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Reports


Inspection carried out on 12 September 2018

During a routine inspection

Harding House 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. Harding House is registered to provide accommodation and personal care for up to 10 people who are deaf with mental health needs. At the time of the inspection there were six people living in the home and one person was in hospital.

A registered manager was in post who was present on both days of the 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.

The registered manager was also responsible for managing Huguenot Place located nearby which is another CQC registered care home which we inspected at the same time as Harding House. Staff working at each service attended joint staff meetings and accessed the same organisational systems in place across areas such as training, care planning and quality assurance.

We inspected Harding House on 12 September and 11 October 2018. The inspection was unannounced on the first day and we told the provider we would be returning on the second day. Our last inspection took place in June 2017 where we rated the service ‘Requires improvement’.

At this inspection we found improvements had been made and the feedback from people using the service reflected this. However, the registered manager reported on the continuing difficulties in recruiting suitable staff with the appropriate communication skills to work effectively with the people living at Harding House.

Appropriate numbers of support staff were allocated to help keep people safe with regular temporary staff used to cover vacancies. People spoken with were generally happy with the support provided by the staff working at Harding House but said that communication could sometimes be a problem depending on which staff were on shift.

We saw staff members had been safely recruited and had access to both mandatory and specialist training. Staff also received regular one to one supervision and additional support when required.

Staff understood how to help protect people from the risk of abuse. The service had procedures in place to report any safeguarding concerns to the local authority. People and staff were protected from potential risk of harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. People had assessments which were individual to the person and their strengths and needs.

Medicines were administered in a safe way. Staff received training and a competency framework was in place to make sure they understood and followed safe procedures for administering medicines.

Staff had received training in the MCA (Mental Capacity Act 2005) and understood the importance of gaining people’s consent before assisting them.

The service completed a detailed personalised support plan for each person with information provided in accessible formats. They kept people’s needs under review and made changes as required.

People using the service felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues. Staff also said they felt comfortable in raising any concerns should they have any.

The registered manager monitored the quality of the service and made changes to improve the service provided when required. Staff and people who used the service found the management team to be approachable.

Inspection carried out on 31 May 2017

During a routine inspection

We inspected Harding House on 31 May and 1 June 2017. The inspection was unannounced on the first day and we told the provider we would be returning on the second day. Our last inspection took place on 26 and 31 August 2016 where we found four breaches of legal requirements in relation to safe care and treatment, dignity and respect, person centred care and good governance.

Harding House is registered to provide accommodation and personal care for up to 10 people who are deaf with mental health needs. Action on Hearing Loss provide the care and support and the accommodation is owned by a separate landlord. At the time of the inspection there were seven people living in the home.

The service had a registered manager who was present on both days of the 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.

Staff had a good understanding of their responsibilities in relation to keeping people safe from harm however the provider did not notify us about an allegation of abuse.

There were enough staff deployed to meet the needs of the people and the results of background checks on staff showed that they were suitably employed.

Medicines were administered and stored safely, however medicines records and audits required further scrutiny. The provider carried out assessments to ensure staff were competent to manage medicines.

Staff training was regularly updated to keep their skills and practice updated and staff signing skills had been reassessed. People told us there had been improvements with the staff team’s signing skills.

People were involved in choosing their own foods and they were provided with a well balanced diet. Staff supported people to adhere to effective food hygiene practices and healthcare services were accessed to regularly monitor people’s health.

The provider followed the legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People told us they were listened to by helpful and kind staff. They made their own decisions and choices about how they received their care. Staff understood how to meet people’s individual needs and respected their privacy and dignity. Advocacy services were accessed to make certain people’s views were listened to.

Care records were personalised and people’s relatives were invited to reviews when people requested this. Staff held regular meetings with people to discuss their individual needs and help them attain their goals. Information about how to complain was available to meet people’s communication needs and they told us they had no concerns. People were confident any complaints they raised would be resolved.

The provider had involved people in how the service could improve and to ensure lessons were learned, and were committed to making improvements. Audits were carried out but further scrutiny was needed to address the shortfalls we found. People and staff were content with how the home was run.

We have made one recommendation about the safe management of medicines. Further information is in the full version of this report.

Inspection carried out on 26 August 2016

During a routine inspection

We inspected Harding House on 26 and 31 August 2016. The inspection was unannounced on the first day and announced on the subsequent day. This was the first inspection of the service since it had registered with a new provider The Royal National Institute for Deaf People.

Harding House is registered to provide accommodation and personal care for up to for up to 10 people who are hard of hearing with mental health needs. The building is owned by a separate landlord who is responsible for any repairs to be carried out in the service. At the time of the inspection there were eight people living in the service.

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.

People told us they felt safe using the service. Staff had received training and understood how to keep people safe from abuse. Prevention measures had been put in place to minimise future re-occurrences of risks to people’s welfare.

Information about the home was not accessible and people who used the service told us they were not understood in their own language. People’s rights were not always respected and staff did not always provide person-centred care.

Recruitment checks were completed to assess the suitability of the staff employed. Staff had not received suitable training to enable them to carry out their roles effectively. There was not a suitable number of staff deployed to meet the needs of the people who used the service.

‘As required’ medicines and stock checks were not safely managed and the cleanliness of the communal areas of the premises were not properly maintained. The storage of medicines was managed safely. Staff had received annual medicines training.

People were supported by staff to attend health care appointments when there were changes to their health care needs or associated risks to their health. Good food hygiene practices were not followed by staff working in the home.

People’s privacy and dignity was respected. People made their own choices about their care and support, and health and social care professionals were involved in these decisions. People told us staff did not treat them with respect. Advocacy support was not always used to ensure people were listened to and their concerns acted on.

Quality assurance systems were not in place to effectively improve the quality of care delivered. Feedback was not sought from people or their relatives to obtain their views regarding how the service was run.

People were supported by staff to attend health care appointments when there were changes to their health care needs or associated risks to their health. Staff followed the legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Care plans had not been thoroughly reviewed to ensure people’s care needs were met.

People were involved in activities in the wider community but told us they not socially stimulated whilst using the service. Some people were not confident any concerns they raised would be resolved. There was an easy read complaints guide available for people. Relatives told us they knew who to report concerns to.

We found four breaches of regulations relating to safe care and treatment, dignity and respect, person centred care and good governance. You can see what action we asked the provider to take at the back of the full version of this report.