We carried out this unannounced inspection on the 7 and 8 March 2017. Highbury Nursing Home provides nursing care and support for up to 38 older people who may also live with dementia. At the time of our inspection 37 people were residing at the home.

We undertook a comprehensive inspection of this home in March 2016. During this inspection we found that the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered provider did not have effective systems in place to assess, monitor and mitigate the risks to health, safety and welfare of people who used the service. We identified some concerns with moving and handling care plans and risk assessments and in addition the systems in place had failed to identify that staff competency was not checked in respect of restricting people’s liberty. After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found improvements had been made and the home was compliant with the requirements of the law.

The registered manager was present during our inspection. 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.

People told us they felt confident that the service was safe and protected them from harm. Staff knew how to help reduce risks to people because plans were in place to guide them. Effective safeguarding procedures were in place to ensure people were protected from potential abuse. There were sufficient numbers of staff on duty to support people in a timely manner. People were happy with the arrangements for their medicines; however the storage of medicines was not always safe.

People told us that staff had the knowledge and skills to support them with their needs. Assessments had been completed to determine people’s mental capacity to make certain decisions. Further work was needed to ensure care records contained guidance of how to support people who had restrictions to their liberty. People were happy with the quality and variety of food and drinks provided and they were supported to access appropriate health care professionals when needed.

People said they were treated well by staff who were kind and caring. People were encouraged to be independent and make choices about their day. People’s privacy and dignity was respected.

People’s care plans reflected their level of support needs and contained people’s individual preferences. Staff supported people in line with their care plans and had a good understanding of people’s life histories as well as their needs and preferences. People told us staff supported them to keep in contact with their family and friends. People knew how to complain and an effective complaints procedure was in place to support people to comfortably raise concerns.

People and staff we spoke with were complimentary about their experience of the home and the quality of the leadership. People told us they were encouraged and supported to express their views and experiences about living at the home. Systems for monitoring the quality and safety of the service were being undertaken to drive improvements within the service.

We carried out this unannounced inspection on the 7 and 8 March 2017. Highbury Nursing Home provides nursing care and support for up to 38 older people who may also live with dementia. At the time of our inspection 37 people were residing at the home.

We undertook a comprehensive inspection of this home in March 2016. During this inspection we found that the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered provider did not have effective systems in place to assess, monitor and mitigate the risks to health, safety and welfare of people who used the service. We identified some concerns with moving and handling care plans and risk assessments and in addition the systems in place had failed to identify that staff competency was not checked in respect of restricting people’s liberty. After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found improvements had been made and the home was compliant with the requirements of the law.

The registered manager was present during our inspection. 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.

People told us they felt confident that the service was safe and protected them from harm. Staff knew how to help reduce risks to people because plans were in place to guide them. Effective safeguarding procedures were in place to ensure people were protected from potential abuse. There were sufficient numbers of staff on duty to support people in a timely manner. People were happy with the arrangements for their medicines; however the storage of medicines was not always safe.

People told us that staff had the knowledge and skills to support them with their needs. Assessments had been completed to determine people’s mental capacity to make certain decisions. Further work was needed to ensure care records contained guidance of how to support people who had restrictions to their liberty. People were happy with the quality and variety of food and drinks provided and they were supported to access appropriate health care professionals when needed.

People said they were treated well by staff who were kind and caring. People were encouraged to be independent and make choices about their day. People’s privacy and dignity was respected.

People’s care plans reflected their level of support needs and contained people’s individual preferences. Staff supported people in line with their care plans and had a good understanding of people’s life histories as well as their needs and preferences. People told us staff supported them to keep in contact with their family and friends. People knew how to complain and an effective complaints procedure was in place to support people to comfortably raise concerns.

People and staff we spoke with were complimentary about their experience of the home and the quality of the leadership. People told us they were encouraged and supported to express their views and experiences about living at the home. Systems for monitoring the quality and safety of the service were being undertaken to drive improvements within the service.

On the day of our unannounced inspection, we found that 33 people were living at this nursing home. We subsequently spoke to six people who lived there, nine relatives, four members of staff and the manager of the home. We found that some people were not able to give us their views on the service because of their complex needs and health conditions.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that care was provided in an environment that was safe, accessible, clean and adequately maintained. People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We spoke to several people who lived at the home. People told us they felt safe. Comments included, “I feel safe here and staff look after me very well.”

