Harmony House Nursing Home

Harmony House Nursing Home is a care home providing nursing and personal care for up to 33 people. The service provides support to adults living with mental health conditions. At the time of our inspection there were 26 people using the service.

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

This was a targeted inspection that considered the leadership and culture of the service, the management of people’s privacy and finances, people’s welfare and staff training.

People told us they were happy at the service. Infection prevention and control processes had improved, but further and sustained improvement was needed. Systems were in place to manage people’s money safely and safeguard them from abuse.

The provider was working on improving training. Some staff said induction support could be improved, and the provider said they would review this. People were supported to have diets they enjoyed.

People spoke positively about the leadership of the service. Some staff said they were not always supported to give open feedback to the registered manager.

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 25 January 2023) and there were breaches 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 in infection prevention and control practice and the provider was no longer in breach of regulations in relation to that. The other breaches of regulation were not reviewed during this inspection.

Why we inspected

We undertook this targeted inspection to check on specific concerns we received about the leadership and culture of the service, the management of people’s privacy and finances, people’s welfare and staff training. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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

Recommendations

We have made a recommendation about the provider’s staff feedback systems.

Follow up

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

Harmony House Nursing Home is a care home providing nursing and personal care for up to 33 people. The service provides support to adults living with mental health conditions. At the time of our inspection there were 29 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risks were not managed safely. Lessons were not always learnt from incidents. The premises were not always secure. Staffing levels were not always appropriate to safely manage risk. Medicines were not managed safely. Safe infection prevention and control (IPC) practices were not always followed.

Records about people’s support needs were not always complete. Most staff training was either completed or underway but staff did not always demonstrate learning from this. The environment needed refurbishment. The systems in place for checking on the quality and safety of the service were not always effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The registered manager handled safeguarding concerns appropriately. A safe recruitment procedure was in place. All necessary checks and tests were carried out to make sure any equipment used was safe. The provider had policies and procedures in place to minimise risk in the event of a fire. Visiting was taking place in line with current government guidance.

People were given enough to eat and drink and there were a variety of menu choices available. People had access to health professionals when required.

There was a positive culture within the home. Staff told us the registered manager was very supportive and approachable. People we spoke with were generally happy with the care they received, and we had good feedback from relatives. The registered manager understood they needed to be open and transparent when mistakes were made. The registered manager had a good working relationship with the local authority and numerous health professionals.

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

Rating at last inspection

The last rating for this service was good (published 8 September 2018)

Why we inspected

The inspection was prompted in part due to concerns received about areas of concern such as medicines, infection control, consent and quality assurance monitoring at the provider’s other services. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

We have approached the provider and requested immediate assurances around their improvement plan. As a result of this an action plan has been produced detailing how they would address the shortfalls identified and work to complete this had begun.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection.

We have made a recommendation about reviewing staff training.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had followed current guidance in relation to infection prevention and control. The home was currently closed to non-essential visitors and admissions. Measures had been implemented to ensure people entering the home did so following current guidance regarding personal protective equipment (PPE) and social distancing. This included temperatures being taken on arrival and PPE being used.

The home was clean and tidy and had designated cleaning staff. We were told regular disinfection of frequently touched surfaces of the home for example handrails and banisters was taking place four time a day. However, there was no record kept of this. A record was implemented immediately.

A recommendation was made to remove anything from the home that cannot be effectively cleaned, such as artificial flowers.

Due to the layout of the home and narrow corridors, the provider had implemented a one-way system to support social distancing. This was working well and everyone was adhering to this.

COVID-19 testing was taking place regularly for people and staff. Staff had access to guidance and policies regarding COVID-19 and infection prevention and control.

Staff had supported people to self-isolate where possible. People and staff’s well-being was managed through regular meetings. One to one time was provided to reassure people who struggled with the restrictions.

Staff had received training and ongoing guidance about COVID-19 and how to safely provide care and support to people. This included how to use and discard PPE safely. There was a good supply of PPE available to staff. PPE was placed throughout the corridors of the home, to enable easy access for staff. Extra PPE stations were required around the communal bathroom areas.

Further information is in the detailed findings below.

The service was last inspected in December 2015 and was rated good. At this inspection we found the service remained good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Harmony House Nursing 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. Harmony House Nursing Home accommodates up to 33 people with a range of mental health and physical conditions, and provides nursing and personal care. At the time of our inspection 28 people were using the service.

There were two registered managers in place. 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. One of the registered managers was also the provider of the service, and in this report we will refer to them as the provider.

