About the service: Highbury House Nursing Home is a care home that was providing personal and nursing care to 20 people at the time of the inspection. Care is offered to people living with learning disabilities, mental health needs, including those detained under the Mental Health Act, sensory impairments and people who misuse drugs and alcohol. Care is offered to both younger adults and older people.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the local area. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

• Services that provide health and social care to people are required to inform the Care Quality. Commission (CQC), of important events that happen in the service. Provider checks had not identified this did not always happen promptly, and the registered manager had not understood all their responsibilities to notify CQC of some important events.

•People told us they considered Highbury House Nursing Home to be their home and were positive it was managed and the care provided.

• People and staff told us they saw the registered manager often and found them approachable.

• Staff knew people’s health and well-being needs well, and acted as advocates for people, which helped to ensure people’s health and well-being needs were met.

• There were sufficient staff to care for people at times people wanted assistance.

• Staff understood risks to people’s safety and supported them to stay as safe as possible.

• People were supported to have their medicines safely and checks were undertaken to ensure these were administered as prescribed.

• The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• People had developed strong bonds with the staff who cared for them, and enjoyed expressing their affection for staff. People were confident to ask for assistance and reassurance from staff when they wanted this, and staff took time to provide this in the ways people preferred.

• Staff knew what was important to the people they cared for and spoke warmly about them, and ensured their rights to dignity, independence and privacy were respected.

• People made their own decisions about their lives and care. Where people needed support to make some decisions staff assisted them, using people’s preferred ways of communicating.

• Staff had received training and developed the skills they needed to care for people, through induction and on-going training. People told us staff knew how to help them.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• Staff ensured people had opportunities to do things which they enjoyed and which responded to their individual needs.

• The views of people and other health and social care professionals were considered when people’s care was assessed, planned and reviewed, so people’s needs continued to be met.

• Systems were in place to take any learning from complaints and to further improve people’s care.

• People’s wishes for their care at the end of their lives had been planned and the views of their relatives considered.

• The registered manager and provider checked the quality of the care provided and developed the service, and people’s individual care, based suggestions from people and staff.

• The registered manager kept up to date with best practice developments, so they could improve the care provided further.

• We found the service met the characteristics of a “Requires Improvement” overall.

Rating at last inspection: Good. The la

This unannounced inspection took place on 26 November 2015. At our last inspection in December 2013, we found that the provider was meeting the regulations that we assessed.

Highbury House Nursing Home is registered to provide accommodation, nursing or personal care for up to 21 adults who have support needs that are related to their mental ill health, learning disabilities, autistic spectrum disorders, misuse of drugs and alcohol or sensory Impairment. The service provides nursing and rehabilitation support to enable people to return to living independently. At the time of our inspection there were 19 people using the service.

The manager was registered with us as is required by law. 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.

Staff were provided with training and were knowledgeable about how to protect people from harm.

We found that medicines management within the service was effective. The service had a suitable amount of staff on duty with the skills, experience and training required in order to meet people’s needs. People told us staff were available to provide the support they needed, when they needed it.

People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs. The service had appropriately identified those people who may need a Deprivation of Liberty Safeguards (DoLS) in relation to potential restrictions they were subject to.

We observed staff interacting with people in a positive and respectful manner. People spoke to us about how genuinely caring and kind staff were towards them. People told us they were encouraged to remain as independent as possible by staff. We observed staff ensured people’s privacy and dignity was maintained.

People were consulted about all aspects of the planning of their care and in relation to the daily activities they were involved in. Activities available within the service were centred on people’s rehabilitation needs, individual abilities, preferences and interests. The provider’s complaints process was clear and was displayed on communal noticeboards for people to refer to.

All of the people and staff we spoke were very complimentary about the quality of leadership within the service. The registered manager and provider undertook regular audits to reduce any risks to people and ensure that standards were maintained. Feedback was actively sought and acted upon from people.

The inspection was undertaken by one inspector who gathered evidence to help us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service caring?

