Archived: Highbury Residential Care Home

Highbury residential care home is a 27 bedded residential home for older people, some of whom have dementia. One the day of our inspection there were 23 people using the service.

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 harm. People told us they felt safe and that there were enough staff available to meet their needs. There was a recruitment policy in place which the registered manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were managed and administered safely.

People enjoyed the meals provided and where they had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were supported to make decisions about the care they received. People’s opinions were sought and respected. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was clear of their role in ensuring decisions were made in people’s best interest.

The registered manager had assessed the care needs of people using the service. Staff had a clear understanding of their role and how to support people who used the service as individuals. Staff knew people well and treated them with kindness and compassion.

People were supported to follow their interests. Information about planned activities were displayed within the home. People’s independence was promoted and staff treated people with dignity and respect.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager and were confident that they would address issues if required. Relatives found the registered manager to be approachable.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People we spoke with told us they were listened to and treated with respect. Relatives were confident that the care being provided was safe and meeting people's needs.

There was a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) which meant that people's human and legal rights would be upheld. Records showed that the service had carried out mental capacity assessments when appropriate and had involved people's relatives in the best interest decision making process. Although nobody using the service was under a DoLS authorisation at the time of our inspection we found they had been used appropriately in the past.

As part of our inspection we looked at a number of people's individual risk assessments We found that risk assessments recorded the potential risks to people and any action that should be taken to minimise the risk. We found that risk assessments were individualised to people, had been regularly reviewed and emphasised that people's choices and wishes should be respected. This meant that people had been protected from risk whilst ensuring their human rights were being protected.

As part of our inspection we looked at how medication was handled. We found that the service had appropriate arrangements in place to ensure that people were protected from the risks associated with medicines and that medication was obtained, stored and administered safely.

Is the service effective?

We spoke with people who used the service and they were all satisfied with the delivery of their care. One person told us, 'They truly look after you and help you with anything you need'.

Care plans were individualised to people and contained information in relation to their personal preferences and needs. People were supported to maintain good health by on-going monitoring and referral to appropriate health professionals when necessary.

Our observations showed that people's care was delivered in a way that reflected this information. We found that staff had a good understanding of the needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. Our observations showed that staff interacted with people in a positive way and treated them with respect and kindness. Staff showed consideration for people's individual needs and provided care and support in a way that respected their diverse wishes and preferences.

People who used the service were very complimentary about the staff team and one person described them as 'kind and compassionate'.

Is the service responsive?

Consideration had been given to supporting people to engage in meaningful activities and the service promoted people's independence and community involvement. Care plans and records demonstrated people's involvement in the delivery of their care and support and the service gathered people's views in a number of ways including questionnaires and residents meetings. We saw that the service responded to people's changing needs and wishes.

People's consent was sought in relation to the provision of care and staff understood the procedures they should follow if people did not have capacity to make a decision at the time it needed to be made. This meant that staff were able to respond in a way that ensured people's legal and human rights.

The service had an appropriate complaints policy and responded to concerns and complaints effectively.

Is the service well-led?

Staff were clear about their roles and responsibilities and had confidence in the registered manager. There was a consistent staff team that had been supported to receive training and development that would enable them to meet people's needs. The manager had ensured there were enough staff on duty at all times to provide effective and appropriate care.

There was a robust quality assurance system in place that monitored the risks to people and others and ensured the service was learning and continually improving.

People who used the service were happy with the care they received at the home. All of the people we talked to praised the staff who looked after them. One person said: "The staff here are all very good and very kind." Another person commented that: "We are looked after and I am comfortable." None of the people who spoke to us had any concerns with the care they received at the home.

We spoke with the relatives of someone using the service. They were happy with the care their relative received at the home. They told us: "The staff here are brilliant. They have bent over backwards to look after her."

Staff said they felt supported and that they had regular training and supervisions. We found this to be reflected in the staff files we looked at. None of the staff expressed any concerns about the quality of care being delivered at the home.

We found that consent to care and treatment was not always obtained at the service and that there were some improvements to be made in relation to the management of medication. We found that complaints were handled in line with the policy in place at the service and that the required checks were carried out on staff prior to them commencing work at the home.

In order to assess the improvements in these areas we spoke with the registered manager at the home, four people who used the service, and the relative of someone using the service who was visiting the home at the time of our inspection.

The people using the service told us that they were happy living at the home and that they were able to participate in activities should they wish to. They were all complimentary about the staff working at the home. One person told us that, at times, they had to wait to be attended to by staff. We saw that people were being cared for by staff who treated them with respect. There were activities taking place at the home at the time of our visit.

We spoke with the relative of someone using the service who commented that: "I think it has improved. There's more interaction somehow and more feedback from the manager."

As part of this inspection we spoke with three people who used the service, four members of staff working at the service, and two relatives of someone who was using the service.

People using the service told us they were generally happy living at the home. One person commented, "I think it's got a lot better. There's a lot more staff on and there's more help for us." Two people we spoke with told us they did not think they were allowed to go out of the home for a walk or allowed to go to their bedrooms during the day. One person said, when asked if they could go for a walk, "I don't think they'd let you do that." Another person told us they did not think they were able to use their bedroom during the day.

Staff reported to us that numbers of staff had been increased and that people's needs at the home were now being met. We observed sufficient staff on duty during our visit. One staff member told us, "A lot of changes have happened at the home. We used to struggle with a shortage of staff but now we have enough staff. I can see many changes."

We reviewed care plans at the service and found that these had been improved on since our last inspection.