Highbury House Nursing Home

Updated 16 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Highbury House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. Highbury House Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We looked at the notifications and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law. We used information gathered as part of monitoring activity that took place on 31 May 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service and two visiting relatives. Staff spoken with included three care staff, a domestic staff member, an agency registered nurse, the deputy and registered manager and the group manager.

We spent time observing people in areas throughout the service and could see the interaction between people and staff. We reviewed a range of records. This included three people’s care records and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service were viewed, including health and safety records, maintenance checks and quality audits. We contacted and received feedback from three visiting professional and three further relatives.

Updated 16 September 2022

About the service

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.