Highbury House

Highbury House is a residential care home providing personal care to up to 11 people. The service provides support to adults with learning disabilities and autism. At the time of our inspection there were 10 people using the service. Highbury House consists of 3 neighbouring properties. People have their own bedroom with ensuite facilities and access to shared communal space. The home is situated close to local amenities.

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

At our last inspection, we found concerns related to staffing and management oversight of the service. These concerns resulted in regulatory breaches. In response to our last inspection the provider sent us an action plan telling us how they were going to make the required improvements.

At this inspection, there continued to be a lack of effective oversight to ensure standards and regulations were maintained. Some areas previously identified as a concern, remained. We also identified additional breaches of the regulations. Examples of audits were either not completed or they were ineffective when completed, in identifying where improvement was needed. Several improvement actions we found during our visit had not been identified through any provider checks at the service. Issues with staffing identified at the last inspection remained.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: 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.

The evidence to confirm people’s restrictions had been imposed in their best interests could not be located and a number of Deprivation of Liberty Safeguards (DoLS) authorisations had been allowed to expire. Staff involved people in making day to day decisions. However, people’s ability to decide was often limited, due to the staff and resources available. People were supported at mealtimes and guidance was in place around healthy eating. However unfamiliar staff and reduced food supplies impacted people’s choices.

The home was clean and areas which had become worn were highlighted for refurbishment. People were able to access healthcare when needed and appointments were made when they felt unwell. However, improved record keeping following a health emergency was needed.

People received their medicines by staff trained to administer. However, improved guidance was needed on why people took certain medicines because the current guidance was not always person centred.

People could personalise their bedrooms and refurbishment work was ongoing throughout the properties.

Right Care: People were not always protected from the risk of harm as accident and incident forms were not reviewed in a timely manner. Actions taken to mitigate the risk of harm could not always be evidenced both in the environment and in the care people received.

People’s care plans were detailed however updates were required. Some updates identified at our last inspection had not been actioned. For example, the physical intervention training being used had changed but the care plans still referenced historic training.

Right Culture: The culture in the home was not always person centred. Staff felt the volume of management changes had impacted and improved relationships were needed. People were not always supported by sufficient staff who knew them well. Agency staff were used but a recent change in provider meant there had been a reduction in the consistency of the support provided. Staff received training and this was monitored closely by the local authority. A recruitment strategy was in place.

The governance systems used were not always effective. Key reviews were not always happening, and it was difficult to access information to confirm the frequency of health and safety checks and action taken. The process to continuously learn and improve care was limited due to the providers systems not being fully embedded.

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 19 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the management of risk in the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. 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 House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risk in the service and how people are safeguarded from potential abuse. We found people were subject to restrictions. However, we could not be assured these were agreed in people’s best interest. We found a continuous breach around the governance of the service. Systems and processes were not embedded, and highlighted improvements had not been made between this inspection and the previous one.

The provider was asked to submit an urgent action plan in relation to key areas following the inspection visit.

Please see additional action we have told the provider to take at the end of this report.

Follow up

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 House is a residential care home providing personal care to up to 11 people across three separate buildings. Each building has its own communal areas and kitchen facilities. The service provides support to autistic people and people living with learning disabilities. At the time of our inspection there were 10 people using the service.

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

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.

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 always support this practice.

Right Support

The service did not always support people to be as independent as they could and to set goals to achieve positive outcomes. The manager told us they intended to put systems in place that would place more focus on promoting people’s independence. Staff supported people to participate in activities in the home and in the local community, but this was sometimes limited due to staffing levels. People were able to personalise their rooms, but some areas of the home required refurbishment. The provider told us this work had now been agreed and this would be addressed. Staff supported people to access health specialists when needed.

Right Care

People were not always encouraged to take positive risks. This had been identified by the manager who told us they would be reviewing all documentation to ensure it was up to date and not overly restrictive. Staff understood how to protect people from abuse. Staff respected people’s privacy and treated them with dignity. Staff were kind to people and treated them with empathy.

Right Culture

People did not always receive care that empowered them as there was not always a person-centred culture at the home. People’s care was not always reviewed to ensure their current needs were being met. Systems in place were not always effective in checking the quality of the service provided to people. The manager told us they were new to post but intended to review all systems in place to ensure effective checks on the quality of the service were in place and improvements made where needed. People were supported by a high number of agency staff, but steps had been made to improve the continuity of staff. The provider told us they were finding it difficult to recruit permanent staff in the local area but recruitment was ongoing and pay had been increased to give an incentive to permanent staff. Staff knew and understood people well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 27 July 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 25 July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and governance at the home. 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.

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.

Enforcement

We have identified breaches in relation to the governance of the home 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.