This inspection took place on the 28 June 2016 and was unannounced.
Harbour Rise Rest Home is a long established care home without nursing, accommodating up to 44 people. People living at the home were older people, some of whom were living with dementia, or physical frailty. The home also provides day care for people, but this was not under a regulated activity regulated by the Care Quality Commission, so did not form a part of this inspection. The home had been undergoing a programme of expansion following the purchase of the adjacent property, and this was almost complete. The programme had involved extensive remodelling of the interior to provide wider corridors and doorways, en-suite facilities for all rooms and improved service and communal areas.
There was 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.
Risks to people’s care were being assessed and mitigated, however, some risks in the environment had not been identified. Some of these were addressed at the time of the inspection. We have made a recommendation about this. People were being protected from the risks associated with medicines and a new medicines management system had been implemented.
Staff understood how to safeguard people from abuse. Staff told us they had no concerns over the quality of care or safety people were experiencing at the home, but would report them if they did. They had received training in how to identify abuse and what actions to take. The home had complaints policies and procedures for people to use to raise any concerns.
We saw that people’s needs were being met in a timely way on the day of the inspection, and records showed that call bells were responded to quickly. The provider told us they had recently increased staffing levels. Although we received some conflicting information about whether there were enough staff on duty to meet people’s needs, the provider told us that members of the management team would always provide additional cover if it were needed and the home would not be short of staff.
A clear recruitment process was in place to identify risks in relation to staff employment. This was reflected in the staff files we saw. There was not a system in place for the recording of decision making in relation to risks identified during the staff recruitment process, however we saw that where risks had been identified they had been assessed. The registered manager agreed to record this in future.
Staff told us they had the skills and training they needed for their job role and we saw they were knowledgeable about people’s care needs. Spot checks were carried out on their performance, and they told us they felt supported. The registered manager told us that systems for recording training, learning and competency were under further development.
Care files and plans reflected people’s needs or wishes about their care and how this was to be delivered. Plans were updated regularly, and contained information about how people wanted to be supported and their life history where this was possible to obtain. Some plans would benefit from additional information being available to support people with behaviours that might be challenging. People received good support from community healthcare services, and referrals were made to appropriate agencies if people’s health deteriorated. Some people with long term health conditions found these had improved since being at the home. People were supported to make choices about meals and they told us they ate well.
The service was supporting people in line with the Mental Capacity Act, and protecting their rights. Assessments of people’s best interests were being carried out where they lacked the capacity to make a decision.
Work was being undertaken on the premises to provide a more comfortable environment for people. This included people living with dementia. The provider had made considerable internal changes to the building to provide bright en-suite bedrooms, wider corridors and doorways and improved service areas. Additional work was being planned to include changes to the dining room and a new café area where people could spend time with families or prepare drinks for themselves.
Good relationships had been built up between people living at the home and the staff supporting them. People told us they liked the staff and were happy with the service they received. Staff took time to understand people’s wishes and spoke with them discreetly about their care. They demonstrated respect for people’s dignity and individuality.
Activities provided were aimed at meeting people’s individual needs and wishes as well as those who enjoyed them in groups. Some activities were being developed to better meet the needs of people living with dementia.
Staff and people respected the registered manager and management team. There was a clear vision for the development of the home that was shared with stakeholders. We identified a lack of robustness in some of the management systems and auditing practices in place, but this was mainly minor issues that were resolved at the time of the inspection.
Quality assurance and quality management systems were in place to ensure people had a chance to share their views and experiences. Records were well maintained, but some policies and procedures needed updating.