Harwood Road

Harwood Road is a care home that provides care and support for up to 15 people. At the time of our inspection there were 14 people using the service including who had mental health challenges. The care home accommodates people in 1 building.

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

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.

People said that Harwood Road was a safe place for them to live. People had risks to them regularly assessed, reviewed and this meant they could take acceptable risks, enjoy their lives, and live safely. Accidents, incidents, and safeguarding concerns were reported, investigated, and recorded. There were enough suitably recruited staff to meet people’s needs. Staff safely administered medicines and prompted people to take them. When required by staff used Personal Protection Equipment (PPE) effectively, safely, and in line with current guidance. The infection prevention and control policy were up to date.

People, and healthcare professionals said effective care was provided, people were not subject to discrimination and their equality and diversity needs were met. Staff received appropriate training, and were supervised. People told us the care staff provided was good, and met their needs. They were encouraged to discuss their health needs, any changes to them, and concerns were passed on to the management and appropriate health care professionals. This included moving to other services if people’s needs changed and could no longer be met. Staff protected people from nutrition and hydration risks, and they were encouraged to choose healthy food options, and balanced diets whilst meeting their likes, and preferences.

The home’s registered manager was visible and there was an open, positive, and honest culture. The provider’s vision and values were clearly set out, understood by staff and they followed them. Areas of responsibility and accountability were identified, for the registered manager, staff and a good service was maintained and regularly reviewed. Audits were thorough, and records were kept up to date. Where possible community links and working partnerships were established and maintained to further minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals told us that the service was well managed and met people’s needs in a professional, open, and friendly way.

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

Why we inspected

The last rating for this service was Good (published 25 October 2018).

We undertook this inspection to check whether the service was continuing to provide a good, rated service to people.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

We did not inspect the key questions of caring, and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harwood Road on our website at www.cqc.org.uk.

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.

Follow up

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

The premises are equipped with 13 bedsits, which offer kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom, and a range of communal areas. At the time of the inspection there were 14 people living at the service and one person was in hospital. The building comprises four storeys and does not have a passenger lift. It is owned by a housing association.

The service had a registered manager, who was present on both days of the inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had registered with CQC after the previous inspection, having worked at the service as a team leader and acting manager.

A comprehensive inspection of this service was carried out on 4 and 5 May 2016 and the service was rated overall as ‘Good’. Effective, Caring, Responsive and Well-led were rated as ‘Good’ and Safe was rated as ‘Requires Improvement’.

In June 2017 the provider notified us that two people who used the service had died at the care home on the same day due to expected causes. This was subsequently found to be incorrect, as the deaths of both people were unexpected. In July 2017 we received information of concern from an anonymous source which indicated potential concerns about how the service supported people during very hot weather conditions and the management of risk. These concerns were reported to the local safeguarding team. Prior to the CQC carrying out an unannounced focussed inspection in October 2017 we were informed by the police that they were gathering additional information at the request of the Coroner’s Office, therefore our inspection did not examine the circumstances of the deaths. The inspection had focussed on safe and well-led only, which resulted in safe remaining ‘Requires Improvement’ and well-led being rated as ‘Requires Improvement’. The overall rating for the service was ‘Requires Improvement’. We found breaches of regulation in relation to safe care and treatment, and good governance. The overall rating for the service was ‘Requires Improvement’.

Following the previous inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. At this inspection we found that the provider had made significant improvements and taken appropriate action to meet the two breaches of regulations. We noted that the registered manager had remained in contact with the Coroner's Office and as there were no further investigations or queries, the bodies were released for burial. Staff had attended the funerals and there was a gathering for service users and staff in June 2018 to celebrate the lives of the two people who sadly passed away last year.

At the previous inspection we had found issues of concern in relation to the safety of the premises, which included the need for staff to undertake bespoke training to understand how to properly switch on and off the radiators. The service did not have a current electrical installations check by a competent person and there were issues with the lack of cleanliness and equipment to prevent cross-infection in the communal toilets. At this inspection we noted that staff had received appropriate training for using the radiators and the communal toilets and bathrooms were hygienically maintained.

At the previous inspection we had found that the service was disorganised. For example, we had observed that records could not be located to clarify how many staff had valid first aid training. Although the quality assurance monitoring reports were of a good quality, we had noted there was no clear evidence to demonstrate how the service used the findings and guidance from monitoring visits and other audits. At this inspection we found that there were proper systems in place to ensure records were up to date and the findings from audits and ‘spot checks’ were actioned as required.

We had also found at the previous inspection that the provider had not correctly informed us of events at the service which must be reported to CQC, in line with legislation. This information enables us to monitor the service and ensure people's safety. At this inspection we found that the registered manager understood her responsibilities and had kept us suitably informed.

