CQC report explained · a residential care home
What the CQC found at Highbury House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, October 2023
Highbury House rated Inadequate and placed in special measures; inspectors found unsafe staffing, weak risk management and ineffective leadership.
This was an unannounced focused inspection over 19, 21 and 25 July 2023. Inspectors spoke with people, relatives and staff, observed care, and checked care files, medicines, training and safety records.
The home was rated Inadequate overall. Safe and well-led were rated Inadequate. Effective was rated Requires Improvement. Staffing levels were not always safe, agency staff affected consistency, and checks and incident reviews were not completed or effective.
Inspectors also found expired DoLS authorisations and could not find evidence that some restrictions had been agreed in people's best interests. Care plans were not always up to date, staff training had gaps, and access to activities and the community was limited.
The home had remained in breach of regulations since the previous inspection, when it was rated Requires Improvement. The provider had sent an action plan, but inspectors found that important improvements had not been made.
Access to healthcare
People were supported to see healthcare professionals when they were unwell. Health action plans and hospital passports were also in place.
“People were supported to visit healthcare professionals when unwell.” from the report
Staff awareness
Regular staff had training to recognise and report abuse and said they would feel able to raise concerns.
“The regular staff on duty had been trained to recognise and report abuse.” from the report
Personalised bedrooms
Some bedrooms had been redecorated and reflected people's individual tastes. Refurbishment work was continuing in the properties.
“Some people's bedrooms had been redecorated and were personalised to people's individual taste.” from the report
Everyday choices
Staff were seen supporting people to make day-to-day decisions, including choices about where to go in the community.
“Staff were seen supporting people to make day to day decisions.” from the report
Unsafe staffing levels
seriousStaffing levels were sometimes below the home's expected level. This meant some people's needs were prioritised and other people had less access to meaningful activities.
“There were insufficient numbers of suitably qualified and experienced staff being deployed to meet people's needs and mitigate any potential harm.” from the report
Incidents and safeguarding
seriousThere was a backlog of accident and incident reports. This meant the home could not be sure that possible abuse or repeated harm had been identified and acted on quickly.
“Robust procedures were not in place to ensure potential abuse was investigated and responded to in a timely manner.” from the report
Risk and safety checks
seriousThe home could not show that safety checks had been completed regularly or that actions from risk assessments had been dealt with. Some risk assessments were not updated after serious incidents.
“The new systems had not been implemented sufficiently to ensure health and safety risks were being mitigated.” from the report
Restrictions and consent
seriousSeveral DoLS authorisations had expired. The home could not locate evidence that restrictions had been properly considered and agreed in people's best interests.
“People were subject to restrictions which could not be evidenced to be in their best interests.” from the report
Out-of-date care information
needs fixingSome care plans and behaviour support information were inaccurate or had not been updated after changes in training. This was particularly concerning because agency staff relied on the plans.
“People's needs were assessed, and care plans were in place, but it was evident that reviews and updates were required to ensure the information was accurate.” from the report
Limited activities
needs fixingStaffing problems and inconsistent support limited what some people could do. Community activities reduced during the pandemic and had not fully restarted.
“Community engagement decreased during the COVID-19 pandemic and had not been fully recommenced.” from the report
- 01How many permanent staff and agency staff are now working on each shift, and how do you ensure there are enough suitably trained staff?
- 02What has been done to clear the backlog of accident and incident reports, and how are safeguarding concerns now reviewed and referred?
- 03Have every person's DoLS authorisation, capacity assessment and best-interest decision been checked and renewed where needed?
- 04Which care plans and positive behaviour support plans have been updated, and how do you ensure agency staff follow the current information?
- 05What improvements have been made following the urgent action plan, including safety checks and community activities?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and the overall rating used the previous ratings for any questions not inspected. This explanation was written from the published report of 21 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2022
Highbury House rated Requires Improvement; inspectors found kind care but staffing, people’s independence and management checks were not reliable enough.
