Archived: Highbury House Care Home

Updated 2 October 2020

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 representative 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 Care Act 2014.

Inspection team

The inspection was carried out by one inspector and one pharmacist medicines inspector on the first day. On days two, three and five the inspector returned to the home alone. The inspector telephoned relatives on day four for their feedback on the service provided.

Service and service type

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

The service did not have a manager registered with the Care Quality Commission. The previous registered manager had left on 02 July 2019. It was unclear if the service had a manager. The provider representative identified the senior carer as the manager. The senior carer disputed this stating they were going to remain as a senior carer.

Notice of inspection

This inspection was unannounced on the first and fifth day.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, this included information related to a specific incident that is under investigation. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider representative was not asked to complete a provider representative information return prior to this inspection. This is information we require provider representatives to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service, five relatives and three friends of people about their experience of the care provided. We spoke with twelve members of staff including senior carers, carers, cooks and an activity co-ordinator. We spoke with three staff members from another home owned by the provider representative who were working at Highbury House Care Home. We spoke with two agency carers, six visiting health and social care professionals and the provider representative who is also the nominated individual.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at a variety of records relating to the management of the service and walked around the building to make sure it was a clean and safe environment for people to live in.

After the inspection

We continued to seek clarification from the provider representative to validate evidence found. We attended a meeting with the local authority to share the evidence from the inspection and review the information they had gathered from recent visits to Highbury House Care Home.

Updated 2 October 2020

About the service

Highbury House Care Home is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 28 people. The property is a large detached house with accommodation over two floors. There is a passenger lift for ease of access and the home is wheelchair accessible. Most of the bedrooms are single occupancy and en-suite.

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

There is a history of non-compliance. The provider representative had failed to respond adequately to serious concerns raised by CQC and improve the care people received. The auditing and governance systems failed to identify or address the concerns raised during the inspection or no action was taken to give oversight of the service being provided. There was a lack of stability in the management team. The provider representative failed to display their rating on their website.

People were at risk of avoidable harm. The provider representative had failed to sustain an environment where infection prevention risks were monitored and reduced. Medicines were not managed safely. There was a lack of oversight on stock control, storage, administration and governance. Good practice guidance on risk management was not consistently followed.

The provider representative did not always follow good practice guidance to ensure robust recruitment procedures were followed. We have made a recommendation about this that can be seen in the ‘safe’ section of this report.

Staff did not always use positive language that promoted people’s individuality. We have made a recommendation about this that can be seen in the ‘caring’ section of the report.

We received mixed opinions on people being supported to express their views and being involved in decisions about their care. Initial assessments involved people and their relatives. However, people and their relatives were not always involved in follow up reviews.

People’s dignity was not always promoted. Everyone received their meals and drinks on plastic plates and in plastic mugs. We have made a recommendation about this.

We observed positive interactions between staff and people who lived at the home. People were comfortable in the company of staff and looked forward to staff coming on shift. One person told us, “They [staff] are very nice, not snappy.”

The provider representative had introduced task orientated routines which were not always liked by people living at the home. We have made a recommendation about this.

People’s care plans held information on their history, likes and dislikes. Communication strategies were in place, however one person required information adding to guide staff how to support them when they were agitated. Families told us they were made to feel welcome. A member of management said they would provide end of life care and support people to remain at the home if that was their preferred place of care. There had been no formal complaints since the last inspection.

The provider representative did not induct new staff appropriately to ensure they had suitable knowledge and skills to meet people’s needs effectively. People told us they would have liked a choice at mealtimes. We did see alternatives being offered when people declined what was presented. We received mixed feedback on how the provider representative liaised with other agencies to keep people healthy. Visiting health professionals were complimentary on how the provider representative was managing one person’s health condition. We were also made aware that one person was hospitalised due to the management team, at the time, failing to seek timely medical support.

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 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 17 October 2018). The provider representative completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been embedded and sustained and the provider representative was still in breach of regulations.

Why we inspected

The inspection was prompted, in part, due to concerns received about the leadership and management of the home, the management of medicines, staffing and good governance. A decision was made for us to inspect and examine those risks.

Concerns were also received following a specific incident, where a person using the service sustained serious injuries. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of infection prevention, unsafe medicines management and a failure to liaise with health professionals.

We have found evidence that the provider representative 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 representative to take at the end of this full report.

The provider representative is working with the local authority to mitigate risk. They have sought alternate medicine suppliers in response to concerns identified, engaged in staff recruitment and are reviewing the leadership and governance of the service.

Enforcement

We have identified breaches of the regulations in relation to the failure to provide safe care and treatment for people and the failure to have effective governance including assurance and auditing systems or processes in place.

A Notice of Decision to vary a condition on the provider's registration was served. They were no longer authorised to carry on the regulated activity, 'Accommodation for persons who require nursing or personal care' from Highbury House Care Home, 580-582 Lytham Road, Blackpool, Lancashire, FY4 1RB.