Harpwood House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 71 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were very detailed in relation to most areas of people’s care and support needs as well as nursing needs. Care plans were person centred and included individual preferences, likes, dislikes and favoured routines. However, care plans were not always updated and clear when health professionals had provided up dated guidance. For example, a person’s care plan stated staff should not give a person oral fluid. This directly conflicted against the person’s SaLT (Speech and Language Therapist) guidance and records for March and July 2025. Which stated the person should be offered drinks throughout the day for their comfort as agreed in the care plan. There was a previous plan which was dated November 2024 which showed nursing staff should be completing mouthcare twice a day and the person should be offered 3 drinks a day of their choice. Care staff told us that nursing staff would only provide these oral fluids for this person. Care notes did not reflect this had been happening. A relative said, “It’s a battle, they tell you staff are going to do the oral care, but they don’t do it regularly. We put camera in his room, so we know they are not doing it.”

Care plans for people on blood thinning medicines did not provide information for staff in relation to signs to look out for when providing personal care or mobility/falls risks. There was some conflicting information in care plans in relation to gender preference of carers. A person had a catheter care plan in place which had last been updated in March 2025. The person no longer had a catheter.

Staff knew people well. A staff member said, “I sit down and talk to my residents see what their preferences are. We have great relationships with the relatives; they are very thankful that we look after their family members. We get family to sit with the residents at lunch to help them see what we do. It works well they enjoy it.” A relative told us their loved one received personal care to meet their needs and was supported to dress appropriately. People told us, “They know how to help me. They will say shower or wash and I say I don't care” and “They ask me each day if I want a shower and will always help if I say yes.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Information was shared with staff during handover regarding any changes to people’s health or care needs. The service worked with other health professionals involved in people’s care. Staff told us how they supported people and their relatives. Relatives told us, they felt staff supported people with appointments and communicated well with GPs and health specialists to ensure people received continuity of care. A relative told us, “I am not sure whether the doctor visits or not because they have nurses who call the doctor when necessary.” Another relative said, “Mum is sleeping a lot at the moment, more than normal. I have spoken with nurse about it, they have spoken with the GP this morning to prescribe sleeping tablets to aid sleep at night and then to promote her to be awake in the day. A visiting professional said, “My experience of the care staff picking up changes in the resident’s health is found through the discussions with the families themselves. They have noted that the care and attention received is very consistent and attuned to the needs of the individual resident. Any issues are flagged through layers of management in order to find a solution to meet the needs of the resident.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. There was a lack of dementia friendly signage and way marking around the service to direct people to communal areas. There were some signs, but they were lost amongst decorations on the walls or were placed too high up for people to see. There was no dementia friendly signage on doors such as toilets, bathrooms and shower rooms. Staff were aware of people’s individual communication needs for example, people who may have hearing or visual impairments. There were some notice boards around the service which had some easier to read information on display. There were no food pictures or plated meals used by staff to aid people’s menu choices at mealtimes. Some dining rooms had a TV screen showing what was available but one dining area did not have this.

Staff shared how they provided information and communicated with people. A staff member said, “[Person] has got very less hearing we always sit near and say loudly to her ear. She is happy with someone sitting with her.”

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.We observed good practice from staff in relation to listening and involving people with their care and making decisions. The registered manager shared with that they held meetings with people and relatives on a regular basis. The meetings were previously held separately but the relatives’ meetings were not well attended. Updates about the service were also shared at these meetings. People and their relatives were sent surveys about the service. These had been sent out in October 2024, with the results reviewed November 2024. The survey results identified areas of concern and improvements required. The registered manager had taken action to address the concerns. For example, they said a staff member had been “Supporting in the laundry in response to feedback from families, she has previously supported our kitchen team and on our last relatives feedback survey we were rated good after previously being rated requires improvement, she has already implemented a number of positive steps which we hope will be reflected in our next relatives survey. We had already increased the laundry hours from 26 hours per day to 30 hours per day.” The registered manager shared that suggestion boxes had been purchased. They were going to be put up next to activities information boards on each floor. This was something that had been raised at the last residents/relatives meeting.

Relatives were also able to review and make comments on the service monthly. The provider and management team reviewed these and acted on any areas required. People were offered informal opportunities to feedback about the service, the management team spent time walking round the service daily and chatting with people. The service published relatives and resident newsletters regularly, recent copies showed people and relatives had been informed about new animals, activities such as choir group, external entertainers, exercise classes and also days out. Relatives had been informed about a lost and found laundry rack in reception; relatives had been asked to check the rail in order to get items back to the right people. The newsletter for people provided a list of dates that the chiropodist would be visiting for the year and information about the different staff uniforms, to aid people to identify who is who and information about activities on offer.

The provider made sure that people could access the care, support and treatment they needed when they needed it. People were supported with medical appointments and follow up appointments. We observed people receiving visits from healthcare professionals during the assessment visit. People’s care records showed that they had received medical help. Relatives told us their loved one has visits from healthcare professionals. People told us they had access to the nursing staff within the service as well as visiting health professionals. Staff gave us examples of when they had recognised people were not acting in their usual manner and the action they took. Most staff were knowledgeable about how to recognise signs of deterioration and care workers said they would report health changes to the nurse on duty if necessary. People were supported to maintain contact with their friends and families. We observed people receiving visits from friends and families during the assessment.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The registered manager was alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, or cultural. They had developed a vision for the service. Part of the vision was, ‘Harpwood House believes that working together makes us stronger when it comes to caring for those living with Dementia, we will work with you to provide the best care for your loved one. We have Dementia Champions who are available as a resource for both staff and families, additionally there are information folders in reception. Harpwood House are accredited under the National Dementia Care Accreditation Scheme (NaDCAS)’. As part of the dementia accreditation the service was inspected and reviewed by NaDCAS. They had suggested some ideas for the service to develop such as improvements to activities to enhance engagement and these were being implemented. The service had just installed kitchenette self service areas in the dining rooms to enable people to help themselves to breakfast and view different options.

A member of staff told us, “We have a digital room where people can send emails and face time. It has just started.” They detailed that they tried to include as many people as they could in activities. When it was quieter in the morning, they shared they sometimes supported people with books, magazines, using the digital table, and a new item which is like a digital table but is a floor-based exercise. This had games like whack a mole, water feature, spot the difference and bean bags. This meant that wheelchair users could be physically involved.

People were given exceptional support to plan for important life changes, so they could makeinformed decisions about their future, including at the end of their life. The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. Some people had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. Some people had ReSPECT (Recommended Summary Plan for Emergency Care Treatment) forms in place. A ReSPECT form records a person's wishes about a range of care and treatments. End of life care plans were as comprehensive as the person wanted it to be and plans were clear in cases where people had chosen not to discuss this element of their care. Staff told us that they worked closely with the local hospice to ensure people had effective support and pain relief to ensure people had dignified, pain free deaths. Medicines were available to keep them as comfortable as possible. The service had received compliments from relatives about care including end of life support. A staff member had been assigned end of life champion within the service. They had completed additional training with the hospice such syringe driver, oral care and just in case medicines. This enabled them to provide person centred end of life care and support to staff who were working with people who were at the end of their lives. Harpwood House have achieved a Gold Standards (GSF) accreditation for end-of-life care. The vision for the service shows they recognise each person’s end of life journey will be different and staff will be at hand to support people during this part of their journey, working closely with the Heart of Kent Hospice.