This was the first inspection of the newly registered service. The visit was unannounced and took place on 23, 24 and 28 June 2022. Inspectors spoke with people, relatives, managers and staff, and reviewed care records, medicines records, recruitment files and other evidence.
The overall rating was Requires Improvement. All five areas were rated Requires Improvement: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were usually treated with kindness and dignity, received medicines safely and had access to healthcare, but their choices, independence and activities were not always supported.
There were not always enough suitably skilled staff, including drivers and staff able to provide two-to-one support. Care plans and risk information were not always up to date. Quality checks did not reliably identify or resolve these problems, and some restrictive practices were not properly reviewed.
The home had a new manager who had been in post for about eight weeks and had applied to register with the CQC. The provider was asked for an action plan and will be monitored with the local authority. The previous provider’s rating was Good in 2019, but this service was newly registered and this was its first inspection.
Kind and respectful staff
People and relatives described staff as kind and supportive. Inspectors saw that staff respected privacy and dignity.
“People and relatives told us that staff treated them with kindness and empathy.” from the report
Medicines were managed safely
Medicines were stored safely, given as prescribed and recorded accurately. Audits were used to check medicines practice.
“Medicines were stored safely, and people received their medicines as prescribed.” from the report
Health support
Staff worked with health professionals and had health action plans and passports to guide support.
“Staff worked closely with other agencies to ensure people received the care they needed.” from the report
Safe recruitment
Staff recruitment included references and DBS checks before people started work.
“People were supported by staff who were safely recruited.” from the report
Communication support
Staff used individual communication guidance, visual aids and Makaton to help people communicate.
“Staff used visual aids and Makaton to support people's communication.” from the report
Not enough suitable staff
seriousStaffing levels and the number of experienced staff were not always enough for people’s needs. This affected access to the community and led to one person being left unsupervised despite needing one-to-one support.
“There was not a sufficient number of suitably qualified, competent, skilled and experienced staff members deployed to meet people's needs and ensure they were not placed at risk of harm.” from the report
People’s independence and choice
needs fixingPeople were not always supported to make their own decisions, take positive risks or develop independence. Meal choices were sometimes restricted by a rigid plan.
“People were not always supported to have maximum choice and control of their lives” from the report
Out-of-date care information
needs fixingSome care plans and positive behaviour support plans had not been updated or printed in people’s files. This meant staff might not have had current guidance.
“People's care was not always reviewed to ensure their current needs were being met.” from the report
Weak quality checks
seriousThe home’s systems did not reliably check that essential tasks were completed or that people’s needs were being met. Fire safety actions and maintenance work had not been followed up properly.
“Systems had not been established to adequately check the quality of the service and ensure that essential tasks had been completed and that people's needs were met.” from the report
Environment needed improvement
minorSome communal areas were sparse and some communal bathrooms needed refurbishment. The provider said refurbishment had been agreed after the inspection.
“Some communal bathrooms required refurbishment but this had been identified by the manager and regional manager” from the report
- 01How many permanent and agency staff are currently used, and how do you make sure each shift has enough staff with the right skills?
- 02How do you guarantee that people who need two-to-one support can go out and take part in activities at the times they choose?
- 03How often are care plans, risk assessments and positive behaviour support plans reviewed, and how do you make sure staff use the latest versions?
- 04What changes have been made to support people to make their own choices, take positive risks and become more independent?
- 05Which fire safety actions, bathroom refurbishment works and other improvements from the inspection are now complete?
This was an unannounced first inspection of the newly registered care home, covering all five key questions and infection prevention and control; the previous provider’s Good rating was published in 2019. This explanation was written from the published report of 20 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Highbury House
4 rated inspections over 7 years: the service has slipped, from Good to Inadequate.
- October 2023Inadequatecurrent ratingdown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- August 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- July 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2020
Registered with the Care Quality Commission on 27 July 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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