Highbury House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During the last inspection, we found robust procedures were not in place to ensure people were supported safely. Potential abuse was not thoroughly investigated and responded to in a timely manner and the provider failed to ensure there were enough staff on duty. This placed people at risk of harm. This was a breach of regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment) and regulation 18 (Staffing). During this inspection, enough improvement had been made and the provider was no longer in breach of regulation 12, 13 and 18. People told us they felt safe living in the home with the staff who supported them. However, the provider was slow to act on environmental concerns, such as broken fixtures and furnishing. Care plans were in place, although some care plans contained outdated information. The provider acted on all of our feedback, care plans were updated and new systems were introduced to monitor maintenance requests. Incidents and accidents were managed well, and lessons learnt were shared with the staff team. People received their medicines safely and in a dignified manner. People told us they felt involved in their care and support and could take risks. Professionals told us the provider communicated effectively and kept them informed with any changes in people’s health or risks. There were enough staff on duty to support people in line with their care needs and staff were recruited safely.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a culture of learning lessons when things went wrong. Relatives told us the provider learnt lessons from the last inspection. One relative said, “The home has very much improved, they have acted on the areas identified and made improvements. I hope it continues to improve.” However, there were still areas of improvement needed to the overall governance of the service. People told us risks were managed safely. One person said, “I feel safe here. I get to choose how things are done.”

Staff told us there was a culture of learning from incidents and accidents. Staff told us lessons learnt were discussed in meetings and handovers. One staff member said, “We now have regular handovers and team meetings to discuss risks and incidents.” Staff told us mistakes were used as opportunities for growth. One staff member told us they once made a medicine administration error. They explained they needed to undergo further training before they could administer medicines again. The staff member said, “Following the training, the manager was very supportive and checked to see whether I felt confident to administer medicines.”

The provider learnt lessons when things went wrong. During the previous assessment the provider had not reviewed incidents and accidents. During this assessment we found accident and incident forms were completed and investigated by the management team. Trends were examined and referrals made to other agencies such as the positive behaviour support team. Complaints were acted upon, and actions taken clearly recorded. However, further improvements were identified regarding monitoring and auditing of people's care and promptly responding to environmental concerns. The manager responded to our feedback by introducing new systems to monitor people's care and maintenance requests.

People told us they felt involved in their care and support. One person told us, “If I had any concerns or worries, I'd speak to staff. I know the manager and other staff are there to help me.” Another person told us about a potential move into a more independent home and how they were considering a volunteering job. They told us they worried about these decisions, we observed staff supporting the person and providing reassurance and encouragement. Relatives told us they were involved in reviews of people’s care and support. One relative said, “We are involved in care plans and care plan reviews. If I had any concerns, I'd speak with the manager.”

The manager told us how 1 person was being supported with the goal to eventually move on to a more independent supported living service. Staff told us people’s independence was promoted and people were encouraged to access the community and use public transport where possible.

Visiting professionals told us the provider communicated changes in peoples care and support needs effectively. One visiting professional said, “The provider sends in quality returns each quarter to demonstrate how people are meeting their outcomes and progression to move on.”

The provider worked in partnership with other health and social care professionals to assist people to move between services. The provider shared their plans to support 1 person to move to an independent living home. However, some referrals and follow up appointments with health professionals were not carried out in a timely manner. The manager responded to our feedback straight away and arranged the relevant appointments with the appropriate health professionals.

People told us they felt safe living in the home. People told us where they could go to raise concerns. One person said, “If I wasn’t happy, I would find a staff member.” Another person told us, “I do feel safe here. The staff know me well. I think the staff help me feel safe.” Relatives told us they felt people were safe living in the home. One relative told us, “[My family member] is safe living in the home with the staff. Hopefully the provider is becoming settled now they have more staff and a new manager.” Another relative said, “[My family member] is definitely safe. If I had concerns, they’d know about it.”

Staff received safeguarding training and could access the relevant policies and guidance. Staff understood what was meant by abuse and told us they felt confident reporting safeguarding concerns. One staff member said, “We need to report any concerns to the manager straight away.” Another staff member said, “We would go to the Local Authority safeguarding team if nothing was done about our concerns.”

We observed staff supporting people safely. People appeared happy and spent time engaging in activities with staff team. We observed 1 person starting to become distressed, staff responded positively to the person and provided reassurance in accordance with their care plan.

Systems were in place to keep people safe from harm. The provider raised safeguarding referrals with the local authority when needed in accordance with statutory regulations. Safeguarding and whistle blowing policies were accessible to staff and people could access 'easy read' complaints and safeguarding policies. 'Easy read' documents help people to understand written language and use pictures to aid understanding. However, some care plans contained outdated information. This increased the risk of harm because conflicting information may increase the risk of the staff team becoming confused and increase the risk of people receiving incorrect or delayed care. The provider explained they were in the process of updating the care plans for all people but kept the older documentation accessible to staff.

People told us they could take risks. People told us about the activities they enjoyed and the activities they were going to try. Relatives told us staff understood risks to people. One relative told us about the risk posed when taking their family member on a particular activity. They explained staff understood these risks and used positive strategies to support the person.

Staff respected people’s rights to make their own decisions and take risks. Staff told us about people engaging in activities they enjoyed and taking risks, such as people attending the local pub and enjoying an alcoholic drink. Staff told us some people would benefit from a healthier lifestyle, such as more exercise and healthier eating. Staff explained they tried to encourage healthier choices but ultimately respected people’s decisions.

