Harnham Croft Care Home

Harnham Croft Care Home is a nursing home providing accommodation for persons requiring nursing or personal care and treatment of disease, disorder or injury for up to 40 people. The service provides support to adults over and under 65 years, people with physical disabilities and people living with dementia. At the time of our inspection there were 35 people using the service.

Accommodation was provided on three floors accessed by stairs and a lift. People had their own room and access to communal rooms such as lounges and a dining room. People accessed the garden from the ground floor.

People’s experience of using this service and what we found

People’s medicines were managed safely. Staff had been trained and checked for competence to administer medicines. We have made one recommendation about safe use of topical patches.

People and relatives had mixed views about staffing numbers. We found there were enough staff on duty to support and care for people safely. The registered manager reviewed staffing numbers using a dependency tool and by listening to people’s views. Whilst some people said there were times staff were busy, they all told us they felt safe at the service. People told us the care was good and they found the staff to be kind and caring.

People and relatives told us staff treated people in a dignified and respectful way. Staff we spoke with told us they enjoyed their work and found caring rewarding. We observed people being cared for in a dignified way and all interactions between people and staff were respectful. There was regular ‘residents meetings’ and people told us they felt able to share their views and were listened to. Where possible the provider and registered manager made changes in response to feedback received from people and relatives.

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. Risks to people’s safety were assessed and management plans in place. Nurses regularly reviewed records to make changes and updates when needed. Where needed referrals were made to healthcare professionals and their guidance was added to people’s records.

Staff had been recruited safely and provided with training on safeguarding. Systems were in place to make sure people were kept safe from avoidable harm. Staff worked with the local authority safeguarding team when needed and notified CQC of any allegations of abuse. Staff were able to attend various meetings to discuss changes and to share any learning from reviews of incidents.

The service was clean throughout, and domestic staff were employed to maintain good standards of cleanliness. Staff were seen to be using personal protective equipment safely and there was plenty of stock available. The provider made sure staff had training on infection prevention and control procedures and had guidance on working safely. Health and safety checks were carried out and external contractors visited to complete maintenance and servicing of facilities and equipment.

There was a new registered manager in post. They had worked for the provider for many years so was familiar with their policies and procedures. Feedback about the management at the service was positive. People, relatives and staff felt able to approach the management at any time. Quality monitoring systems were in place which were effective in driving improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 January 2020) and there was 1 breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the service ensured they reviewed their staffing levels, on a regular basis, including seeking and listening to people's experience of care to assist them in determining the level of staffing needed. At this inspection we found the provider had acted in response to the recommendation made. The registered manager regularly reviewed staffing numbers and included feedback from people in their review.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 October 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harnham Croft Care Home on our website at www.cqc.org.uk.

Recommendations

We have made 1 recommendation in the key question safe. This is for the provider to review systems in place to keep accurate records of topical patch applications.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Harnham Croft is a care home with nursing and is registered to provide accommodation and support for up to 40 people. People living at the service were mainly older people, living with poor health, or early memory loss. At the time of the inspection there were 31 people living at the service.

People’s experience of using this service:

People, relatives and staff told us there were not enough staff to support them. People told us they regularly had to wait for care and support.

Staff also told us there were not enough of them to meet people’s needs or carry out their care in accordance with their preferences. The reliance on significant numbers of agency staff had led to some people being supported by staff who were not always familiar with their needs. The management team told us they had recently recruited five new care team members who they hoped would address some of the concerns. They told us they had reviewed the staffing numbers and found them to be sufficient to support people. We have made a recommendation about this.

The service did not have a registered manager in post, although a new manager had been appointed, and we were assured they would be making an application to do so. A temporary or ‘turnaround’ manager was in post and supporting the service until the new manager had completed their induction.

Management systems had not always been operated effectively to ensure the quality of the service people received. For example, we saw evidence concerns about staffing levels had been raised and assurances had been given the service had acted to resolve this in December 2018. However, this remained the issue on this inspection.

Staff had worked hard to ensure people received personalised support which met their needs and preferences, however due to staffing issues this had not always been successful. People told us staff were kind, and some said they had no concerns about their care. Systems were in place for the management of concerns or complaints, and to respond to incidents and accidents.

