Archived: Harmony 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.

This is the first assessment for this newly registered-service where a rating has been awarded. This key question has been rated requires improvement.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider’s process was for night staff to complete a care plan for people newly admitted to the home. However, staff told us they only had limited information to complete an accurate care plan. One staff member told us, “We sometimes hear about new admissions the day before, or on the day, sometimes via the WhatsApp group. You don't get a care plan or assessment; you have to ask nurses on the first day if it's not been covered beforehand.” Staff told us some people’s care information was not on the electronic system which was only done once paper versions were completed by night staff. We were told by nursing staff they only got access to people’s information when they had access to it on the electronic system. We saw 1 example for a person who moved into the home end July 2025. We saw 4 specific care plans for this person that were needed which had not been completed. Those 4 care plans should have been completed because staff needed to know that personalised information, for example how they needed to be mobilised and information about special and modified diets to provide effective and safe care. Upon our return, these had been completed 04 and 05 August 2025.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used recognised tools to assess and identify risks to providing people’s care and support. This included the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties. Using the IDDSI, care plans clearly identified how people needed their food prepared or to what consistency they needed their drinks thickened to reduce their risks of choking. However, supplementary diet choice records and daily records did not always correctly tell staff, how people required their foods prepared. A staff member supporting people during mealtimes said they had dysphasia training since joining the home. They told us about a person in a particular room “Had normal food.” In the dining room we found a diet sheet preference updated 29 July 2025 recorded stated “pureed” food and a diet sheet updated 31 July 2025 stated “pureed.” We checked more completed diet sheets and found one person was recorded as a soft diet on 29 July /2025, yet on 31 July 2025 they were recorded as normal diet. In some cases, we saw 3 people’s specific meal preferences were recorded differently across breakfast, tea and lunch. This could cause confusion to staff in how to give the person their meal, putting the person at risk. We spoke with one staff member who said they occasionally supported 1 person whose records stated they required a soft diet; however, the staff member told us they gave them a normal diet. There was no evidence to show, this had caused the person harm.

Important information, such as people’s medicines records was not available to us during our first day because the system had gone down. The provider had no other back up to ensure people’s important information remained available. We did see people’s daily records recorded if people required repositioning or if people required regular checks to ensure they were safe, were completed. We reviewed care records for 1 person with epilepsy. Nurses completed care plans that clearly detailed the steps to take during and after the person experienced a seizure and any rescue medicines practices required. Staff completed a falls care plan for another person identified as being at high risk of falls, this plan included actions for staff to reduce the risk of a fall. Where people’s levels of agitation increased, care information directed staff what to do.

The provider worked across teams and services to support people, but improvement was needed. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Some improvements were required to support staff to work across staff teams more effectively. For example, ancillary staff were not always present at shift handover meetings and did not have access to information technology-based communication platforms. This meant they were not always sure who was residing in the home, and who was in hospital. One staff member told us the quality of the handover they received varied. However, staff told us they were provided with some information about people’s interests and hobbies and significant events in their lives, such as falls they had experienced, when they first moved into the home.

A staff member told us the co-ordination between teams needed to be further improved, to enhance people's care experience further. For example, by organising personal and nursing care so it was provided at the same time such as; pain relief, dressing changes and taking clinical photos. This would help to ensure people experienced less disruption and promoted their well-being. Staff told us people had access to support from physiotherapist, social workers ambulance and paramedics.

We observed handover from the night to morning staff. Staff told us the electronic system [Person Centred System] enabled them to share information about people which ensured people’s needs were met safely. Staff told us they worked across all floors so got to know most people in the home. Care staff and nurses spoke positively of working together. Staff recorded in daily notes when healthcare professionals had visited/called to discuss a person’s care so staff could be informed of any changes to the person’s care needs.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control.

Care records included information of people’s health conditions to help staff understand their health and support needs. However, we did see a care plan for a person new to the service did not have all of their care plans completed in a timely way. Care staff told us they felt able to report any changes in a person’s health to the nurse in charge and were confident these would be acted on. We saw many people were cared for in bed with limited opportunities to get out of bed. When we asked one staff member how people in bed were supported with social care needs, they told us, “People in bed have TV only.” This did not support a varied or health lifestyle to maintain a person’s wellbeing. A staff member responsible for activities with people said at times it was difficult to ensure everyone in the home had been spoken with or involved in activity sessions. People’s comments showed us at times, they felt isolated. Comments included, “The staff are fabulous but there’s just no entertainment. I used to be able to go outside now I can’t. There’s just not enough staff to take me” and “They haven’t discussed any interests or hobbies I may have, but they wouldn’t have the time to do that. I’m just here to be looked after although I think I could be looked after better.” For others, they did feel more involved and were given opportunities to be involved in social activities in the home.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff were able to explain how they monitored people’s health and wellbeing to improve outcomes. Staff understood what action to take if they identified a concern. During the handover meeting a nurse shared information with another nurse regarding monitoring a person’s blood sugar levels to make sure they did not raise any further. There was an instruction to refer to the dietician if this did not improve. Another person required staff to monitor their fluid intake to ensure it did not exceed a certain range. We saw from records; this was being achieved however the daily fluid amounts did not total correctly with the totals generated by the electronic system. The manager agreed to look into this to see what needed to be done to ensure records remained accurate. One nurse told us they did not always have time to monitor care staff due to their other duties. For example, making sure drinks with a thickening agent in were not left on the table. Nurses also told us they had a number of allocated tasks to complete which made it difficult to have sufficient time to monitor people’s health and welfare.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Where a person's capacity to understand information related to their care and support was questionable, care plans included a mental capacity assessment (MCA) and best interest decision relating to the decision that needed to be made. However, some capacity assessments contained either no, or very limited, information about how people had been supported to understand the decision to be made so they had the best chance possible of making their own decision. We found some recorded decisions had sufficient information; others could benefit from more details to show how and what they did to ensure the person had opportunity to understand or not, at different times or with additional support from family or advocates.

We did see staff seek people’s consent for their daily choices. People told us staff gave them choices, such as what they wanted to eat or what they wanted to wear. However, as we have reported, people did not always feel their individual preferences were sought to become involved in some activities in the home, or when they wanted to have a bath or shower. Records in relation to best interest decisions about people’s medicines did show GP and pharmacy involvement.