Archived: Highbury House Care Home

Highbury House Care Home is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 28 people. 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. Most of the bedrooms are single occupancy and en-suite.

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

There is a history of non-compliance. The provider representative had failed to respond adequately to serious concerns raised by CQC and improve the care people received. The auditing and governance systems failed to identify or address the concerns raised during the inspection or no action was taken to give oversight of the service being provided. There was a lack of stability in the management team. The provider representative failed to display their rating on their website.

People were at risk of avoidable harm. The provider representative had failed to sustain an environment where infection prevention risks were monitored and reduced. Medicines were not managed safely. There was a lack of oversight on stock control, storage, administration and governance. Good practice guidance on risk management was not consistently followed.

The provider representative did not always follow good practice guidance to ensure robust recruitment procedures were followed. We have made a recommendation about this that can be seen in the ‘safe’ section of this report.

Staff did not always use positive language that promoted people’s individuality. We have made a recommendation about this that can be seen in the ‘caring’ section of the report.

We received mixed opinions on people being supported to express their views and being involved in decisions about their care. Initial assessments involved people and their relatives. However, people and their relatives were not always involved in follow up reviews.

People’s dignity was not always promoted. Everyone received their meals and drinks on plastic plates and in plastic mugs. We have made a recommendation about this.

We observed positive interactions between staff and people who lived at the home. People were comfortable in the company of staff and looked forward to staff coming on shift. One person told us, “They [staff] are very nice, not snappy.”

The provider representative had introduced task orientated routines which were not always liked by people living at the home. We have made a recommendation about this.

People’s care plans held information on their history, likes and dislikes. Communication strategies were in place, however one person required information adding to guide staff how to support them when they were agitated. Families told us they were made to feel welcome. A member of management said they would provide end of life care and support people to remain at the home if that was their preferred place of care. There had been no formal complaints since the last inspection.

The provider representative did not induct new staff appropriately to ensure they had suitable knowledge and skills to meet people’s needs effectively. People told us they would have liked a choice at mealtimes. We did see alternatives being offered when people declined what was presented. We received mixed feedback on how the provider representative liaised with other agencies to keep people healthy. Visiting health professionals were complimentary on how the provider representative was managing one person’s health condition. We were also made aware that one person was hospitalised due to the management team, at the time, failing to seek timely medical support.

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.

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 17 October 2018). The provider representative completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been embedded and sustained and the provider representative was still in breach of regulations.

Why we inspected

The inspection was prompted, in part, due to concerns received about the leadership and management of the home, the management of medicines, staffing and good governance. A decision was made for us to inspect and examine those risks.

Concerns were also received following a specific incident, where a person using the service sustained serious injuries. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of infection prevention, unsafe medicines management and a failure to liaise with health professionals.

We have found evidence that the provider representative needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

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

The provider representative is working with the local authority to mitigate risk. They have sought alternate medicine suppliers in response to concerns identified, engaged in staff recruitment and are reviewing the leadership and governance of the service.

Enforcement

We have identified breaches of the regulations in relation to the failure to provide safe care and treatment for people and the failure to have effective governance including assurance and auditing systems or processes in place.

A Notice of Decision to vary a condition on the provider's registration was served. They were no longer authorised to carry on the regulated activity, 'Accommodation for persons who require nursing or personal care' from Highbury House Care Home, 580-582 Lytham Road, Blackpool, Lancashire, FY4 1RB.

Highbury House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highbury House Care Home is registered to provide accommodation for persons who require nursing or personal care for up to 28 people. 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. Most 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 21 people living at Highbury House Care Home.

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.

At the last inspection in July 2017, we found five breaches of regulation. We found breaches in the regulations related to Person-centred care, Need for consent, Safe care and treatment, Good governance and Fit and proper persons employed. In addition to the requirement notices we made a recommendation related to staffing.

Following the inspection in July 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. This was not provided to us.

At this inspection we saw improvements had been made. Care plans held person-centred information and people or their representative had signed to indicate consent. Recruitment procedures were robust and staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. Medicines were stored and administered safely. We saw staff administering medicines to people followed good practice guidance.

However, at this inspection we found quality monitoring systems and processes did not consistently identify areas of concern so improvements could take place. Audits and checks carried out had not identified some of the issues we identified on inspection.

This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We noted certain parts of the home were unclean and processes were not consistently implemented to assess the risk of preventing and controlling the spread of infections

This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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

We have made a recommendation the registered provider reviews staffing levels and staff deployment.