There was an understanding of people’s rights in relation to Deprivations of Liberty authorisations under the Mental Capacity Act 2005. Some information was updated while we were at the service to ensure restrictions on one person’s liberty were better understood and recorded.

Care plans we reviewed were up to date, and reflected people’s needs, including risks associated with their healthcare and how to mitigate them. Plans had been drawn up with the involvement of people, or others authorised to act on their behalf. Some people told us they had not received or did not know how to access oral or foot care, and we have made a recommendation about this.

The building had been maintained to a high standard. Because of the needs of some of the people living at the service we found the building would benefit from some additional adaptation to meet the needs of people living with sensory or early memory loss. We have made a recommendation about this.

People received their medicines as prescribed, and systems were in place to safeguard people from abuse. The service responded to any concerns or complaints about people’s wellbeing. Recruitment processes had been followed safely.

Staff spoke positively about people and their work at the service, and about the affection they felt for the people they cared for. Formal staff support systems had fallen behind, but it was planned the new manager would put these into place at an early opportunity in line with the organisations expectations. Staff told us they felt able to go to the turnaround manager for advice and support. It was expected they would also be able to ensure people had the correct training in place to meet people’s needs.

Activities were available that met people’s needs and interests.

Rating at last inspection: The last rating for this service was good (report published 29 April 2017).

Why we inspected:

This inspection was carried out in line with the frequency suggested by their previous rating.

Enforcement – We have identified one breach of regulation in relation to governance in the home as systems and audits were ineffective to identify areas of improvement. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

The inspection took place on the 21 and 22 February 2017. The first day of the inspection was unannounced. This was the service’s first rated comprehensive inspection since their last inspection on 24 September 2013. During that inspection they were not compliant with two of the standards we assessed. A responsive follow up inspection was completed on the 2 January 2014, where we found the service had put actions into place and were meeting the legal requirements assessed.

The service had a registered manager in post. 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 and their relatives told us Harnham Croft had a welcoming and homely atmosphere. Everyone we spoke with were highly complementary about the care and support received, as well as the strong leadership from the registered manager. The service encouraged and enabled people to voice their opinion about how the home was run. People were at the heart of the home and the registered manager told us they managed the home with help from people. For example people were invited to staff meetings with the registered manager commenting “We go to theirs so it’s right they are invited to ours.” People were at the forefront in making decisions from the colour and furnishings of the home to which charity they wanted to fundraise for. There was very much a “You said, we did” culture promoted within the service.

The service responded quickly to peoples’ wishes and needs. For example one person had been unable to attend their granddaughter’s wedding, so this was recreated at the home with the local vicar blessing the wedding. Another example was where staff walked a visiting donkey three flights of stairs to see a person who was end of life as they wished to see the donkey. Staff understood the importance of promoting peoples emotional well-being as much as their physical care needs.

People were treated with dignity and their right to privacy was respected. Staff knocked on people's doors before entering and sought people's permission before undertaking any care tasks. We found staff had a good understanding of people's needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection, with not hesitating to seek assistance where required and sharing jokes with staff.

People's medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

Staff had received appropriate mandatory and specific training in order to meet the changing needs of people. Staff told us they felt well supported by the management team. They received support and on-going development through reviews and an annual appraisal with their line manager.

Before people moved into Harnham Croft an assessment of their needs was undertaken. Care plans had been completed which explained how people wished to be supported and care needs were monitored and reviewed to ensure the support given continued to meet people's needs. We saw that where people could not give signed consent, their verbal consent was recorded.

People could take part in various activities in and outside of the home. The service had good links with the community and involved the community in fetes, fund raising and other events. We saw a thank you letter from the Mayor, thanking staff and people for including him in an Open Day.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People told us they were regularly consulted about their care and took part in monthly residents’ meetings.

Risk assessments were in place to support people to be as independent as possible. Risks to people's personal safety had been assessed and plans were in place to minimise these risks. Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place. There were enough staff on duty to meet people's care and support needs safely.

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence. The management operated an on call system to enable staff to seek advice in an emergency. This showed leadership advice was present 24 hours a day to manage and address any concerns raised.