Harpwood House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People had their needs assessed before moving to the service. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. The assessment included making sure that support was planned for people’s diversity needs, such as their religion, gender, marital status, culture and their abilities. However, when assessments were updated and amended, the changes were not always recorded in the person’s care plan which led to inconsistent information. The registered manager told us after the assessment that they had implemented changes in response to our feedback. They said, “The duty manager (nurse) and care coordinator on each floor are now doing (reviewing) 1 care plan each, each day per floor and this comes through as a report.”

Assessments included information about what people could do for themselves. Each person’s care plan and assessments were also reassessed once a month as part of the ‘resident of the day’ process. This ensured that every person’s care plan and risk assessment were updated at least monthly. People were reassessed as their needs changed to ensure the care they received met their needs.

Some people were able to recall being involved in their assessments and care planning process and some people told us they had not been involved.

A relative said, “[Loved one] was assessed at home before coming in. My sister was involved in the care plan and likes and dislikes. It did take time to put some things in place.” We observed that staff knew people well.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. The provider had systems and processes in place to meet people’s nutrition and hydration needs. However, it was not always evident that drinks were offered in a timely manner as we viewed many overdue fluid reminders on the online care planning program. Records showed that people were potentially not having enough fluids to keep well. We discussed this with the registered manager. They felt this was a recording issue and added this to the action plan for improvements. We observed people being prompted and encouraged to drink throughout the day.

Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen to staff responsible for preparing, cooking and serving meals. Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it. We observed staff asking people what food choices they would like.

We received mixed feedback about the food. Comments included, “Food is good. You get a choice. You have fresh fruit. No problems. I look quite well living on their food. They will always give you more and they would get you something else if you didn't like something”; “I'm on a diet. I'm not too keen on the food. I would like more beef. There are three different choices. I do get enough to eat. They do go around with cake after breakfast and in the afternoon”; “Food is passable, average. If we don't like the meal, we can always have a sandwich. Lunchtime there are options but at supper there is only one option” and “Food is disgusting. As people here have dementia they can't speak up. Main meals in the day are not too bad. Evenings are eggs, soup and sandwich. Everyday. You get different soup but the same sandwiches. Yes, there is a choice, and you get a vegetarian option If there is nothing you want, they will do you a salad or a jacket potato.”

We observed quite a lot of people failed to finish their main meal; it was not possible to ascertain if this was due to the quality or quantity of the food provided. A person reported that their meal was inedible as it was too salty, they were offered a different meal which they ate. We observed a person being given their lunch 2 hours after being given breakfast with no option to see if they wanted a delayed meal to space their meals out. Some people who were living with diabetes were not always offered snacks that met their dietary needs. A relative also told us their loved one was given the same cake and snacks as non-diabetics, and they were concerned for their loved one’s health. We asked staff who supported their loved one and they confirmed this. We reported this to the registered manager, who told us they would take action to address this.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider had a clear process in place to escalate health concerns. However, this has not always been done in a timely manner. A person who had been extremely constipated had been seen by the visiting GP on 09 July 2025. We checked to see if constipation was the reason for the visit. The GP was unaware of the constipation and confirmed that it was not discussed or reviewed during their visit. Clinical staff were not always present when people were seen by the visiting GP which meant that clinical notes and records of GP visits were not always up to date. A person’s records showed that staff had not been following their guidance produced by healthcare specialists in relation to mouthcare to maintain good oral hygiene. The care plan and information about the task contained conflicting information.

People’s care plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. A healthcare professional told us, “On the whole the management and senior clinical team at Harpwood are very good and engaged with our clinical team at the practice.” The registered manager and nurses told us, they worked with the local hospice when people were at end of life, to seek advice and support. Nursing staff and other staff told us there were good links with other health professionals such as SaLT (Speech and Language Therapy), the GP, physicians associate, TVN (Tissue Viability nurse). A staff member told us, “The GP round is every Wednesday.” Trained nurses within the service reviewed and updated people’s clinical records daily if they required nursing care. The registered manager and management team reviewed and amended the process to learn lessons from where things had not worked quite as well. Such as staff working together to ensure constipation was more effectively monitored.