People and their relatives said staff kept people safe. People’s medicines were managed safely. Risks to people were assessed and monitored. Plans were in place to support people in emergency situations. The premises were clean and tidy, and the provider had effective infection control processes. People were safeguarded from abuse. Staffing levels were sufficient to support people safely. The provider’s recruitment procedures minimised the risk of unsuitable staff being employed.

Staff received regular training in a range of areas relevant to people’s support needs and were supported with regular supervisions and appraisals. 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 were supported to maintain a healthy diet. Staff worked with a wide range of external professionals to monitor and improve people’s health and wellbeing. The building had been adapted and customised for the benefit and comfort of people.

People said they were happy living at the service and that staff were kind and caring. People were treated with dignity and respect. Staff supported people to maintain their independence and live as full and free a life as possible. People were supported to access advocacy services.

People received personalised support based on their assessed needs and preferences. Support plans contained information on how people could be supported to communicate and engage effectively with the service. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. Policies and procedures were in place to provide end of life care where this was needed.

The registered managers had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Staff spoke positively about the culture and values of the service. The registered manager and provider carried out a range of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people, relatives, external professionals. The provider and registered manager had developed links with a number of community groups and bodies to help enhance the health and wellbeing of people using the service.

Harmony House is a nursing service that until recently provided care for up to 33 people with mental health needs. The service operates over three floors. The number of places increased on 30 December 2015 as the provider had identified that the service could be developed and enhanced so purchased the adjacent building. They have totally and carefully renovated the building to provide an additional 12 bedrooms, another two bathrooms, an additional office and more communal space.

The provider is the registered manager and has been in this role since they commenced operating the service in 2011. A provider 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.

At the time of the inspection 21 people lived at the service and we met nine of the people who used the service. They told us that they were very happy with the service and found it met their needs.

We found that the provider and staff consistently ensured people were supported to lead an independent lifestyle. The registered provider had purchased a mini-bus and designed a programme of activity that enabled people with different skill sets to fully engage in a range of activities within the community. We heard from the people that they thoroughly enjoyed these activities.

Staff readily identified triggers that would lead people to become distressed or that their mental health was deteriorating. We found this had a very positive impact on people and led to a marked reduction the number of occasions people were admitted to hospital. Also we found that the staff’s extensive knowledge of people had enabled them to readily spot changes in people’s presentation and this had led to the staff taking prompt action to prevent people causing significant harm to themselves .

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. We found that the registered provider had fully embedded a computerised system for recording care delivered at the service and this was very effective.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities. Staff had also received training around the application of the Mental Capacity Act 2005 and the Mental Health Act 1983 (amended in 2007). The staff we spoke with understood the requirements of this this legislation.

Staff shared with us a range of information about how they as a team worked very closely with people to make sure the service enabled each person to reach their potential.

People and the staff we spoke with told us that there were enough staff on duty. We found that were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had an effective system in place for dealing with people’s concerns and complaints. We found that people felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. The recent refurbishment programme had enhanced the whole service and we found the registered provider had carefully considered how the space could be developed to best meet people’s needs. They had created facilities for people with mobility needs and facilities to assist people to develop their independent living skills.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the service.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider had implemented these and used them to critically review the service.

The people we spoke with during the visit told us that they liked living at the home and that the staff were good at their jobs. One person said, “This is a good place. The staff are fine.”

We found that since the last inspection in October 2013 the owner/manager had provided additional training for staff around the application of the Mental Capacity Act 2005 and reviewed the nursing staff’s understanding of the Mental Health Act 1983 (amended 2007) code of practice. He had introduced the range of documents required when a person appears to lack the capacity to make decisions. We found that the work completed at the home ensured people could lead the least restrictive lifestyle and the people we spoke with confirmed that this was the case.

Following our last visit the owner/manager had worked with the consultants and approved social workers to ensure they had a full list of conditions people were subject to and that these could be applied in this setting.

We found that the owner/manager had introduced a computerised record system and this readily supported staff to detail clearly all the actions that they took and how they worked with the people who used the service.

Some people had limitations placed upon them around going on leave the building independently and how much they smoked. Some of the people we spoke with told us that they had agreed to these limitations, as they were in their best interest. They found that without help people had run out of cigarettes before they received their following week’s money. People also said that because of their physical health they needed someone to go with them when they went out. However, these agreements had not been recorded in their care plans.

We found that although the provider had ensured all the staff completed training around determining if people had capacity to make decisions and when they could restrict people’s lifestyles, they had not applied this to their practice. We also found that staff needed to gain more awareness around the use of Community Treatment Order conditions.

We found that staff received a wide range of training and were very knowledgeable about people’s care needs and mental health conditions.