People who used the service were supported by safely recruited staff. Sufficient staff were deployed to ensure that people were supported to attend appointments with staff, where required. Staff were supported by the provider to carry out their responsibilities through the provision of relevant training, individual supervision, team meetings and an annual appraisal.

People were supported to contribute to the planning and monitoring of their care and support plans. Risk assessments had been developed to identify and mitigate risks to people's safety. People were safely supported to receive their prescribed medicines and access care and treatment from external health care professionals. Staff encouraged people to eat healthily, participate in communal cooking sessions and gain useful skills to meet their nutritional needs. The provider ensured that staff received appropriate training to understand the principles of the Mental Capacity Act 2005 and make sure that people's human rights were upheld.

The activities programme at the service supported people to take part in meaningful occupation, which included a successful gardening project in the rear garden. Pub lunches, walks in London parks, cinema trips and other outings took place regularly. Staff consulted with people during the residents' meetings to gather their views about menus, activities, refurbishment issues and the daily running of the service.

People were treated in a respectful manner by staff and they were provided with information about how to make a complaint about the service. The provider encouraged people to get involved in co-production groups and other forums to improve the quality of their care and support, if they wished to.

The registered manager had developed positive relationships with people who used the service, staff, relatives and other stakeholders. A considerable amount of work had been carried out to improve the service and we received complimentary comments from people and staff about the registered manager's hands-on approach. Regular audits and checks were carried out by the registered manager and the provider, and any areas for improvement were actioned within a short period of time.

The care home provides 13 bedsits, which offer kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom. Communal areas include a lounge, a separate dining room and activities area, a main kitchen, laundry room, and a small courtyard and garden at the rear of the premises. There are offices which people can use for private meetings. The building comprises four storeys and does not have a passenger lift. The property is owned by a housing association.

This inspection was prompted by two notifications in June 2017, which informed us that two people who used the service had died at the care home on the same day. The provider had originally informed us that the deaths of both people were expected. This was subsequently found to be incorrect when we spoke with the provider, as the deaths of both people were unexpected. In July 2017 we received information from an anonymous source which alleged that the deaths were due to neglect by the provider. It was alleged that some radiators were faulty during very hot weather conditions. We reported these concerns to the local safeguarding team and asked the provider to send us a copy of their own investigation report, and copies of the two Coroner’s reports when they were issued. At the time of the inspection we had been informed by the police that they were gathering additional information at the request of the Coroner’s Office. Therefore, this inspection did not examine the circumstances of the deaths. However, the information shared with CQC about the deaths of the two people who lived at this care home indicated potential concerns about how the service supported people during very hot weather conditions and the management of risk. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Harwood Road on our website at www.cqc.org.uk.

The service had a registered manager, who had worked for the provider for several years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the registered manager was no longer working at the service. He had given notice of his resignation and was due to leave the organisation in November 2017. Since the inspection visit to the service, the CQC has received an application for the de-registration of the registered manager and an application from the provider to register the current team leader as the new registered manager.

The provider had addressed a concern identified at the previous inspection, which was a potential risk of a person not receiving the personal care they needed to meet a health care need. Although the person’s support was provided by visiting agency staff, the provider had obtained written guidance for staff and arranged for staff to receive applicable training from a health care professional. This meant that the person’s care could be delivered by staff in the event of unforeseen circumstances preventing agency staff from carrying out their visits. However, people’s risk assessments were not being updated following a change in their circumstances, for example if they had an accident or hospital admission.

We were sent a copy of the provider’s own action plan to improve the standard of safety for people using the service. At the time of the inspection the timescales for completion were not yet due; however, it was difficult to determine how much progress had been made. For example, staff were due to receive training about how to properly switch on and off the radiators. The team leader had not received this training and there was no list to evidence which staff members had been trained.

We found issues of concern in regards to the maintenance of the premises. The service did not have a current electrical installations check by a competent person and there were issues with the lack of cleanliness and equipment to prevent cross- infection in the communal toilets.

Issues about how people were supported with their medicines had arisen as part of the provider’s own investigation. We observed safe practices to assist people to comply with their medicine needs.

At the previous inspection we had noted that agency staff were being used to fill staff vacancies and the provider had experienced difficulties with staff recruitment. At this inspection we found that progress had been made to achieve a permanent staff team and the recruitment was satisfactorily undertaken, in order to ensure that people received their care and support from staff with appropriate knowledge and skills.

People who used the service told us they felt supported by staff, although one person told us that the deaths of two people at the service had made them feel anxious. We received some mixed views from health and social care professionals about the quality of care and support people received. The provider had ensured that people were offered support following their bereavements, and this support was also offered to staff.

