve well-being and independence for people with dementia were in place.

Care records were not always fully completed, accurate or up to date. Some sections of care records were in-depth and individualised to the person’s needs, whilst other sections lacked detail or were inaccurate and out of date. Some information in relation to care needed and incidents that had occurred was missing.

The home had a complaints procedure which was made available to people they supported and their relatives. There was mixed views about how concerns were handled. Eight people we spoke with who lived at the home said they had no complaints about the home. However one person was not happy with how concerns were handled.

The registered manager told us the views of people who lived in the home were sought. There were formal systems in place for people’s views to be sought but there were no residents meetings when we inspected. Surveys about the person’s experience of living in the home had not been sought within the previous two years. This lessened the opportunity for people to voice their opinions. The registered persons sought people's views towards the end of the inspection. 

The registered person’s did not fulfil their responsibilities. They did not ensure people’s care and the environment were safe and meeting people’s needs. The registered manager had not informed the Care Quality Commission (CQC) about incidents as they were required to.

Although there were systems in place to assess and monitor the quality and safety of the services provided, these were not operated effectively.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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

27 August 2014

During an inspection looking at part of the service

At our previous inspection in May 2014 we found the home was not meeting some of the standards we assessed. Some areas of infection control were not adequate. We asked the service to provide us with an action plan demonstrating what they had done to address the non-compliance. We received an action plan from the registered manager. This detailed the procedures put in place to address the concerns. This inspection was to see what actions had been taken.

On this inspection, these areas of concern had improved and the service was compliant. We did not speak with people on this inspection but we toured the building to check that infection control was satisfactory.

We observed the home was clean with no unpleasant odours. Actions had been taken to ensure flooring and furnishings were clean and protected people from the risk of infection. Personal protective clothing was accessible to assist with infection control. These measured assisted with reducing any risks of infection and with making the home a pleasant environment to live in.

15 July 2014

During a routine inspection

The inspection was led by one inspector. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that the staff were kind and helpful and supported them as they wanted. One person said, "To be honest the staff couldn't be better. They are brilliant. They will do anything for you.' A relative said of their family member, 'The staff meet all her needs, she looks well, better than she did before she came here.'

People living in the home were treated with respect and dignity. We saw that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. There were enough staff on the inspection to support people as they needed.

The home had policies and procedures in relation to the Mental Capacity Act. Staff were aware of Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made. This meant that people would be safeguarded as required.

Most areas of the home were safe, clean and hygienic; some bedrooms were not and did not consistently follow safe practices around infection control. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control and hygiene.

Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained.

Is the service effective?

People confirmed and records showed that people were able to see their visitors in private and that friends and relatives could visit whenever they wished.

People's health and care needs were assessed and reviewed with them. We saw that care plans were up to date and reflected people's current individual, dietary, cultural and religious needs.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

People told us that they enjoyed living at Highbury House and were comfortable there. One person said, 'I am satisfied with my care. The staff are so kind and helpful. I am very happy here.' A relative told us, 'I couldn't fault the care here. The staff are excellent.' Good care practices were observed. People were supported by kind, attentive and informed staff. We saw that staff supported people sensitively and patiently and gave encouragement and guidance.

Care plans were being maintained, and regularly updated, recording the care and support people were receiving. Care records were computer based although hard copies were printed off as needed so that people and their families were involved in updating care. One relative said, 'The staff always keep us involved of any changes in care or illness.

People said they could make their views, ideas or concerns known to the manager and staff. One person said, 'If I asked for anything to be changed the manager and all the staff would do that. They are always asking if you need anything or any help.' Another person told us, 'The manager comes round to check we are alright and if we want anything.'

Is the service responsive?

Staff assisted people with personal care discretely and sensitively and in a timely manner. Religious and cultural needs were taken into account and these were being met as people wanted. We observed people involved in daily living activities, social and leisure activities or chatting with staff. People said that they enjoyed the activities.

People said they had no complaints and were happy in the home. One person said, 'I could tell them [the staff] anything and they would sort it out for me. They will do anything to help you' Another person told us, 'They couldn't be better or more helpful. If I am not happy with anything I just tell them. If I don't like a thing I am not afraid to say so.' A relative told us, 'I haven't had any concerns about how they care for mum, but they are so willing to listen I am sure they would deal with any problems.'

