Highbury Residential Home

Highbury Residential Home is a residential care home providing personal care for up to 27 people. The service provides support to older people, many of whom are living with dementia. At the time of our inspection there were 23 people using the service.

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

We have made a recommendation that the provider consider current guidance within the Accessible Information Standard to develop information systems.

The provider had introduced improvements to the environment people lived in to help ensure it was clean, well maintained and appropriate equipment was in place. Further improvements were needed in areas relating to food preparation and storage and some furnishings. Staff followed safe procedures in using and disposing of personal protective equipment (PPE).

Risks to people's safety were assessed and were monitored but care plans did not always reflect the detailed information and guidance staff needed to keep people safe. For example, some risk assessments were not personalised to the individual person and did not fully reflect changes in people's needs. Risks were mitigated as staff demonstrated they understood how to keep people safe. Staff understood safeguarding processes and were confident to report any concerns.

Care plans and records did not fully reflect people's involvement in the development and review of their care. Systems and processes had been implemented or were planned to address this. These were in the early stages and were not fully embedded into working practices at the time of our inspection

Peoples' medicines were managed safely. There were systems in place to monitor stock control. The amount of medicines received and administered were recorded. Medicines audits were being completed.

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 knew people well and understood their needs. They completed training to give them the skills and knowledge they needed in their roles. Staff described readily available support and guidance from managers which helped to develop their working practices.

People were supported to have enough to eat and drink in line with their preferences and needs. Staff enabled people to access a range of specialist and routine health and social care appointments to maintain their health and well-being.

People were encouraged and supported to do things they enjoyed and spend time with people who were important to them. This reduced the risk of people becoming socially isolated. People described staff as kind and caring; valuing each person as an individual and consulting them at all stages about their care.

Staff were able to support people through their end of life care. Further training was planned to develop the quality of end of life care and ensure people's physical and spiritual needs were met.

There was a new manager in post who had applied for registration with the Care Quality Commission. They had identified issues and concerns prior to our inspection and were in the process of implementing these. They demonstrated a clear commitment to providing people with good care that enabled them to achieve the best possible outcomes. People and staff spoke positively about management changes and described a culture that was open, approachable and supportive. The service sought out partnership working with other agencies to provide people with high quality care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 August 2021) and there were breaches of regulation. This service has been rated requires improvement for three consecutive inspections. At this inspection we found improvements had been made but the provider remained in breach of Regulation 12 as, although significant improvements had been made in infection prevention and control, these were not fully embedded at the time of our inspection.

Why we inspected

We carried out an unannounced focused inspection on 14 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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.

Follow up

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

We found the following examples of good practice.

The registered manager was implementing changes to the service and improvements were being made. We observed staff wearing personal protective equipment (PPE) consistently in accordance with government guidelines.

Robust systems were in place to ensure safe visiting to the service. We saw evidence lateral flow tests and COVID-19 vaccination status of visitors were checked before they were allowed into the service.

A visiting area had been designated in the service so people could safely see their family and friends.

The service was clean and high touch points and COVID-19 specific cleaning schedules were in place.

Highbury Residential Home is a care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

Highbury Residential Home provides accommodation to people in one adapted building. Some people living at the service had shared bedrooms while others had their own bedrooms with an en-suite toilet and sink. There were also communal lounges, dining area and a garden.

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

Improvements were being made to the service and a new registered manager was in post. While the registered manager was working hard to improve the governance of the service, concerns raised at the previous inspection had still not been fully met.

Staff were wearing personal protective equipment (PPE) in accordance with government guidelines more consistently. We found however systems to monitor and ensure staff were wearing PPE at all times needed to be improved.

Improvements to the service’s cleaning schedules had not been implemented at the time of inspection. The service also could not evidence the environment was being consistently cleaned.

There were not enough staff to provide housekeeping services. The provider and registered manager were aware of this and were actively recruiting.

Improvements had been made to systems and processes to manage the service. Not enough time had passed however to embed the new systems and processes to demonstrate changes would be sustained.

