Archived: Harpers Villas Care Centre

Harpers Villa Care Centre is a residential care home providing personal care and accommodation to people aged 65 and over who may also be living with dementia. The care home is registered to provide support to 26 people in one adapted building. At the time of the inspection six people lived at the home.

Following the last inspection, we had been advised by the provider of their intention to decommission the service and a planned closure was in place.

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

People were being supported to move to other homes due to the planned closure of the service. We completed this targeted inspection due to the registered manager leaving and an increase in safeguarding incidents in relation to the management of medicines.

We found further improvements were required with the management of medicines to ensure people consistently received their medicine’s when they needed them. In response to our findings the management team implemented daily checks to ensure people received their medicines as required.

We saw enough improvements had been made to meet the previous breaches in relation to the management of risk, staffing and the management of safeguarding processes.

People told us they felt safe, and relatives had no concerns about their loved one’s safety. Staff knew how to escalate concerns and were aware of potential risks to people’s safety and wellbeing. The management team were aware of their responsibilities to report safeguarding incidents.

People were supported by sufficient numbers of staff to ensure their needs were met.

Staff were following current government guidance and wearing the appropriate personal protective equipment.

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 Inadequate (published 18 February 2020) and there were multiple breaches of regulation. In response to this we imposed positive conditions onto the providers registration. 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 some improvements had been made in some of the areas we reviewed. However, we found further improvements were required with the management of medicines and the provider was still in breach of regulation.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about medicines practices, staffing and safeguarding concerns. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make continued improvements. Please see the Safe section of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harper Villa Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service until it closes.

We have identified a continued breach in relation to the management of people’s medicines at this inspection. We have decided to not take any additional enforcement action. The positive conditions imposed on the providers registration following our last inspection will remain in place.

Follow up

We will continue to monitor information we receive about the service until it closes.

Harpers Villas Care Centre is a care home providing personal care to 26 people aged 65 and over. At the time of the inspection 17 people lived at the service. People who used the service had a range of support needs related to old age and dementia. The accommodation is organised into three floors, however the top floor was not in use at the time of the inspection.

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

People were not sufficiently protected from the risk of harm, including potential abuse, risks associated to health conditions and the behaviour of others. People did not always receive their medicines as prescribed. People told us there were not enough staff to meet their needs and our observations confirmed this.

The management of the service was inadequate as the provider did not carry out robust checks to ensure that care was being delivered safely and effectively. Audits were carried out by the management team and provider, but they had failed to ensure that people were always safe and their needs were being met. As a result, people were exposed to the risk of harm.

We received mixed feedback from people in respect of meals. Meal times were functional rather than a pleasant social experience. Guidance from healthcare professionals were not always followed to ensure people’s needs were met. 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.

People did not receive support that was consistently caring and respectful. Care given was task centred rather than person-centred and not all needs were met.

People had limited opportunities to be involved in meaningful activities. People and relatives felt able to make a complaint but did not always receive a satisfactory response. People’s personal wishes during their final days had not been fully explored.

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 Requires Improvement (published 30 October 2018) and we identified a breach of regulation 17, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulation 17 and further breaches were also identified. The overall rating of the service has deteriorated to Inadequate.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

Enforcement:

At this inspection we have identified breaches in relation to safe care and treatment, safeguarding, good governance and staffing. The inspection also identified breaches in relation to the provider’s failure to notify the commission when Deprivation of Liberty Safeguards (DoLS) were authorised as is required. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Harper Villas 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.

Harper Villas accommodates a maximum of 26 older people that may have dementia. People live in one building that was adapted to meet the needs of people living there. There were 23 people living at the home at the time of our inspection. The provider was also offering day care provision, this not an activity that is regulated by CQC. There were no additional staff employed to provide care for people attending for day-care.

The service has a registered manager who was present during our inspection. 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.

Our inspection was prompted following by concerns from local authority commissioners, which had led to several safeguarding alerts.