People told us staff worked with GP’s and health professionals to meet their health needs. Comments included, “Any medical needs are quickly dealt with”; “The Nurse will get in touch with the doctor if I need anything. I see the Chiropodist and the eye person. The Home sorts this out” and “Optician and the feet person come here to see me. They do watch and keep an eye on you.”

Relatives said, “The doctor is contacted, when necessary, e.g. sometimes she eats too much and make herself sick and they are on it straight away. The optician and chiropodist visit, but I am not sure re the dentist”; “They can see when he is in pain and respond, the nurses come and see him. On another occasion he had tummy ache, and they administered medication” and “The doctor visits every Wednesday and because of his medication regime the nursing staff are always on it and will contact the doctor if necessary. He sees the chiropodist, hairdresser and optician and I take him to the dentist.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. A person had moved into the service to recover and gain strength and was being discharged back to their own home. People told us they were supported with their healthcare. A person told us, “I have had the optician come here. They arranged it for me.” Another person showed us dressings on their hands and arms which the nurses and changed. The GP and physicians associate carried out a weekly visit. They told us that staff supported people well to understand the medical appointment and what was going on. People living at the service had access to onsite nurses employed by the provider and other health care professionals, for example, the community mental health team, chiropody, dietician, dentists and SALT (Speech and language therapists). Visiting was encouraged and people were supported to attend medical appointments. Staff had a good understanding of meeting people’s changing needs. We observed staff supporting people to maximise their independence such as encouraging them to walk with equipment, providing lots of praise and providing reassurances.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. Staff across the service had become champions within the service to drive improvement. Champions were in place for a number of different important areas such as skin care, continence, falls, medicines, infection control, end of life, dementia, nutrition and hydration and oral health. Staff told us they completed additional training to complement their champion roles. The registered manager said, “The champions are a great resource for the team as a whole, we also have champions boards with the different areas located in the staff corridor, these contain a lot of useful information and the name of the champion.”

A staff member told us, “On a day-to-day basis people’s conditions change, we review and monitor. We apply NEWS2 [NEWS is a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adults and is a key element of people’s safety and improving outcomes.] A healthcare professional told us, “I believe this to be a good home, staff are generally responsive and alert to signs of deterioration in people. I have a good relationship with the nurses at the service and work closely with them. I find them to be knowledgeable with a good understanding of people’s needs.”

The provider had also put in place information and support for relatives to enable them to understand more about the service and different diagnoses. These were available in the reception area near to where relatives signed in. They included information about funding, end of life care, dementia and Alzheimer’s and ‘support for you’. The service had employed a visiting Psychotherapist to provide support for relatives. They told us, “Through our discussions in the support group, the service has been complimented on the cleanliness of the environment, the space available for residents, and the engagement from support staff. When discussing with management, I hear that they wish to keep developing the service to meet the needs of their residents. We were very excited to develop the support group for the relatives, as this was something that had been identified as a need and that it would be appreciated.”

The provider always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect. Most people told us staff were kind, friendly and approachable. Comments included, “They are all kind. Always nice and friendly and they do their best. Always call me by my name”; “They always say good morning or good afternoon. I think they are good” and “They are kind and helpful and nothing is too much trouble.”

We observed a number of positive interactions throughout the assessment. Staff had an open, friendly rapport with people and most staff knew people very well. Care provided was person centred, people were treated with respect and were supported to spend their time how they chose. When people became anxious or upset staff responded promptly, such as offering distraction or a change of environment.

Relatives were very positive about the staff and the way they treated their loved ones. They described staff as caring, kind, attentive and patient. Staff respected people’s privacy, treated people with dignity and respect and always asked for consent to care. Comments included, “The are staff lovely and mum is happy there” and “Staff are incredibly polite and courteous, there are different faces, but some are the same and it is a big place.”