Harmonia Village

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to people’s safe care and treatment and the cleanliness of the service.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety because lessons were not always shared to continually identify and embed good practice. There was a system and process in place for incidents and accidents. When incidents occurred care plans were recorded as being updated but some information in some care plans was limited and needed more detail. For example, one person’s care plan did not include information on what methods of diversion had worked to calm the person down when they been upset. Opportunities to share this learning with staff had been missed and there had been a number of incidents.

Another person had fallen on more than one occasion. Staff had identified the person was at risk from a urinary tract infection (UTI), which can increase the risk of falls when the person is unwell. However, there was no risk assessment for UTI’s for the person to support staff to reduce the risk of re-occurrence. Other actions had been taken to reduce the risk of falls such as assessments to see if mobility aids would reduce the risk and referrals to the fall’s clinic.

The number of falls had increased over the last 3 months. We discussed this with the registered manager who was aware of the trend and was trialling a new approach to monitoring people’s movement to seek to reduce this. It was too soon to determine if this adapted approach was effective at reducing the number of falls overall.

The provider worked with people and healthcare partners to support people to transition when they moved into the service. The deputy manager supported new people to ensure they were settled in, and relatives were kept informed where appropriate. Staff spent time with people ensuring they were orientated with the new surroundings. Partners told us the information they provided for staff was usually shared with them. However, where care plans lacked detail about people’s care and support, this limited the information available to share with other services when people moved between services, for example, when people went to hospital. Feedback from partners was mixed with some partners saying details were lacking in the paperwork shared with them.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff knew how to identify concerns and how to raise them with the appropriate authorities. One staff said, “I feel 100% confident to raise concerns.” Staff used a tool provided to them by the local authority to support them to assess when to share information about concerns with the local authority safeguarding team.

People told us they felt safe living at the service and that they were confident concerns would be addressed. One person said, “I’d speak to the manager, and I think [they’d] do something about it.”

Some people were not able to leave the service independently due to risks to their safety, therefore, they were deprived of the liberty to do so. Where this was the case appropriate authorisations were in place to ensure this was done so with legal authority.

The provider did not always work well with people to ensure peoples’ risks were recorded. This increased the risk staff would not know details needed to support people effectively.

Staff used an electronic system of care planning which promoted staff to undertake tasks such as checks on people and turning people cared for in bed. However, some care plans and risk assessments lacked some information, and the quality-of-care planning was varied. For example, the houses were equipped with de-choking devices. There were no risk assessments in place for these to set out any risks people faced in relation to their use. Staff knew when people were at risk of choking and how to perform basic life support. However, some staff told us they did not know how to use the de-choking device. This increased the risk they would be used incorrectly or not used when needed. We raised this concern with the registered manager and staff received training on the de-choking device following the inspection.

Another person’s care plan for the risk of seizures, listed which staff should complete tasks when someone had a seizure. This included instructions for the duty nurse to move sharp objects in the immediate environment, rather than this being completed by the first staff member on scene, this increased the risk this action would be delayed.

Staff did know how to provide support for some risks for people. For example, staff knew how to support people with their diabetes and how to identify people were at risk of being unwell. Positive risk taking was observed. For example, one resident was supported to have a cigarette in the garden when they wanted to do so. They were supported to do this safely using a fire-resistant tabard to reduce the risk of burns.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff told us how they would raise concerns about safety. One staff member told us, “There are QR codes in all the houses and in the hub, and we have a maintenance team. Repairs are usually done quickly unless a part needs to be ordered which may take more time. We escalate our concerns routinely on the device and you put whether the repair or problem is urgent”.

Fire exits were clear, uncluttered, fire safety equipment well maintained. Personal evacuation plans were in place for everyone in a grab bag which was accessible in the reception area. Equipment such as hoists appeared in good condition and were regularly checked. Radiators were covered, taps were tested and ran hot water at safe temperature. The service was compliant following a recent fire inspection and staff knew how to evacuate people safely in the event of a fire. Health and safety audits had been completed. Essential servicing of the utilities and hardware had taken place.

The provider had not always ensured there were enough staff deployed in some areas of the service to provide effective support to people. Feedback from people who lived at the service was mixed with some people saying there were enough staff and others telling us there was not.

One person said, “I think there should be someone here in the building (referring to one of the houses). There is never a staff member here.” There were some concerns about the effectiveness of support provided to some people in this house. We raised these concerns with the nominated individual (NI) on the first day we visited the service. The NI is a person nominated by the provider to be a contact for concerns and feedback from CQC. These concerns were addressed during the inspection and a further member of staff was deployed to address this risk. However, the services systems and processes to assess the number of staff needed had not identified this need prior to the inspection. Staff told us the extra member of staff was an improvement, and it enabled them to support people in the house more effectively.

Staff had been safely recruited. All necessary checks had been carried out and documents were up to date. Staff received regular supervision and told us they valued the experience. One staff member told us, “We have supervision every couple of months, and we are asked about how we are feeling, if we have any concerns and if we have any suggestions to improve things. I always feel supported and valued because my manager listens and makes good comments on my work”.

Staff had completed most of the training needed to support people. However, not all staff had competed training in learning disability and autism and positive behaviour support. We raised this with the service who addressed these concerns following the inspection.

Some areas of the service were not kept as clean as they could be. The accommodation was divided into 6 houses, where most people lived, and a central hub where there were also some bedrooms and a communal area. People from the houses spent time in the hub undertaking activities and eating meals in the communal area. All of the buildings were situated in one secure site. There were areas in the hub which needed to be cleaned. The floor seals in the communal bathrooms were damaged and there were visible stains on the walls and grime in the damaged seals. This increased the risk of areas harbouring bacteria. Some areas where people regularly touched were visibly dirty. In the hub the tables and table matts were dirty and felt sticky in places. Staff then laid the tables for lunch without cleaning them.

Most of the houses appeared clean and smelt pleasant. However, one house smelt strongly of urine and sufficient action had not been taken to address this prior to the inspection. Feedback from people varied and people’s experience varied depending on which house they lived in. Most people told us their house was clean. One person said, “There are cleaners in every day. It’s very clean, I’ve got no issues.” However, another person told us they were very unhappy about standards of cleanliness kept in their home.

Domestic staffing levels had been increased in December 2024 as there had been complaints from residents. We raised concerns during the inspection and action was then taken for example, by increasing staff to provide more continence support to some people. However, more work had been needed prior to the inspection to address concerns.

People’s medicine was on the most part administered safely. However, there were some issues which needed to be addressed.

Medicines were stored and disposed of safely. The number of medicines in stock were audited and matched records. There were sufficient medicines in stock to ensure people received their medicines. Medicines administration records were accurate, and medicines were appropriately recorded. Where medicines were time critical staff recorded the time of administration and were aware of the need to give medicines on time.

However, prior to the inspection the service was not able to evidence their blood glucose machine had been calibrated to ensure it was accurate. People’s pain patch placement had not been rotated as regularly as they should have to reduce the risk of skin irritation. One person’s medicine was being administered mixed in with a drink, what drinks staff could use had been stated by the GP, but this information had not been shared with staff. We raised these concerns during the inspection and these issues were addressed.