Highbury Nursing Home

Highbury Nursing Home is a residential care home providing personal and nursing care to up to 38 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 22 people using the service. The home was purpose built and contained communal lounge and dining areas. People had their own rooms. Some had en-suite facilities, and some did not. There was a shared garden area. At the time of the inspection rooms which could be used to accommodate 2 people sharing were not being accommodated by 2 people.

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

We found the provider had failed to consistently investigate incidents and accidents. This meant that some risks of abuse or neglect were not considered or shared with the local authorities safeguarding team. Some areas of the home still required maintenance and repair making them difficult to clean adequately.

Many care staff still required training in some key areas such as the Mental Capacity Act, Dementia and other health conditions for which some needed care. Care plans contained information about people’s medical needs but not much detail about their wishes and preferences. People were supported by a fully recruited staff team.

More guidance was needed for staff to ensure people were supported to be as independent as they could be. People and their relatives described the staff team as caring. Meetings had begun for people to talk about ways in which the service could improve.

Efforts to provide information to people in a way they could understand had improved. The provider had recruited more staff to support people with activities and interests. People and relatives provided positive feedback about improved access to activities.

Systems to monitor the quality and safety of the service had failed to enable the management team to identify some of the concerns we found on inspection. Risk monitoring systems had failed to highlight some risks to people around the home. This left people at possible risk.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was a person using the service who had a learning disability.

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 inadequate in all key questions (published 22 February 2023). At the last inspection there were 9 breaches of regulation in relation to the following areas: People being treated with dignity and respect, the leadership and oversight of the service, the safety and well being of people living at the home, how people were protected from the risk of neglect and abuse, meeting people’s nutritional and hydration needs, providing care in the way people wanted it, the need to obtain consent from people, how staff were recruited and the training and support offered to staff. We carried out enforcement activity to place conditions on the provider's registration to support them to improve in this area. These conditions remain in place.

At this inspection we found sufficient improvement had not been made in some areas and the provider remained in breach of some regulations.

This service has been in Special Measures since 01 March 2023. During this inspection the provider demonstrated that improvements have been made in some areas. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement 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 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 Nursing Home on our website at www.cqc.org.uk.

Enforcement

This inspection has identified continued breaches in relation to how people were protected from risks of abuse and neglect, how people’s safety and well-being were monitored, the training provided to staff and how effective the systems leadership had put in place to make sure people received good care. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes sending us monthly reports of action the provider has taken to monitor and make improvements within the service.

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 request reports to be sent to us monthly to monitor the planned improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbury Nursing Home is a care home providing personal and nursing care for up to 38 people aged 65 and over some of whom are living with dementia. At the time of inspection 26 people lived at the home. The accommodation is organised into 3 floors with a communal area on the ground floor.

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

We were not assured the provider was keeping people safe. The provider had not fully protected people from the risk of abuse and improper treatment. The provider had failed to ensure there were sufficient numbers of staff on duty to meet people's needs. People's medicines were not always managed and administered safely.

The provider failed to ensure staff received relevant training. People's needs and choices had not always been fully assessed. People’s nutrition and hydration needs were not being met. The provider was not working in line with the principles of the Mental Capacity Act. The environment was unsafe.

The provider had failed to ensure people were treated with dignity and respect at all times. People and their relatives were involved in making decisions about their care.

People’s care plans did not provide staff with clear guidance. The provider failed to ensure people were supported to follow their interests or take part in meaningful activities. The provider lacked understanding of their responsibilities under the Accessible Information Standard.

The provider failed to ensure effective systems and processes were in place to assess, monitor and improve the safety and quality of service users’ care. Robust systems and processes to enable staff to record and report accidents or incidents were not in place. Staff did not feel supported in their role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not 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 the service under the previous provider was requires improvement, published on 15 January 2020.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people living in the home, the management of the home, staffing levels, infection control practices, and medicines. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report. The provider has not taken sufficient action to mitigate the risks to people.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, dignity and respect, need for consent, safe care and treatment, nutrition and hydration, good governance, staffing and fit and proper persons employed 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 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.

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.

Highbury Nursing Home is a care home providing personal and nursing care to 38 people aged 65 and over some of whom are living with dementia. At the time of inspection 34 people lived at the service. The accommodation is organised into three floors with communal areas on the ground floor.

We found the following examples of good practice.

¿ On arrival visitors were asked to consent to a lateral flow test (LFT) and their temperatures recorded. Visiting family members were provided with gown and appropriate personal protection equipment (PPE).

¿ There were clear zones identified throughout the home to safely promote social distancing whilst mitigating the risk of cross infection.

¿ There was additional cleaning of touch points in communal areas to mitigate the risk of cross infection.

¿ The service kept in contact with family members through essential visits, social media, letters phone calls, window visits and the visiting pod.

¿ Staff adhered to PPE guidance and practices. There was a plentiful supply of PPE at all PPE stations situated close to people’s bedrooms.

¿ Clear plans were in place for those who may be required to self-isolate. For those people who may struggle with isolation additional support was provided.

¿ Staff continued to support people to access healthcare services. Arrangements were in place should people need to attend hospital and return to the home safely.

¿ The service had a separate visiting pod for relatives and friends which enabled them to see their loved ones safely.