We observed staff responding promptly to people and supporting people safely to minimise risk. We observed people being told about risks, such as risks from hot drinks and daily activities. One person attempted to pick up a hot cup of coffee, staff intervened calmly and encouraged the person to be mindful of the risks of scalds. We observed staff supporting people who were experiencing distressed emotions. Staff spoke to people with warmth which helped to de-escalate the situation, staff used diversion and distraction techniques to help support people.

Risk assessments were in place to meet people’s health and care needs. Risk assessments were person-centred, proportionate, and regularly reviewed with people, where possible. The provider recorded any use of restrictions on people’s freedom, and the manager reviewed the use of restrictions to look for ways to reduce them. However, where risk was identified and care monitoring was required, such as the need to weigh people monthly due to risk from excess or loss of weight, we found there were gaps in the recordings. People’s oral care was not clearly recorded and where people required their bowel movement monitored, there were gaps in the recordings. The manager responded to our feedback by updating the care plans and introducing new monitoring systems.

People were actively encouraged to be aware of risks from the environment. We saw examples of people being involved in fire drills. However, when people’s furnishings in their bedroom or in communal areas needed repair, the provider was slow to act and repair the damage. The manager raised these concerns promptly using the provider's electronic system of raising a maintenance ticket. However, people needed to wait several months for these items to be repaired. The provider acted on our feedback by reviewing the system of raising tickets and recruiting additional maintenance staff. The home was undergoing refurbishment at the time of this assessment. People were involved in choosing the new colour scheme of the environment and furnishing. One person told us about the colour they had chosen and the pictures to hang on the wall. One relative told us, “The home is under refurbishment at the moment, long overdue. I know [my family member] was involved choosing the colour schemes.”

Staff told us the new refurbishment would make a positive difference to people’s living environment. Staff told us they were trained to use equipment in the home and felt confident to do so.

People moved freely around their home and staff followed safe practices when using equipment. We observed staff wearing the appropriate personal protective equipment (PPE), such as gloves and aprons. However, we raised concerns over cleaning products being accessible in an unlocked cupboard under the kitchen sink and a sharp knife being left in a drawer. The manager responded straight away, explaining all people were supported on a 1:1 basis, meaning people were observed in communal areas, such as the kitchen. Although the manager agreed the products needed to be locked away in accordance with risk assessments and policy. The manager ensured all cleaning products and sharp knifes were locked away and reminded the staff team of the protocols in place.

Environmental checks were carried out in accordance with health and safety regulations. However, the provider was not proactive when responding to broken pieces of equipment. The provider responded to our feedback and introduced new systems for a more timely response to maintenance requests. Monitoring systems were introduced to alert the provider to the length of time maintenance requests were taking in order to increase accountability.

People told us there were enough staff available to support them. One person said, "I think there is enough staff here to help me. I have the same staff supporting me. I like them.” Relatives told us staffing levels had improved. One relative said, “The staff team is much more stable, they seem to know what they are doing. The staff are approachable and kind.” Another relative told us, "There always seems to be enough staff here to support [my family member]. The staff seem to have had enough training. They always seem knowledgeable, they're lovely.”

Staff told us how staffing levels had improved since the last assessment. One staff member said, “Staffing levels are loads better. I can’t tell you how much it has improved.” The manager told us the use of agency staff had reduced significantly and they now had a higher level of permanent staff working in the home.

The service had enough staff, including for 1:1 support for people to take part in activities and visits how and when they wanted. We observed staff engaging with people and responding promptly to people’s requests.

People were supported by staff who had received relevant and good quality training in evidence-based practice. This included training in the wide range of strengths and impairments people with a learning disability and or autistic people may have, communication tools, and positive behaviour support. Staff were recruited safely. Recruitment files showed all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed.

During the site assessment the home was undergoing refurbishment. People told us they were involved in the colour scheme and furnishings. Relatives told us they had concerns over the state of the environment historically although they were pleased it was now under refurbishment.

Staff told us part of their duties included regular cleaning. One staff member said, “There are cleaning schedules in place. We do cleaning in the morning, middle of the day and end of the day. Each member of staff has cleaning allocated according to their workload and it has to be done. We swap it over depending on which people need more support on that day from each staff member.”

We observed cleaning by staff and people. We observed refurbishments taking place by contractors. We observed staff wearing personal protective equipment (PPE) when needed. We observed people taking part in general cleaning. One person’s care plan highlighted how they enjoyed this, especially the hoovering.

The provider was promoting safety through the layout and hygiene practices of the premises. There was a clear Infection Prevention Control (IPC) policy in place which was accessible to staff. Posters displaying good IPC practices were seen around the home. Easy read IPC information was available to communicate good IPC practices to people.

People told us they received their medicines safely. One person said, “Staff help me with my medicines, I always get them morning, afternoon and night-time.” Relatives told us staff were competent at administrating medicines. One relative told us, “Staff are good at giving [my family member] the medicines they need.” We observed people receiving their medicines in a dignified way. Staff told people what medicines they were taking before administrating.

The manager explained people’s behaviors were not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (Stopping The Over-Medication of People with a learning disability, autism or both). One staff member told us, “STOMP means stopping the over medication of people. It's important to monitor all medicines and try to reduce any medicines which may impact negatively on people.”

Medicines were handled safely by trained staff. People were offered pain relief medication, in accordance with their preferences and health professional guidance. Medication Administration Records (MAR) matched the correct quantities of medicines and medicines were stored safely in line with manufacturer guidance. Medicine errors were reported, investigated and followed up.