Archived: Lord Harris Court

Lord Harris Court is registered to provide care (with nursing) for up to 90 people. There were 74 people resident on the day of the visit, including three people in hospital. The building offers accommodation over three floors, in seven named units. There were eight vacancies and eight rooms not available because of refurbishment or repair. The first and second floors are accessed via a lift. The shared areas within the service are spacious and meet the needs and wishes of people who live in the home.

The service has not had a registered manager running the service since February 2016. 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. The service was, currently, being managed by an interim manager, two support managers, and a deputy manager. A new manager had been appointed.

The management team recognised their responsibilities to keep people, visitors to the service and staff safe. Any risks were identified and managed to make sure that people and others were kept as safe as possible. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were able to describe How they kept people safe from all forms of abuse and any physical harm.

People received safe care because there were enough staff, with the right skills and knowledge to care for people safely. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by properly trained staff. However, some records were not completed accurately and some guidelines for the use of medicines to be taken, as required, were not available.

The management team and staff protected people’s human and civil rights. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provides a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The staff team took the necessary action to make sure they upheld people’s rights and the management team made the appropriate DoLS referrals to the Local Authority (Supervisory body).

Staff were properly trained and supported to enable them to meet people’s health and well-being needs. People were supported to make sure they received health and well-being care from appropriate professionals. Staff were trained in a variety of areas of care, so that they could meet the complexity and diversity of changing needs presented by the people in their care.

The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences. Staff built relationships with people so that they were able to provide more effective care. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times.

People benefitted from a well-managed and improving service. The management team was described by staff as very supportive and approachable. Staff told us the management team that had been in the home for approximately four months had made improvements to the care provided. The service had a number of ways of listening to people and making sure they maintained and improved the quality of care provided. Improvements had been made as a result of quality checks and listening to the views of people, other professionals, people’s relatives and the staff team.

We spoke with the registered manager, two deputy managers, and three care workers. We had not identified any issues when speaking with people using the service previously, and did not speak with them at this inspection. We did observe staff requesting and acting in accordance with the consent of those they supported during our inspection.

We looked at twelve people’s care plans. We saw these clearly recorded people’s preferences and wishes, including who they wished to be involved in decisions about their care and welfare. Where people had been assessed as not to have capacity to make a decision, we saw evidence of appropriate actions taken by the provider, such as an assessment of their mental capacity, and evidence of a best interest decision.

Managers displayed a clear understanding of the rights of individuals to make decisions, and explained the actions they had taken to promote and support these decisions when challenged by others without a legal right to do so.

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 caring?

The service was caring because staff took time to get to know people so that they could support them safely and as they wished. One relative described staff as “very kind and caring”. We observed staff were respectful and responsive to people. They supported them at their pace, and took time to chat with people. One person told us they thought the service was like “a four star hotel”, and another said they were “by and large very happy with” the care provided.

Staff told us they had time to get to know people, which meant they could care for people as they wished. We saw staff responded promptly when people asked for assistance, and were discreet when providing personal care. They took action to promote people’s dignity if this was compromised. For example, one care worker noticed someone’s clothing was riding up due to their posture. They ensured the clothing was put back in place, and provided reassurance to the person whilst doing so.

Is the service responsive?

Care needs were assessed before people were admitted. Care was planned and reviewed to ensure it met people’s identified needs. Changes in people's needs were identified promptly, and care workers were proactive to promote people’s wellbeing. For example, when people were confined to their beds due to health issues, records showed staff helped them to re-position regularly to avoid developing pressure sores.

When issues were identified, action was taken to improve the service. For example, when people identified issues regarding catering, actions were taken to improve the dining experience. Meeting minutes and feedback in a dining comments book showed catering staff responded to comments and concerns raised.

We saw people were referred to health providers such as the GP and physiotherapist to ensure their health needs were met. Staff arranged appointments promptly when they identified signs that suggested people required support from a health professional.

Is the service safe?

One person told us “I feel safe here. They [staff] don’t rush me. I am very happy here”. Specific risks affecting people were identified and assessed. Actions were put in place to reduce the risk of harm. This information was recorded in people’s care plans, and reviewed monthly. Staff were aware of identified risks and their responsibility to promote people’s safety.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DOLS). The DOLS are a legal process to ensure that people who lacked mental capacity to make decisions were not deprived of their liberty, other than in accordance with the law. The deputy manager told us they had applied for DOLS previously, and were aware of the process to follow.

Is the service effective?

