Harbour View Care Home

Harbour View Care Home is a nursing home providing personal and nursing care for up to 50 adults. 45 people lived at the home at the time of the inspection.

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

People told us they felt safe living at the home and were supported by staff who knew how to raise safeguarding concerns. Safeguarding procedures were in place to protect people from the risk of abuse, and to educate staff on how to recognise and respond to concerns. However, infection prevention protocols were not robustly followed, and we were not assured by measures in place including measures to reduce the risks associated with COVID-19. We made a recommendation about infection prevention practices.

Risks to people were assessed and, in some cases,, actions had been taken to reduce the risks however, this was not always consistent because risk assessments were missing or not always up to date. People were supported to receive their medicines, however there were areas of improvement in staff training, record keeping and storage of unwanted medicines. We made a recommendation about medicines management.

Staff were recruited safely and there were adequate numbers deployed to support people. The premises and equipment have been serviced and maintained in line with manufacturer’s recommendations.

The registered provider and their staff used a variety of methods to assess and monitor the quality of the service. However, the provider’s systems and processes needed to be robust to ensure shortfalls were identified and acted on in a timely manner; including recommendations from other professionals. There had been a delay in rectifying shortfalls in IPC practices. Staff worked in partnership with a variety of agencies to ensure people's health and social needs were met. The provider had sought relevant authorisation to protect people from unlawful restriction under Deprivation of Liberties (DoLS). We received positive feedback from staff regarding management.

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 good (published 09 November 2018)

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention practices, shortages of basic supplies and medicines management practices. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harbour View Care Home 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 coronavirus and other infection outbreaks effectively.

Follow up

We will work alongside the registered provider and local authority to monitor progress and will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in 2015 the location was rated 'Good' overall. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Harbour View Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 50 people across two separate units, each of which have separate adapted facilities. There were forty five people in residence when we visited. People living in the service may have complex physical or mental health needs or are living with dementia and they need the support of trained nurses.

The home had a suitably qualified and experienced registered manager who had both a nursing and social care background. 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 staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well. Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. Accidents or incidents management was of a good standard.

The registered manager and her senior team kept staffing rosters under review as people's needs changed. We judged that the service employed enough nurses and care staff by day and night. There were suitable numbers of ancillary staff employed in the home.

Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. Nursing staff told us they were given time and opportunity to keep their practice up to date.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. Any issues were dealt with promptly and appropriately.

People in the home saw their GP and health specialists whenever necessary. Where necessary nurses in the home would liaise with external specialist nurses and consultants. The staff team had good working relationships with the local health and social care teams in the area.

Good assessments of need were in place, and the staff team reviewed the delivery of care for effectiveness. They worked with health and social care professionals to ensure that assessment and review of support needed was suitable and up to date.

People told us they were satisfied with the food provided and we saw suitably prepared meals being served. Nutritional planning was in place and special diets catered for appropriately.

Harbour View Care Home is a purpose built home. It had suitable adaptations to ensure people were safe and had enough personal and shared space. The house was warm, clean and comfortable on the day we visited. Suitable equipment was available.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People who lived in the home told us that the staff were caring. We also observed kind and patient support being provided. Staff supported people in a respectful way. They made sure that confidentiality, privacy and dignity were maintained.

Risk assessments, nursing plans and care plans provided detailed guidance for staff in the home. People in the service were aware of their care plans and many had influenced the content. The management team had ensured the plans reflected the person centred care and nursing that was being delivered.

Staff could access specialists if people needed communication tools like sign language or braille.

Staff took people out locally and encouraged people to follow their own interests and hobbies. We saw evidence of regular activities and outings for people.

The service had a comprehensive quality monitoring system in place and people were asked their views in a number of different ways. Quality assurance was used to support future planning.

We had evidence to show that the registered manager and the operations manager were able to deal with concerns or complaints appropriately .

Records were well organised, easy to access and stored securely.

Harbour View Care Home is located on the outskirts of Whitehaven in a residential area. The service is a nursing and care home mainly for older people. The home is able to provide care services for up to 50 people, in single en-suite bedrooms. Communal living areas such as lounge areas, dining rooms, bathrooms and showers are available throughout the home. Accommodation is provided on two floors and there is a passenger lift to help people to access the first floor. The home has a range of equipment suitable to meet the needs of people living there. The home mainly provides support to older people but also offers care to younger people with complex healthcare needs.

The service had a registered manager. 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.

We spoke with people living at Harbour View Care Home and they told us that they felt safe and happy living there. We saw that the people who lived there were well cared for, relaxed and comfortable in the home and the atmosphere was open and inclusive.

People we spoke with complimented and praised the staff who supported them and we saw caring and sensitive interactions between people living there and staff.

People were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit the home.

The service had carried out risk assessments to ensure that they protected people from harm. We saw that the staff knew how to identify abuse and protect people from it.

People received their care from staff who they knew and who knew how they wanted to be supported. There were also enough staff to provide the support that people needed.

Staff were well trained and supported by the registered manager and the organisation. The training programme for staff in the home was comprehensive and staff were able to request additional training as and when they felt it would benefit them in their role.

Medicines were ordered, stored, administered and disposed of correctly.

The staff spent time with people and understood that this was an essential part of their role. Support plans were based on thorough assessments and were written using a person centred approach so that people’s individual needs were catered for.

People were included in decisions about their care. The staff knew how people communicated and gave people the time they needed to make choices about their lives and to communicate their decisions.

People were provided with meals and drinks that they enjoyed and were supported to take a good diet that was based on an assessment of their nutritional needs. Those who required support to eat or drink received this is a patient and kind way.

The manager of the home was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Mental Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood how to ensure people’s rights were protected.

People were asked for their views of the home both formally, using questionnaires, and on a daily basis as staff provided support and their comments were acted on.

People knew how they could raise a concern about their safety or the quality of the service they received.

The registered manager provided good leadership. Both people living in the home and staff spoke highly of the manager’s style of leadership, describing it as ‘firm but fair’. The provider had systems in place to ensure the delivery of good quality care.

Staff spoken with said they were well supported within the home and given training that helped them in their role. All of the staff that we spoke with said that the manager was supportive and available to talk about issues relating to the home.

We found the service to be appropriately staffed for the needs of the people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with dementia and other complex healthcare needs. The home had developed a good working relationship with the local healthcare teams in order to ensure people had access to expert healthcare advice.

The manager implemented the organisation's quality monitoring systems that ensured the standards of care, the safety and maintenance of the home. We found that accurate record keeping ensured that people were protected from the risks of unsafe or inappropriate care and treatment.

People we spoke with understood the care and treatment choices available to them and said they were involved in making decisions about their care and support. The majority of people we spoke with told us that they were treated well by staff. One person told us, "My relative is now being nursed at the end of her life and they have received faultless nursing care. The staff have been very kind and we can stay in a visitors room overnight."

While the majority of comments received were positive about how people were treated there were a few exceptions. Some people felt that there were certain 'unwritten rules' in the home that limited choice, for example not bothering staff when they were busy. The manager is looking at how to overcome these perceptions and where there were institutional practices how these might be overcome.

The home had an effective system to regularly assess and monitor the quality of service that people receive. We saw that when issues had been raised through customer surveys these were responded to and action plans were put in place.