Highbury House

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 Care plans were in place, although some care plans contained outdated information.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.

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.

People were supported by kind and compassionate staff, who treated them with dignity and respect.

Relatives told us staff encouraged people to be independent and encouraged people to engage in activities.

People’s protected characteristics were respected, and people’s individuality was promoted.

Staff told us they felt supported by the management team.

People told us they were involved in their care planning and future goals. The provider worked in partnership with other health professionals to meet people’s goals.

Visiting professionals told us staff knew people well and the provider kept them informed in changes in people’s health and support needs.

Relatives told us staff supported people to maintain relationships.

Staff understood people’s communication needs and used other forms of communication to understand people’s wishes and needs.

During the last assessment the provider did not demonstrate effective governance, including quality assurance and health and safety auditing. This was a breach of regulation 17 (Good governance).

During this assessment, we found the provider had acted on the areas of concern identified. However, additional governance concerns were found regarding care monitoring and auditing, making timely referrals to health professionals, and responding to environmental concerns. This meant the provider remained in breach of regulation 17 (Good governance). .

The provider learnt lessons from the previous inspection and made improvements to the care and support provided to people. However, further improvements were needed to the overall governance.

The manager was new to the service and in the process of registering with us. The manager responded to our feedback by introducing new systems to monitor care and maintenance requests. They arranged referrals with the appropriate health professionals and introduced new systems to monitor timely reassessments of people’s care needs with professionals.

Staff told us they had confidence in the new manager's leadership and they felt able to raise concerns.

The manager was aware of the duty of candour and shared their plans to continue to improve the care and support provided to people.