Communication between staff was effective. Staff told us they were updated daily on the physical and mental health requirements of the people they supported. Liaison with health providers, such as the GP, physiotherapist and pharmacist, was effective. One person told us the physiotherapist had advised exercises to promote their mobility. They said staff were aware of the exercises they required and helped them to exercise as directed.

Staff attended training to ensure they could safely support people. We saw training was kept up to date. Staff were supported through regular supervision and appraisal meetings. Staff told us managers were available and responsive. One care worker told us “They don’t sit behind closed doors. They are always there for staff and residents”.

People’s involvement in their care plan was documented, for example noting their preferences and wishes. People we spoke with told us staff listened to their comments and acted accordingly. Staff understood people had a legal right to refuse care and support if they wished. One care worker told us “I encourage people but would never force them. I look at alternatives”.

However, when a decision was made on a person’s behalf, we did not always see documented evidence of the process to assess the person’s mental capacity beforehand. This assessment would indicate if the person was able to make that decision for themselves. Others, such as the person’s relatives, were sometimes asked to consent on a person’s behalf when it was not clear if they had a legal right to do so. This meant the provider could not demonstrate that people were always legally supported with decision-making in their best interests or as they would wish.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and recording people’s capacity to make decisions, and ensuring others asked to decide on a person’s behalf have a legal right to do so.

Is the service well led?

People and staff told us that managers sought their comments and feedback. We saw meetings were arranged for people, their relatives and staff throughout the year. Feedback from an annual survey was analysed and a summary shared through these meetings. This noted actions that were planned to address issues raised.

The provider conducted quality assurance audits to ensure policies and procedures were followed, and the Health and Social Care regulations were met. For example, we saw care plans were reviewed and updated monthly. A health and safety audit considered environmental hazards that may impact on the safety of people and others. Any issues identified were managed appropriately to reduce the risk of harm.

The provider had a system in place to ensure staff received appropriate training, supervision and appraisal, and implemented checks and audits to ensure the system was effective. This meant people who use the service were supported safely by staff trained to provide them with suitable treatment and care. One member of staff told us “Training is a lot more intense now. We have opportunities to do more long distance learning and gain more qualifications. We have regular supervisions and appraisals.”

The manager showed us training and supervision matrixes. These provided an easy reference for senior staff to monitor, to ensure staff maintained training and attended supervisions in accordance with the provider’s guidance.

The manager was aware of the few instances where training was out of date, and had put in place measures to ensure people who use the service were not at risk of potential harm. We saw rotas were set to ensure staff did not perform tasks related to lapsed training, and training dates were set to enable staff to renew their training as soon as possible.

We saw people who use the service had personal risk assessments to ensure they remained safe. These were updated regularly. One relative said “it’s wonderful. I don’t have to worry about my loved one."

We spoke to seven care workers, who told us staffing levels had improved recently. We found sufficient staff numbers were allocated to support identified needs. We saw evidence this was reviewed monthly.

We looked at audits the manager carried out to ensure the quality of the service was assessed and monitored. We noted the results of a residents' and relatives' survey, which stated 100% of the residents would recommend the home to others.

The registered manager was on leave at the time of our inspection. We spoke with the assistant director of quality and compliance, and the quality and compliance auditor for the Royal Masonic Benevolent Institution, and were assisted by the deputy home manager of Lord Harris Court.

We found the provider had taken action and had put arrangements in place to ensure care staff received appropriate supervision and appraisal. The deputy home manager told us managers at the home had started to meet monthly to ensure supervisions and appraisals were undertaken to meet their policy guidelines.

We found all care staff were booked to receive training they had not received or that was out of date. However, the provider had not yet implemented suitable arrangements to ensure staff received appropriate training, on an ongoing basis, to enable them to deliver care and treatment to people using the service safely and to an appropriate standard.

Most people experienced care and support that was planned and delivered in a way intended to ensure their safety and welfare. However, we found this was not the case for one person. The provider had recognised that people's care plans were not all up to date or accurate. However, the system the provider had introduced to address that meant it could potentially take up to a year before all people's care and treatment had been audited to ensure their needs were being met.

The provider had put a system in place to make sure staff had all had safeguarding refresher training. People told us they felt safe living at the home and were happy with the staff providing their care. One person told us "The staff are lovely, dedicated, marvellous. They do it for the love of it."

We found the provider had addressed concerns regarding the premises, meaning people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found the provider remained non-compliant with the regulations related to staffing and supporting workers. The systems the provider had in place did not enable them to accurately assess their compliance with the essential standards of safety and quality.