Highbury House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

During the last inspection we found people were subject to restrictions which could not be evidenced to be in their best interests. This was a breach of Regulation 11 (Consent). During this assessment we found improvements had been made and the provider was no longer in breach of regulation 11. Staff knew people well and could tell us about people’s risks. However, care plans were not always kept up to date with people’s current care needs and there were gaps in care monitoring records. The provider responded to our feedback, they updated care plans and implemented new audits to monitor the care provided to people. Timely referrals for reassessment of people’s support needs were not always made or followed up. The manager responded to our feedback and arranged consultations with relevant health professionals. 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.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were involved in decision making and they told us about their future plans. One person told us they regularly attended keyworker sessions where they discussed the support and care needed. Relatives told us they felt involved in the care people received. One relative said, “The provider lets me know if anything changes in [my family member’s] care.”

Staff knew people well and told us about their risks without referring to documentation. However, staff were unsure about one person’s food consistency requirements. This was due to the person’s swallowing needs being assessed in hospital several months earlier. Therefore, this required review and follow up. This review had not been reviewed in a timely manner. The manager responded to our feedback straight away and arranged for the person’s dietary requirements to be reassessed. Staff told us people’s care needs were discussed in team meetings and handovers.

Care plans were in place for each person and reflected a good understanding of people’s needs, including relevant assessments of people’s communication support and sensory needs. However, some care plans contained outdated information. The provider explained they were in the process of reviewing care plans and showed us the updated care plans on the electronic system. However, having outdated information available increased the risk of staff becoming confused regarding the current assessed care and support required by people.

People told us they were supported to take part in the activities they preferred. One person told us, “I like to go for walks and sometimes to the little park. I do this and staff come with me. I do get to choose the things I do.” One relative told us the provider was trying to encourage people to engage in activities they enjoyed. However, 2 relatives told us they did not know what activities their family members engaged with each week. People told us where they could go to have their health needs met, such as the doctors and dentist. Some people’s care plans detailed how staff were to support them with independence skills. However, we observed staff completing these tasks for people without encouraging them to take part in the activity. The manager explained these skills were no longer possible due to a recent event in the person’s life. However, the care plan had not been updated to reflect this.

Staff told us about people’s preferences, likes and dislikes. Staff told us about people’s health needs and how these were met. However, staff did not always complete their care monitoring tasks in accordance with the care plan. There were numerous gaps in care recordings and people's oral care was not being monitored in line with their care plans.

Care plans were detailed and contained information about people’s health and care needs, such as whether they experienced difficulties with eating and drinking or whether they experienced health difficulties such as constipation. However, where the care plan detailed how these conditions were to be monitored, such as monitoring bowel movements, there were multiple gaps in the monitoring and no action taken when gaps were found. The manager responded to our feedback, explaining people did not always require this level of monitoring. They updated the care plans to reflect this clearly.

People told us they received support from the staff team and could access health professionals when needed. However, some people experienced delays when having their care needs reviewed and reassessed by health professionals. This meant the provider could not be assured they were receiving the most effective care. The manager responded straight away and arranged for people’s care to be reviewed with relevant professionals, such as SALT teams (Speach And Language Teams) and GPs (General Practitioners). People received information regarding their health in accessible formats. We observed easy read materials informing people about risks to their health and wellbeing. People attended events which focused on their wellbeing and raised awareness of potential health risks. Relatives told us the provider worked in partnership with other services. One relative said, “The provider works well with other teams. [My family member] has a special diet.”

Staff told us they work effectively with other professionals. One staff member told us how they were waiting for a second opinion from a health professional to support a person’s mobility. Another staff member said, “We work closely with physiotherapists, we have a good relationship with them. We also work with social workers and GP's, chiropodist. We are quite open. I'd approach the professionals if I have concerns. The physiotherapists are on the same wavelength which is good.”

Visiting professionals told us the provider worked in partnership and followed their recommendations. One visiting professional told us the provider had made improvements since the last assessment. However, they told us further improvements were needed around record keeping, support planning and auditing.

Processes were in place to refer people to health professionals. However, records did not clearly detail the contact with professionals or record outcomes of people’s health appointments. The manager responded to our feedback by introducing systems to record details of health appointments. The provider held events for people, relatives and staff where they worked in partnership with other professional to raise awareness of risks and promoted people’s wellbeing. Team meetings took place regularly where risks to people and changes in people's care were openly discussed.

People told us staff supported them to live healthier lives. One person told us how the staff supported them to attend mental health appointments to assist with their wellbeing. We observed staff encouraging people to eat healthily. However, people’s care was not always monitored in accordance with their assessed need. Relatives told us staff kept them informed when people's health changed. One relative said, “The staff contact me regarding changes about [my relatives] care. The staff rung me in the evening to let me know about [my relatives] chest infection.”

Staff supported people to live healthier lives, one staff member told us, “We try to promote healthy diet with people. We try to encourage salads and fruit. Try and make it a bit different for people.” However, some staff were unsure about people’s dietary requirements. For example, staff were unsure about the food consistency for 1 person and another person was observed eating food outside of the specifications of their assessment. The manager responded straight away and arranged for the identified people to have reassessments and whilst following reassessment there was no identified risk to these people, the reassessment should have taken place in a timely manner.

Records showed the provider used innovative ways to promote healthier living, such as sexual health awareness events and the provider shared their plans for a wellbeing festival for people, staff and relatives. This included a range of outdoor and indoor activities to promote physical, mental, sexual and spiritual wellbeing for people using the service. However systems were either not in place or not effective when monitoring and following up referrals of peoples needs and changing care requirements. The manager responded to our feedback and introduced new systems to monitor and record referrals clearly.

People and relatives told us review meetings were held to discuss the care and support people received and agree future goals. However records did not clearly record visits with health professionals. We observed refurbishments taking place to improve the living environment for people. However, when an item of furniture needed repair people needed to wait an unacceptable amount of time to have the repairs made. People's communication methods were regularly reviewed. Some people experienced difficulties with verbal communication. Relatives told us staff understood their family member’s communication abilities. One relative said, “Staff know [my family member] well and understand their needs. [Staff] seem to take their time with them all. Even when [my family member] keeps repeating themselves, staff are really good.”

Staff told us they monitored people’s care needs. However, staff were not always monitoring people's health in accordance with the care plan. The manager told us when concerns in people's health were identified these concerns were passed on to relevant health professionals. However, these meetings and conversations with health professionals were not always recorded. The manager responded to our feedback and introduced new monitoring and recording systems.

People’s care plans set out strategies to enhance independence, and demonstrated evidence of planning and consideration of the longer-term goals. However, some peoples care plans were outdated and people’s care was not always monitored in accordance with care plans. People records contained health actions plans / health passports which were used by health and social care professionals to support them appropriately.

People told us made their own choices. One person told us they could wake up and go to bed when they liked. They told us they could engage in their own choices of activities. Another person said, “Staff ask me if I'm OK with support before helping me. “

Staff understood the principles of the Mental Capacity Act. Staff told us they empowered people to make their own decisions about their care and support. One staff member told us, “Most people living here are lacking capacity in some way, but they still have choices such as choosing their own clothes.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Assessments of people’s mental capacity and best interest meetings had taken place to ensure decisions made were appropriate and least restrictive. This related to the decisions concerning where a person should live and personal care.