This inspection visit took place on 16 and 17 October 2018 and was unannounced on the first day.

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

Highbury House Care Home is registered to provide accommodation for persons who require nursing or personal care for 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. There are private parking facilities at the front of the building and garden areas at the rear. During this inspection there were 21 people living at Highbury House Care Home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in July 2017, we found five breaches of regulation. We found breaches in the regulations related to Person-centred care, Need for consent, Safe care and treatment, Good governance and Fit and proper persons employed. In addition to the requirement notices we made a recommendation related to staffing.

Following the inspection in July 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. This was not provided to us.

At this inspection we saw improvements had been made. Care plans held person-centred information and people or their representative had signed to indicate consent. Recruitment procedures were robust and staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. Medicines were stored and administered safely. We saw staff administering medicines to people followed good practice guidance.

However, at this inspection we found quality monitoring systems and processes did not consistently identify areas of concern so improvements could take place. Audits and checks carried out had not identified some of the issues we identified on inspection.

This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We noted certain parts of the home were unclean and processes were not consistently implemented to assess the risk of preventing and controlling the spread of infections

This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation the registered provider reviews staffing levels and staff deployment.

We have made a recommendation the registered provider ensures all staff who have access to people who may be vulnerable receive appropriate training.

We have made a recommendation the registered provider gather people’s views on the meals provided and review the mealtime experience people receive.

The service had systems to record safeguarding concerns, accidents and incidents and acted as required to make improvements and minimise future risks. The service monitored and analysed such events to learn from them and improve the service.

The registered manager had systems to ensure people’s care, treatment and support was delivered in accordance with best practice guidance and current legislation.

Care plans held information that guided staff on people’s likes dislikes and health conditions. People told us the

This inspection took place on 28 July 2017 and was an unannounced inspection.

Highbury House is located in South Shore, Blackpool. The home is registered to accommodate up to 28 people who require assistance with personal care. 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. The majority of the bedrooms are single occupancy and en-suite. There are private parking facilities at the front of the building and garden areas at the rear. During this inspection there were 21 people lived at Highbury House.

Highbury House was registered with The Care Quality Commission (CQC) as a partnership until February 2017 when the home was registered with CQC as a limited company - D.M Care. This is the first inspection of the home as the new legal entity. The director of the new legal entity D.M. Care was a partner in the previous partnership. This enabled continuity of care during the change of legal entity.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found for recruitment, management of medicines, consent to care, person centred care and governance.

Staff did not always manage medicines safely. Medicines were not always recorded accurately or people given their medicines as prescribed as there were inconsistencies in the amount of tablets recorded and those left.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had not ensured medicines were managed safely.

People were not always supported to have maximum choice and control of their lives. The registered provider had procedures to assess people’s mental capacity and to support those who lacked capacity to manage risk. However, there was no record of people of their consent to care and treatment or that of a representative to their care.

This was a breach of regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because care and treatment must only be provided with the consent of the relevant person.

Care plans were personalised in that people’s care was recorded, but people and where appropriate their representatives were not involved in reviewing their care and making decisions about how they wanted their care provided.

This was a breach of regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people were not involved in planning their care so it met their needs.

Some carpets and furniture were unclean and unhygienic in communal areas. This increased the risk of cross infection.

We made a recommendation to improve cleaning schedules and the effectiveness of cleaning to keep the home clean and hygienic and reduce the risk of cross infection.

Robust recruitment practices were not always followed. This reduced the safety of appointing new staff and was contrary to the home’s recruitment procedure.

This was a breach of regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as recruitment procedures must be operated effectively.

There were mixed views from people about staffing levels. Some people felt staffing levels were usually appropriate others said staff were busy. From our observation staff carried out personal care promptly but oversight of people was limited and there was little staff interaction except for practical tasks.

We made a recommendation for the registered manager to review staffing levels and skill mix so they respond to the changing needs of people using the service.

Although we found the registered manager and staff team provided good care and the registered manager supported and encouraged the staff team, the home was not always well led. Audit systems were in place however they were not always robust or effective as they did not identify the iss