This was a targeted inspected that considered elements of safe care and governance at the service. Based on our inspection of these areas, whilst improvements are being made, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture consistently.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 6 August 2021) and there were multiple breaches of regulation.

At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on specific concerns we had about safe use of PPE, infection prevention and control measures and how the service was being led. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how the service is kept clean, and how the service is led at this inspection. At the last inspection a warning notice was served identifying concerns we had about the service. Whilst some improvements have been made, not enough action has been taken by the provider and the warning notice continues to be unmet.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbury Residential Home is a care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

Highbury Residential Home provides accommodation to people in one adapted building. People had their own bedroom with en-suite toilet and sink. There was a shared lounge, dining area and garden people living at the service can access.

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

The service was not well-led. There were continued concerns about the governance of the service as there had been a number of changes to management and there was not a registered manager in post at the time of inspection. Staff failed to consistently wear personal protective equipment (PPE) at all times when supporting people in accordance with government guidelines.

People did not always receive safe care. Care plans and risk assessments were not always reviewed frequently, and the quality of information available to staff was not always of a good standard.

Some improvements had been made to medicines management, but audits were still not being completed and monitored appropriately.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 11 May 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At the last inspection there were multiple breaches of regulation. At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

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.

We received concerns in relation to how people were being cared for and the environment being in a unsafe condition in some areas of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Highbury Residential Home 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staff failing to wear PPE in accordance with government guidance and regarding how the service is managed at this inspection.

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

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbury Residential Home is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection.

Highbury Residential Home accommodates up to 27 people in one adapted building. People had their own bedroom with en-suite toilet and sink.

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

People were not always kept safe and did not always receive medicines in line with best practice and protocol guidance. Despite concerns with medicine management people and relatives told us they felt safe.

Staff were not trained in the Mental Capacity Act (MCA). People’s movements were restricted by staff and were placing people under levels of restriction that were unnecessary and disproportionate.

Assessment were in place to identify people’s risks, but they were not consistently person-centred.

The culture within the service was not always caring and people’s needs were not always met. However, people and their relatives said staff were very caring.

Staff knew people well, but care plans were not always person-centred. End of life care was provided by staff who were passionate about ensuring people had a dignified and pain free death, as well as caring for and supporting relatives.

The introduction of a new manager had improved staff morale. However, governance systems and processes failed to identify and address concerns. Opportunities for learning were missed.

People were supported to have choice and control of their lives, but staff did not always support them in the least restrictive way possible and in their best interests. Staff had not always received training to ensure people were supported in this way. Policies and systems in the service did not always support this practice.

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 8 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Highbury Residential Home is a 27 bedded residential home for older people, some of whom have dementia. On the first day of our inspection there were 21 people using the service. This was the first inspection of the service since the provider changed their legal entity in October 2016.

The service had a registered manager. 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.

People were protected from the risk of fire. Action had been taken when it had been identified that fire safety precautions were not adequate to prevent harm in case of a fire. Safety checks had been carried out on the environment and the equipment used for people’s care to ensure that they were safe.

There were enough suitably trained, supported and competent staff to meet people’s needs.

Staff understood how to support people to remain safe and measures were in place to prevent avoidable harm.

People received their medicines as prescribed by their doctors. Their health needs were met and if required they were supported to access health professionals. People enjoyed their meals and had enough to eat and drink.

People were supported in line with the requirements of the Mental Capacity Act 2015.

People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. Dignity and respect for people was promoted. People were supported to pursue activities of interest to them if they wanted to.

The care needs of people had been assessed and were regularly reviewed to ensure they continued to be met. Staff had a clear understanding of their role and how to support people who used the service.

People were given opportunities to feedback about the service they received. People and staff felt that the registered manager was approachable and action would be taken to address any concerns they may have.

Systems were in place to measure the quality of care delivered. The registered manager had a good over sight of the service.

Staff were clear on their role, the expectations of them and the aims and objectives of the service. Where necessary the provider’s disciplinary procedures had been implemented.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.