We have made a recommendation the registered provider ensures all staff who have access to people who may be vulnerable receive appropriate training.

We have made a recommendation the registered provider gather people’s views on the meals provided and review the mealtime experience people receive.

The service had systems to record safeguarding concerns, accidents and incidents and acted as required to make improvements and minimise future risks. The service monitored and analysed such events to learn from them and improve the service.

The registered manager had systems to ensure people’s care, treatment and support was delivered in accordance with best practice guidance and current legislation.

Care plans held information that guided staff on people’s likes dislikes and health conditions. People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care.

We observed positive interactions between staff and people at Highbury House Care Home. Staff used humour and appropriate touch and treated people with respect and patience.

Staff we spoke with told us they felt supported by the management team and were encouraged with their personal development.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us any concerns raised had been addressed by the registered manager.

We looked around the building and found equipment had been serviced and maintained as required. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

Staff delivered end of life support that promoted people’s preferred priorities of care.

People told us there were a range of activities provided to take part in if they wished to do so. We observed activities taking place and saw these were enjoyed by people who participated.

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 21 people lived at Highbury House.

Highbury House was registered with The Care Quality Commission (CQC) as a partnership until February 2017 when the home was registered with CQC as a limited company - D.M Care. This is the first inspection of the home as the new legal entity. The director of the new legal entity D.M. Care was a partner in the previous partnership. This enabled continuity of care during the change of legal entity.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found for recruitment, management of medicines, consent to care, person centred care and governance.

Staff did not always manage medicines safely. Medicines were not always recorded accurately or people given their medicines as prescribed as there were inconsistencies in the amount of tablets recorded and those left.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had not ensured medicines were managed safely.

People were not always supported to have maximum choice and control of their lives. The registered provider had procedures to assess people’s mental capacity and to support those who lacked capacity to manage risk. However, there was no record of people of their consent to care and treatment or that of a representative to their care.

This was a breach of regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because care and treatment must only be provided with the consent of the relevant person.

Care plans were personalised in that people’s care was recorded, but people and where appropriate their representatives were not involved in reviewing their care and making decisions about how they wanted their care provided.

This was a breach of regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people were not involved in planning their care so it met their needs.

Some carpets and furniture were unclean and unhygienic in communal areas. This increased the risk of cross infection.

We made a recommendation to improve cleaning schedules and the effectiveness of cleaning to keep the home clean and hygienic and reduce the risk of cross infection.

Robust recruitment practices were not always followed. This reduced the safety of appointing new staff and was contrary to the home’s recruitment procedure.

This was a breach of regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as recruitment procedures must be operated effectively.

There were mixed views from people about staffing levels. Some people felt staffing levels were usually appropriate others said staff were busy. From our observation staff carried out personal care promptly but oversight of people was limited and there was little staff interaction except for practical tasks.

We made a recommendation for the registered manager to review staffing levels and skill mix so they respond to the changing needs of people using the service.

Although we found the registered manager and staff team provided good care and the registered manager supported and encouraged the staff team, the home was not always well led. Audit systems were in place however they were not always robust or effective as they did not identify the issues CQC noted during the inspection.

This was a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as Systems to provide good governance and ensure the safety and wellbeing of people were not effective

Most of the people we spoke with were positive about the quality of the meals but felt there was a lack of choice. There were frequent drinks provided but staff did not always check people drunk these.

Staff had been trained in care and had the skills and knowledge to provide support to the people they cared for.

People we spoke with said their health needs were met promptly and care records reflected this.

People told us staff were caring and respectful and assisted them promptly. They said staff were familiar with their care needs and preferences. One person said “They treat me very well, they’re kind.” We observed staff were cheerful and friendly when they supported people during the inspection.

There was an assortment of views regarding activities. Some people did not want activities; others said they would like more and they got bored when they were “just sat’ doing nothing”.

People told us they felt safe and contented at Highbury House. One person said, “I’ve no reason not to feel safe. I am quite happy here.” The service had procedures to protect people from abuse and unsafe care. Staff were familiar with these and had received training in safeguarding adults.

We saw risk assessments were in place which provided guidance for staff. These measures reduced risks to people.

People told us they felt able to complain if unhappy with something. Most issues raised were about laundry going missing. This was sometimes found at a later date.

People told us their relatives were made welcome and there were no restrictions to visiting.

You can see what action we have asked the provider to take at the back of the main body of the report.