People were supported by attentive staff who encouraged people to be as independent as possible. We saw that care workers showed patience and supported people with their decision making. People's preferences, interests and diverse needs were recorded and staff regularly checked with people if they wanted to change them or to introduce new objectives. Care plans and risk assessments were regularly reviewed to ensure that staff had up to date information about people's needs. Staff had adopted a flexible system so that they could respond to people's needs and requests at short notice. People who used the service and their relatives had completed satisfaction surveys.

Is the service responsive?

We found evidence that people were supported in how to make a complaint if they were unhappy. We saw that any complaints received had been dealt in with accordance with the service's complaints policy. Before admission people were supported in making visits to the home to give them opportunity in making a decision about moving in and for staff to observe their interactions with other people who already resided in the home. This process included a full physical and mental health assessment. The home had its own minibus, which helped to keep people involved with their local community. An external professional had suggested a daily living task that a person could enjoy doing. Staff were in the process of arranging for this to happen and for monitoring the person's enjoyment of it.

Is the service safe?

People were treated with dignity and respect and staff asked for permission before carrying out a task. The home had policies in place in relation to the Mental Capacity Act 2005 and all care staff had received training. Recruitment practices were thorough and safe and where necessary staff were subject to disciplinary action. Newly recruited staff did not work by themselves until they felt confident and when they had been assessed to do so. People who were assessed as being at risk were escorted during outings from the home. Staff knew about risk management plans and we saw examples of where they had been followed. People's care files contained risk assessments that were relevant to them both in the home and in the community.

Is the service effective?

People's physical and mental health needs were assessed upon admission and as an ongoing process. Other health needs had been assessed such as nutrition, skin care and mobility. People's diverse needs had been recorded and care plans developed, which were regularly reviewed. We spoke with some people who used the service. One person told us: "X (a named nurse) always looks after me".

Is the service well led?

The service worked in partnership with key organisations such as community psychiatric nurses, psychologists and social workers to support care provision and service development. Staff told us they were clear about their roles and responsibilities. Staff also had a good understanding of the ethos of the home and the need to provide a good service at all times. We found there was a quality assurance system in place that protected people who used the service and made ongoing improvements for their benefit. We found that people were able to influence the way they were cared for and supported through their monthly meetings with their key worker and residents meetings.

As part of our inspection we spoke with three people who used the service, two relatives, three members of staff and the registered manager.

Before people received any care, support or treatment we saw they were routinely asked for their consent. One person told us, “Staff always let me do what I want”.

We saw that care was planned and delivered sensitively. People had their needs individually assessed. One person said, "Staff organise activities for me that I like to do.”

Suitable nutritious food and drinks were available to people throughout the day or on request. We saw that people’s dietary and nutritional needs were being met.

People we spoke with said they felt safe and would tell staff or the manager if they were unhappy or worried. The staff we spoke with had a good understanding of how to protect people from the risk of abuse.

We found that medicines were safely stored, handled and administered. Records we looked at in regard to the administration of medicines were accurate.

There were 19 people living at the home at the time of our inspection. We spoke with 10 people, four staff and the manager. We walked around the home and observed how people were being supported.

All of the people spoken with told us they liked living at the home. One person said “it is nice here, there is a relaxed atmosphere, and it is normal, I feel comfortable here”. Another person told us “I love it here, we choose how we spend our day, and the staff support us when we need them to”.

People told us that staff respected their privacy and dignity and that they were given choices about their care, how they spent their day and about what food they wanted to eat. We saw positive interactions between staff and people that lived at the home.

We saw that people’s needs were assessed, and support plans were developed in consultation with them. Staff spoken to were able to tell us about people’s needs, this ensures they receive support is a way they prefer.

People said they felt safe living at the home. We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home.

Staff spoken with told us they felt supported by the manager, and have regular training opportunities.

People told us they knew how to raise any concerns, and systems were in place to address these. People have regular meetings which enable them to raise any issues about the service.