This is the first time the service has been rated Requires Improvement

We found areas where the provider was in breach of regulations. We found the provider’s systems for governance were not always effective in identifying and addressing risks to people promptly and needed improvement. In addition, the provider had not notified us of allegations of abuse as required by the law. You can see what action we told the provider to take at the back of the full version of the report.

We have also made recommendations. We have recommended that the provider considers how they could improve the environment for people living with dementia in line with national recognised guidance. We have also recommended that the provider improves people’s access to information in a way that consistently reflects their individual communication needs and in accordance with the Accessible Information Standard.

Despite the lack of notification to CQC of allegations of abuse, staff demonstrated a good understanding of safeguarding procedures. Following local authority visits, several risks to people were identified. Audits in place had failed to identify some risks to people that had not been assessed by the provider. People were satisfied with how their medicines were managed, but there were areas were medicines management could be safer. We found there was not sufficient staff available at night to ensure the provider was able to follow their fire procedure. The provider has stated more night staff will be employed. There was an impact on staff time during day time hours due to the additional dependency levels of people attending for day-care. We saw prospective staff were subject to checks prior to their employment.

People’s consent was sought consistently by staff and the registered manager had made applications to the local authority for any restrictions that may be a deprivation of a person’s liberty. People were supported by staff on a day to day basis to have maximum choice and control of their and we saw staff supported them in the least restrictive way possible; the policies in the service supported this practice but some systems did not. Some care plans were agreed by people’s relatives and it was not clear whether these relatives were legally able to make these decisions.

People were confident in staff who they felt were competent and trained to meet their needs. The provider did however need to consider how training input for staff was to be monitored, so that staff skills and knowledge were maintained. We were made aware by the local authority that the response to people’s healthcare needs had at times been delayed, but people were confident they could access external healthcare whether on a routine or emergency basis. People had a choice of food and drinks were made available frequently, although systems to identify where people were at risk of dehydration or malnutrition needed improvement.

People received care from staff that were kind and caring and respectful. People were treated in a dignified and respectful way by staff. There was a good rapport between people and staff. People could maintain their independence and make choices about their daily living. People could maintain relationships with people important to them. Even when staff were busy we saw they made a committed effort to ensure they were caring in their approach to people.

People’s care plans did not consistently reflect all their needs, wishes and preferences although staff knew what people liked, disliked and what was important for them. People had access to some leisure opportunities, although the provision of this was inconsistent as staff did not always have the time. People felt able to complain and were confident these complaints would be responded to.

People and their relatives expressed satisfied with the care provided and felt the standard of care was good and managers and staff were approachable. Staff felt well supported and liked working at the home.

Harper’s Villas Care Centre provides accommodation for up to 26 people requiring personal care who may have dementia. At the time of the inspection there were 22 people living at the service.

There was a registered manager in post. 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.

People were supported by a staff team who knew how to keep people safe from the risk of harm and abuse. Potential risks had been assessed and staff supported people in a way which reduced these risks. People were supported by sufficient numbers of staff who had been recruited safely. People received the medicines they needed to support their health.

Staff ensured people were consenting to their care before supporting them and the provider worked within the principles of the Mental Capacity Act 2005. The provider had consulted with the local authorities to ensure, where people’s liberties were deprived in order to keep them safe, the appropriate legal process was followed.

People were provided with the appropriate support to eat and drink. People received food which was in line with their beliefs or health needs. Staff sought the assistance of outside healthcare professionals in order to keep people well.

People were treated with kindness and respect. People’s privacy and dignity was promoted.

People’s individual care needs and preferences were understood. Staff used appropriate care planning in order to deliver care which met people’s individual needs. Records showed and people confirmed staff consulted them regarding their needs.

People and their relatives were provided with opportunities to give feedback on the service. The registered manager had systems and processes in place to monitor and audit the quality of care. Where appropriate, the provider took action to improve identified areas for development.