We were told by the team leader and members of the staff team that there had been a difficult working relationship between two members of the management team which had hampered good communication and effective decision making, but this was now resolved through changes in the management structure at the service. It was not clear when the provider was due to have commenced the actions to improve the safety at the service as the action plan we were shown and the recommendations in the provider's investigation report had different dates.

We found that the service presented as disorganised. The quality assurance reports were of a good quality but there was no clear evidence to demonstrate how the service used the findings and guidance from monitoring visits and other audits. One of the actions from the provider's investigation report was for the staff team to develop mechanisms to engage with people who use the service and obtain their feedback and some work was being undertaken to achieve this.

The provider had not correctly informed us of events at the service which must be reported to the Care Quality Commission (CQC), in accordance with legislation. This information enables us to monitor the service and ensure people's safety.

We have made one recommendation and issued two breaches of regulation in this report. The provider is recommended to seek guidance and advice from a reliable source in regards to its' responsibility to satisfactorily notify the CQC of events at the service. The provider must ensure that people are provided with a safe and hygienic home and the provider must ensure that the quality assurance system is actively operational in terms of being used to improve the quality of the service people receive.

You can see what actions we have asked the provider to take at the back of this report.

There are 13 bedsits, which provide kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom. Communal areas include a lounge, a separate dining room and activities area, a main kitchen, laundry room, and a small courtyard and garden at the rear of the premises. There are offices which people can use for private meetings. The building comprises four storeys and does not have a passenger lift.

The service had a registered manager in post, who had worked for the provider for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered manager was based at another local registered service run by the provider and was not actively involved in the daily management of Harwood Road. The provider confirmed that they were in the process of applying for the service manager to be registered by the Care Quality Commission to manage the service.

At the previous inspection in September 2015 we found three breaches of regulation and made one recommendation. The provider had not informed the Care Quality Commission of significant events in the service that impacted on the safety and wellbeing of people who used the service. People’s safety had not been properly ensured due to the non-completion of some fire prevention measures and inconsistent practice with the management of medicines. The provider had not documented how they addressed people’s healthcare needs and preferences in a person centred way within their care plans. We made a recommendation for the provider to seek guidance about how to support people to use their food budget to purchase and prepare balanced meals.

Following the inspection the provider sent us an action plan which highlighted the action they would take in order to improve. At this inspection we found the provider had met the three breaches of regulation and achieved sustained improvements in regards to the recommendation.

Staff were properly recruited and although there were sufficient staff to support people to meet their needs, we noted that a significant proportion of the staff team comprised regular bank staff and agency workers. The provider demonstrated that this issue was being addressed through recruitment initiatives, so that people could benefit from building longer-term relationships with a stable staff team.

Staff understood how to protect people from abuse and the provider notified relevant authorities. Risks to people’s safety and wellbeing and actions to mitigate these risks were not clearly identified at all times.

Appropriate arrangements were in place to support people to safely take their medicines and access healthcare services. Records showed that people were consulted about food choices, supported to get involved with food preparation and cooking, and encouraged to eat a healthy diet.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. The service manager and the staff team understood and adhered to the principles of upholding people’s human rights in line with legislation.

People were supported by staff who had suitable training to meet their identified needs. Staff were observed to demonstrate a caring approach and were respectful towards people. Some improvements had been made to the premises so that people could enjoy a welcoming and comfortable home environment that promoted their dignity, however, this work was still ongoing.

People’s needs were individually assessed and they were consulted about their needs and wishes. Care plans showed that people were involved in setting objectives for their recovery and reviewing their progress. People told us they were asked for their views about their care and support, and were provided with information about how to make a complaint.

The provider worked in an open way with people and their relatives, for example through sharing information at residents’ meetings and seeking the views of people and their relatives about the quality of the service at review meetings. People and staff told us that the service had improved due to the leadership of the service manager and clear systems were in place for monitoring care practices and record keeping.

Staff we spoke with demonstrated a good knowledge of the needs of the people they worked with. They described how they drew up support plans involving the person and if appropriate their family members or other professionals.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There was a safeguarding policy in place and knew what protocols to follow if they suspected abuse.

We looked at staff training records. We saw that staff had the opportunity to develop professionally and had received training in areas relevant to their role. This included equality and diversity, manual handling, lone working and medication administration.

Records were kept securely and could be located promptly when needed. Records were kept both electronically and in paper format. Paper records were kept in a lockable filing cabinet in the staff office. All computers were password protected. All staff at the service had access to the database and had passwords to access it.

People who use the service felt able to raise any concerns with staff. One person described staff as "very responsive". We saw information on how to make a complaint on display and heard of examples of how complaints had been investigated and resolved satisfactorily.