This inspection was carried out on 10 October 2017 and was unannounced. At their last inspection on 20 October 2015, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Highbury Rise provides accommodation for up to 23 older people, some of whom live with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 21 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run

People felt staff and staff were aware of individual risks. There were sufficient staff to meet people’s needs and these were recruited appropriately. Staff felt trained and supported for their role. Medicines were managed safely, however, further monitoring was needed to help ensure records were consistently accurate.

People were supported to eat and drink and had regular access to health and social care professionals. Staff worked in accordance with the principles of the Mental Capacity Act 2005 (MCA) and promoted choice and involvement. Staff knew people well, were caring and respected people’s preferences.

People received care that met their needs in a way they liked and care plans contained up to date, clear information. Activities were provided however, some further development was needed for the activity organiser to ensure these met everyone’s needs. There were no recent complaints and feedback was sought from people, their relatives, staff and visiting professionals.

People, relatives and staff were positive about the management of the home. There were effective quality assurance systems in the home and there was visible leadership for staff. The ethos of the home was person centred and the environment was homely.

This inspection was carried out on 20 October 2015 and was unannounced.

Highbury Rise provides accommodation and personal care for up to 23 older people, some of who live with dementia. There were 21 people living at the service on the day of our inspection. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

When we last inspected the service on 2 April 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. One had been authorised. The manager and staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People received care that met their individual needs and were positive about the staff who supported them. There was varied menu available and people were given assistance to eat and drink where needed.

There was an activities plan which took into account people’s hobbies, interests and life histories and plenty of opportunity to go out for the day and into the community. People’s feedback was sought and complaints were responded to appropriately. Lessons learned were shared through the staff team.

People, staff and professionals were positive about the leadership in the home. There were systems in place to monitor the service and address any shortfalls. There was an open and inclusive atmosphere in the home and people came first.

Is the service safe?

The service had robust systems in place for identifying and reporting any concerns about people’s safety and welfare. Staff had received training on protecting people who used the service from the risk of abuse and had a good awareness of their role in relation to this. People who used the service told us they felt happy to go to a staff member if they were worried about their safety and welfare.

The environment was safe and well maintained. There was a refurbishment programme ongoing to update any areas that required it. The staff were all familiar with health and safety requirements and had received regular support and training. There were some areas where cleanliness needed improvement but this was addressed on the day of inspection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care and support they received. They also told us that their preferences were respected. Care plans were discussed with key staff members and information was shared with the staff responsible for delivering the care. One person who used the service told us, “I couldn’t ask for more, I get everything I need.”

Is the service caring?

We observed staff with people who used the service. Staff responded promptly to requests for assistance and communicated with people respectfully, in way that showed they knew people well. This included the catering staff who we observed serving people their breakfast. Staff were kind and checked on people throughout the inspection to ensure they were safe and if the needed anything. People were given blankets for over their legs when a room felt cooler and staff supported people in locating their belongings when they had mislaid them. We saw one person who was becoming anxious be well supported by staff. This was done in a way that quickly resolved their anxiety and soon had them chatting, laughing and enjoying an activity.

Is the service responsive?

We saw from care plans that when people moved into the service their needs were assessed and recorded. We also saw that when their needs changed their care plans were updated to reflect this. There was evidence of people’s involvement in the planning of their care and their requests were carried out. For example, additional support was given to a person’s family member regarding an issue they raised when needed.

Is the service well-led?

The manager was a visible member of the team throughout the day working alongside staff and setting examples. The reaction of staff and people who used the service confirmed that this was a normal occurrence. When we arrived at the service the manager was taking part in the handover. This demonstrated their approach of being involved and open.

There were regular audits completed and action plans developed. There was a record of these actions being completed. The views of people were taken on board and new systems of working were derived from these and shared with the staff team.

There were regular checks on staff performance through observation and supervision. The manager worked with staff to share examples of good standards of care.

We looked at five people's care plans and saw that they were person centred. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with people who were living at the service. One person said, "They are caring."

We saw that people had their strengths and abilities assessed and this included their capacity to make decisions. Staff had a clear understanding of how to support people to make a choice to enable them to obtain consent to an activity or care task. One member of staff gave us an example of how they supported people’s choices, “I knock on the door, ask them if I can help them with getting up, they say no I go back later.”

We inspected Highbury Rise in response to some information of concern that we had received. We spoke with four members of staff and they all were clear on what their roles were in response to safeguarding people from the risk of abuse. We spoke with five people who were living at the service who all told us they would speak with the carers if they were worried. One person said, "“All the staff are caring and kind, I haven’t met anyone who isn’t.” However, we noted that there was a current safeguarding concern under investigation for this service.

We found that staff were supported by the management team and received regular one to one supervisions. Records showed that staff training was updated annually.

On our inspection visit on 5 April 2013 we found that Highbury Rise was not supporting people or recording information appropriately to ensure sufficient nutrition and hydration.

On our inspection on 5 July 2013 we found that the service had made improvements to the structure of mealtimes and the way in which they recorded information in relation to a person's dietary intake. This ensured people living in the home received the support that they required. We spoke with five people and they were positive about the food and the support they received. One person told us, "It's very good."

On our visit on 05 April 2013 we saw that people who used the service were involved in the planning and reviewing of their care. We found that people’s views were listened to and acted upon. We looked at support plans and spoke with people who all spoke positively about the service and the care they received. One person told us, "I stay up in the evening with the night staff, we have a good natter. We get on well."

We saw that the service had some systems in place to support nutrition and hydration however improvements around how this was managed were required.

We looked at medication management and found that the systems in place were appropriate. This ensured that people received their medication safely and in accordance with the provider’s own policy. We saw that staff had received training in medication administration and were in the process of completing further medication training.

As part of the inspection we looked at staff files. We saw that staff had been taken through robust recruitment procedures and their capability for the role had been assessed prior to them starting employment.

We looked at the provider’s complaints management system. We saw that all complaints received had been managed in accordance with their own policy. People we spoke with told us that they had not needed to make a complaint but knew how to if the need arose. One person told us, "I'd go through to the office, [the manager] is good."

When we inspected Highbury Rise on 3 July 2012, we spoke with some people about their experiences of living there. Some of the people at this home were living with dementia and were not able to express themselves verbally so we also used our Short Observational Framework for Inspection (SOFI) tool. This is a tool that allows us observe how well people are engaged by each other and the staff and what their overall mood is. Our observations showed kind, respectful, light-hearted and natural interaction between the staff and people living there.

One person told us, “I get my specific needs”. Another person said of the choice of food, "If I don't like it I can always get something else."

We asked people how they were involved in decisions about their care and about the way the home was run and one person said, "We have meetings when we get to say what we need”. Another person said, “Whatever I ask for gets done.”

People also said that they were well cared for by staff who understood their needs. One person said, “I am well looked after here”. Another person told us, “I’ve never had cause to complain”. One of the people we spoke with said that they were involved in reviewing their care plan with their key worker on a frequent basis.

People we talked with spoke enthusiastically about some recent outings and other trips that staff at the service had organised for them and which catered for their specific interests; for example a trip to see the Queen during a jubilee visit and a trip to a local stable.

People also said they felt safe at the home.