Highbury Rise

Highbury Rise is a residential care home providing accommodation and personal care to 20 people at the time of the inspection. The service can support up to 23 people.

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

People’s medicines were not always managed safely, while staff had been trained and audits were in place, we found systems did not always ensure records were accurate. When we visited there was a heatwave. We found the national heatwave plan was not consistently followed, and this placed people at risk. Management systems did not ensure these issues were identified or managed.

People told us they were happy and felt safe, and staff were kind. Relatives also told us they were happy with the care and support provided. Care plans were in place and staff knew people well. People told us they had enough to do. People were supported to eat well; however more frequency and accessibility was needed to ensure people had sufficient fluid intake during the heatwave.

Individual risks were assessed. Infection control measures were followed in most cases. However, some areas needed refurbishment due to chipped paintwork and carpets with malodours. The lift had been repeatedly breaking down which had meant people were frequently left in their rooms. Staffing was adjusted to manage this, but the reoccurring issue was causing frustration. The registered manager advised a new, and more efficient, lift company had been contracted to manage the issues.

People told us there were normally enough staff to assist them as needed, relatives agreed. Staff told us there was enough of them to meet people’s needs, however the lift issues had been adding a strain. Staff received training and regular supervision. They felt well equipped for their roles.

Complaints systems were used and people and their relatives told us they could speak up.

People, relatives, and staff were positive about the registered manager and how the service was run. There were regular meetings to share feedback and obtain views. There were audits and checks in place to manage the quality of the service.

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 information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

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.

Rating at last inspection

The last rating for this service was good (published 20 October 2017). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to the safe care and treatment 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Highbury Rise provides accommodation for up to 23 older people, some of whom live with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 21 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run

People felt staff and staff were aware of individual risks. There were sufficient staff to meet people’s needs and these were recruited appropriately. Staff felt trained and supported for their role. Medicines were managed safely, however, further monitoring was needed to help ensure records were consistently accurate.

People were supported to eat and drink and had regular access to health and social care professionals. Staff worked in accordance with the principles of the Mental Capacity Act 2005 (MCA) and promoted choice and involvement. Staff knew people well, were caring and respected people’s preferences.

People received care that met their needs in a way they liked and care plans contained up to date, clear information. Activities were provided however, some further development was needed for the activity organiser to ensure these met everyone’s needs. There were no recent complaints and feedback was sought from people, their relatives, staff and visiting professionals.

People, relatives and staff were positive about the management of the home. There were effective quality assurance systems in the home and there was visible leadership for staff. The ethos of the home was person centred and the environment was homely.

The service had robust systems in place for identifying and reporting any concerns about people's safety and welfare. Staff had received training on protecting people who used the service from the risk of abuse and had a good awareness of their role in relation to this. People who used the service told us they felt happy to go to a staff member if they were worried about their safety and welfare.

The environment was safe and well maintained. There was a refurbishment programme ongoing to update any areas that required it. The staff were all familiar with health and safety requirements and had received regular support and training. There were some areas where cleanliness needed improvement but this was addressed on the day of inspection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care and support they received. They also told us that their preferences were respected. Care plans were discussed with key staff members and information was shared with the staff responsible for delivering the care. One person who used the service told us, 'I couldn't ask for more, I get everything I need.'

Is the service caring?

We observed staff with people who used the service. Staff responded promptly to requests for assistance and communicated with people respectfully, in way that showed they knew people well. This included the catering staff who we observed serving people their breakfast. Staff were kind and checked on people throughout the inspection to ensure they were safe and if the needed anything. People were given blankets for over their legs when a room felt cooler and staff supported people in locating their belongings when they had mislaid them. We saw one person who was becoming anxious be well supported by staff. This was done in a way that quickly resolved their anxiety and soon had them chatting, laughing and enjoying an activity.

Is the service responsive?

We saw from care plans that when people moved into the service their needs were assessed and recorded. We also saw that when their needs changed their care plans were updated to reflect this. There was evidence of people's involvement in the planning of their care and their requests were carried out. For example, additional support was given to a person's family member regarding an issue they raised when needed.

Is the service well-led?

The manager was a visible member of the team throughout the day working alongside staff and setting examples. The reaction of staff and people who used the service confirmed that this was a normal occurrence. When we arrived at the service the manager was taking part in the handover. This demonstrated their approach of being involved and open.

There were regular audits completed and action plans developed. There was a record of these actions being completed. The views of people were taken on board and new systems of working were derived from these and shared with the staff team.

There were regular checks on staff performance through observation and supervision. The manager worked with staff to share examples of good standards of care.

We saw that people had their strengths and abilities assessed and this included their capacity to make decisions. Staff had a clear understanding of how to support people to make a choice to enable them to obtain consent to an activity or care task. One member of staff gave us an example of how they supported people's choices, 'I knock on the door, ask them if I can help them with getting up, they say no I go back later.'

We inspected Highbury Rise in response to some information of concern that we had received. We spoke with four members of staff and they all were clear on what their roles were in response to safeguarding people from the risk of abuse. We spoke with five people who were living at the service who all told us they would speak with the carers if they were worried. One person said, "'All the staff are caring and kind, I haven't met anyone who isn't.' However, we noted that there was a current safeguarding concern under investigation for this service.

We found that staff were supported by the management team and received regular one to one supervisions. Records showed that staff training was updated annually.

On our inspection on 5 July 2013 we found that the service had made improvements to the structure of mealtimes and the way in which they recorded information in relation to a person's dietary intake. This ensured people living in the home received the support that they required. We spoke with five people and they were positive about the food and the support they received. One person told us, "It's very good."

We saw that the service had some systems in place to support nutrition and hydration however improvements around how this was managed were required.

We looked at medication management and found that the systems in place were appropriate. This ensured that people received their medication safely and in accordance with the provider's own policy. We saw that staff had received training in medication administration and were in the process of completing further medication training.

As part of the inspection we looked at staff files. We saw that staff had been taken through robust recruitment procedures and their capability for the role had been assessed prior to them starting employment.

We looked at the provider's complaints management system. We saw that all complaints received had been managed in accordance with their own policy. People we spoke with told us that they had not needed to make a complaint but knew how to if the need arose. One person told us, "I'd go through to the office, [the manager] is good."