Is the service well-led?

The registered manager become registered with the Care Quality Commission (CQC) earlier in 2014 and with the provider and staff team was making changes in care and quality monitoring. There were regular informal checks of quality and the manager was developing and increasing formal quality assurance checks. Senior staff identified and addressed any problems. We were notified of any incidents or issues relating to the home in a timely manner.

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Staff also received regular training to assist with their development.

Written handovers were completed to ensure staff knew any changes in care arrangements. Staff supervision was in place although the manager acknowledged she was behind with these. Formal staff meetings had been arranged. This meant that staff had some involvement in decisions about the home.

12 February 2014

During an inspection in response to concerns

Due to the nature of our inspection visit, people living at the home did not specifically speak to us about the outcome areas we assessed. Following our visit, we made a referral to the Environmental Health department in order that they could make an assessment regarding an incident that involved a fall of a person within a specific area of the home. The service provider must consider any recommendations made by this authority with a view to improving the layout of this specific area of the home, if improvements are needed.

9 December 2013

During an inspection looking at part of the service

Due to the nature of our visit, we did not have the opportunity to discuss record keeping with people living at the home. At this visit we found that the records were being securely stored in locked cabinets in the office. Only staff with authority to access the personnel records did so. Staff who needed to access care files relating to people living at the home could do as and when required. These records were kept in the office when in use, or held confidentially by staff if they used them in other areas of the home.

8 August 2013

During a routine inspection

People at the home said that they felt involved in their care and support, and they were consulted about it and their consent was obtained. The service provider was involved in the assessment of people's needs and care plans and risk assessments had been written to ensure those needs were met safely. People at the home said that they felt safe living at the home, and the service provider had systems in place to monitor the quality and safety of the services provider. We found that some of the records were not held securely and confidentially.

5 November 2012

During an inspection looking at part of the service

We spoke with several people about their medicines and the way they were handled. Nobody raised any direct concerns about the way their medicines were managed.

Overall we found people were given their medicines safely.

31 July 2012

During a routine inspection

We visited the home unannounced on the 31/07/2012 to see if improvements had been put in place from the previous inspection. We spoke with a range of people about the home. They included, the owner, manager in charge, assistant manager, staff, residents and relatives. We also had responses from external agencies including social services, the fire service and the health and safety agency. This was in order to gain a balanced overview of what people experienced.

Comments we received from people living at Highbury House, including relatives and other professional agencies were positive. People told us the service had improved. We saw they had put in place systems to ensure the building was safe and people were supported and cared for by competent staff. Residents spoken with said, "It's very homely and the staff are wonderful." Also, "I feel safe, there are always people around to help if you need them."

We spoke with relatives and staff about the furnishings and cleanliness of the building. One relative said, "I have no problems with the cleaning staff they do a great job. The place is always clean and tidy when I come here." One staff member spoken with said, "We have more domestic staff now which helps."

We spoke with Blackpool County Council Contracts monitoring department. They had been monitoring the home following concerns identified at previous visits. They now felt the home had addressed all the issues and concerns they identified, to ensure people were well cared for and lived in comfortable surroundings.

9 January 2012

During an inspection looking at part of the service

People we spoke to during our inspection told us that they were happy in the home and felt well cared for and the staff were very kind and treated them well. They told us they felt safe and liked living at the home.

People told us that:

'I have made friends since I moved here, the home is very good.'

'I feel much better since coming here, I have put weight on.'

'The staff are great, they respect my privacy when I am in my room and I can come and go as I please.'

'I can't recommend the home highly enough. The staff will do anything for you'

22 September 2011

During a routine inspection

People we spoke to during our inspection told us that they were happy in the home and felt well cared for and the staff were very kind and treated them well. They told us they felt safe and liked living at the home.

People told us that:

'The staff are smashing and really look after you well'.

'The care is good. I am being well looked after

However they also told us that :

'the place could do with smartening up'.

A relative told us that staff seem very good, friendly and attentive and seem to care about they do. They also told us they thought their relative looked well cared for.

In the user satisfaction surveys we found that all respondents recorded that they felt more staff were needed and some people had raised concerns about the cleanliness and d'cor of the home.