We found that the home’s safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care and nursing homes. While no applications have been made under this legislation for any person living at Highbury Nursing Home, we found that the provider understood their responsibilities in relation to the law.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We found that there were arrangements in place to deal with foreseeable emergencies and staff were trained and understood the emergency procedures at the home.

We concluded that people were safe at Highbury Nursing Home and protected from harm.

Is the service effective?

People were supported by care and nursing staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices. We found that staff had effective support, induction, supervision, appraisal and training. Care staff told us that they were well trained, competent and able to safely meet the needs of the people who used the service.

People’s day to day health needs were met. This is because people’s needs were assessed and care and support was planned and delivered in line with their individual care plans. We saw that people had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

People and their relatives told us that they were happy with the care they received and the care staff who supported them.

We concluded that care staff had the appropriate skills and knowledge to ensure that people received safe, effective and appropriate care and support.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us during our inspection that care and nursing staff were attentive, polite and sought consent before providing care and support. We saw that staff were patient with the people they were supporting and treated them with respect and dignity.

We spoke to relatives of people who lived at the home. They were very complimentary about the standards of care being delivered and the competence of staff delivering care and support. Comments included, “My relative receives excellent care thank you, I have no worries here.”

The staff we spoke with demonstrated to us that they knew the people they were caring for well including their preferences and personal histories.

We concluded that people who lived at Highbury Nursing Home received care which was delivered with compassion and respect for their dignity and human rights.

Is the service responsive?

People receive care, treatment and support with their valid consent when they need it. We found that there was enough suitably trained and experienced staff on duty to provide safe and appropriate care to people when they needed it. We did not see people kept waiting for assistance.

People know how to share their experiences or raise a concern or complaint. We found that people were encouraged to make their views known about the care, treatment and support they received at Highbury Nursing Home. This was achieved by holding group meetings, sending out survey questionnaire forms and seeking feedback on a variety of topics that were important to people who lived at the home. We found that the home had a detailed complaints policy which was fit for purpose.

We found that care and nursing staff had regular meetings with the manager of the home and had the opportunity to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

We concluded that people who lived at this home were involved in their care and listened to in a way that responded to their needs and concerns.

Is the service well-led?

We found that the manager had worked at this nursing home for several years and knew all her staff and the people who lived there very well.

We found that the staff we interviewed were motivated, caring, supported and open. All were complimentary of the manager of the home and told us that they would have no hesitation in recommending Highbury to their family and friends.

People who lived at the home and their relatives were very complimentary about the manager. Comments included, “I have a good working relationship with the manager, she keeps me informed about issues I need to know about” and “The manager and staff keep me informed about any changes.”

A check of records showed that the provider had an effective system to regularly assess and monitor the quality of service that people received and a system to manage and report accidents and incidents.

We concluded that there was effective leadership at Highbury Nursing Home and that people received care and support in a safe environment and were treated with respect, care and consideration.

There were 32 people living at Highbury Nursing Home at the time of our inspection. We subsequently interviewed seven of the people who lived there, four of their relatives and six members of staff.

People told us that they were happy with the care they were receiving. Comments included, “It’s very good here and the food is just wonderful” and “I feel safe here and the food is really good, they know what I like."

Relatives of people using the service also made complimentary comments about the home. Comments included, “I don’t think my relative would find any better nursing home than this.”

Our inspection confirmed much of the feedback we had received. We found the home to be clean, comfortable and well maintained. Our observations and conversations with people using the service confirmed that most of the staff were attentive, polite and respectful. Care staff had a good knowledge of all of the people who lived there and were familiar with their preferences and health conditions.

We found that there were good quality checking systems and procedures in place to ensure that people remained safe and secure.

We saw that people were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience. People experienced care, treatment and support that met their needs and protected their rights.

We used a number of different methods to help us understand the experiences of people who lived at the home, because some people had complex needs which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. In addition we spoke with five people and five relatives about the care provided in Highbury House.

People told us that they were able to make choices about how their personal care was given. Completed provider surveys showed us that people thought that they were involved in their care and most people said that they were supported to be as independent as possible.

People living in the home and their relatives said that the care in the home was good. They said that they could raise any incidents of concern with the manager and these concerns would be dealt with. They said that care staff were kind and helpful and they could talk to any of them.

We observed that people received assisted when needed. During our SOFI at the lunch time meal, people that needed assistance to eat were well supported.