Harcourt Gardens Care Home

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 newly registered service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive culture of safety where staff understood how to recognise and report concerns. Staff described clear safeguarding processes and told us, “Everything is taken seriously… we report to the senior, then the manager,” demonstrating confidence in escalation procedures. Incidents were reviewed, and audit activity in areas such as medicines and IPC showed that learning was used to improve practice. Visiting professionals confirmed staff communicated concerns effectively and took appropriate action to reduce risks.

However, while governance systems had identified shortfalls in MCA and DoLS processes through audits and action plans, these had not yet been fully embedded into day-to-day practice, as evidenced by ongoing gaps in care records. This demonstrated that learning was recognised but not consistently translated into sustained improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. Professionals confirmed referrals were made appropriately to manage risks, communication was very good, timely and staff took responsibility to improve people’s health and wellbeing.

Staff demonstrated an understanding of how to respond to risks and escalate concerns appropriately. Care plans included hospital information packs and detailed summaries, supporting safe transitions between services.

The provider worked with people and partners to protect people from avoidable harm and abuse. Staff demonstrated a clear understanding of safeguarding responsibilities, with 1 staff member describing safeguarding as recognising when “things aren’t right” and reporting concerns through appropriate channels. Safeguarding concerns were recorded and responded to appropriately, and staff had received relevant training to support their role. The provider-maintained oversight of safeguarding activity through established processes.

People told us they felt safe living at the home, and relatives expressed confidence in staff. A relative said they chose the home as it supported their relative’s independence in a safe environment.

Opportunities were identified to improve the consistency of documentation relating to MCA and DoLS processes linked to safeguarding and restrictive practices. The provider had recognised these areas and had actions in place to strengthen practice. Overall, safeguarding systems were effective, with ongoing work to improve consistency in recording and application.

The provider worked with people to assess and manage risks associated with their care and wellbeing. Care plans included detailed risk assessments covering areas such as falls, nutrition and mobility, supporting safe and individualised care. People told us staff understood their needs, with 1 person stating, “Staff are good, they know what I need,” demonstrating confidence in risk management. Staff responded appropriately to changing risks, for example taking prompt action following a choking incident and making a referral to specialist services.

The provider detected and controlled potential risks in the care environment. The home was clean, well maintained and supported people’s safety and independence. Observations confirmed that communal areas were organised and supported safe movement throughout the home.

Some environmental issues were identified during the inspection, including storage and minor maintenance concerns. These were addressed immediately by the management team.

The provider-maintained oversight of environmental risks through audits and checks, and actions were taken to address identified issues.

These arrangements supported a safe environment, and the provider responded promptly to address any issues identified through routine oversight processes.

The provider made sure there were enough qualified, skilled and experienced staff to meet people’s needs. Staffing levels were supported by a dependency tool, and rotas showed staffing levels met or exceeded assessed needs.

Staff told us they worked well together and understood the needs of the people they supported. A staff member described a supportive team where concerns could be raised and acted upon. Recruitment processes were robust, and staff received training, induction, and supervision appropriate to their roles.

The provider assessed and managed the risk of infection. The home was clean and hygienic, and staff followed appropriate infection prevention and control procedures.

Audits were in place to monitor compliance, and improvements had been made over time. The provider had identified gaps in some cleaning records and had taken action to address these.

Staff had access to appropriate equipment and training to support infection control practices.

While some recording gaps remained, there was no evidence this had impacted people’s safety.

The provider made sure medicines were safe and met people’s needs. People received their medicines as prescribed, and staff followed appropriate procedures for administration.Systems were in place to monitor medicines management, including regular audits and oversight processes. Where issues were identified, actions were taken to address them.The provider had recognised areas for improvement through audit activity and were implementing actions to strengthen practice.This demonstrated that medicines systems were safe, with ongoing work to improve consistency.