Archived: Harmony 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. This is the first assessment for this newly registered-service where a rating has been awarded. At the February 2024 assessment under the previous legal entity, although we found some issues there was not enough quality statements assessed so we could not rate. At this assessment this key question has been rated requires improvement.

Requires improvement: This meant people’s needs were not always met because care was not always provided in a person centred way. The service was in breach of legal regulations in relation to person centred care.

This service scored 57 (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 make sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People and relatives were genuinely positive of staff; how nice staff were with them and how staff did their best. Yet what was clear through some conversations with us, was their care was not always personalised to them such as when and how they wanted it. We have referred to some examples in the report how people’s routines were not always supported. One person said, “They’ve not discussed my care with me. They haven’t talked to me about what I like and don’t like. There are days when there’s nothing I like. If I had a choice of care staff, I’d chose only female staff, but they haven’t asked.” Another person said mealtimes was not always good for them. This person said, “The food is 1 of the downers. We don’t get a great deal of choice or variety. I don’t eat meat and everything is mashed. I’ve just gone off meat since not being able to swallow.” At that point, a member of staff came into this person’s room, without knocking, and asked them what they wanted for dinner and told them it was roast chicken. The person said they did not eat meat, and the staff member came back with the sandwiches they had ordered the previous day, with crusts still on even though they needed to be removed. Another person explained to us how staff moved them to get ready for personal care which caused them some discomfort. Some people preferred staff of a certain gender but were not asked, others were not asked, and it did not cause them any concerns. Some people did not leave their bed or bedroom and that was their choice whilst others did want to get up but had to wait longer than they wanted. Some people conversations showed they were happy with their care and when they received it. What was evident from people and relatives feedback was more could be done to improve their care when needed. The service was in breach of legal regulations in relation to person centred care.

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.

The provider reviewed local healthcare needs to help them develop the service based on what people wanted and what was available locally. People were supported to obtain help from other health and social care professionals and referred to specialist health teams where appropriate. Commissioners of care feedback to us was of an improving service and where improvements were identified, actions were taken to make sure people continued the right levels of care.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People's communication needs were identified and recorded in their care plans. Where English was not a person’s first language, action had been taken to support communication. Information on how to report a concern or a complaint, planned activity sessions and information for visitors promoting good hygiene practices were displayed around the home. A relative told us they felt involved and included when necessary.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff didn’t always involve people in decisions about their care and told them what had changed as a result.

The majority of people did not always feel involved or listened to. One person said, “I haven’t seen an epilepsy nurse for ages, so I’ve not had my tablets reviewed for that. I do go to the hospital. I have no idea if my diabetes is managed. It’s not been checked for ages.” Another person said, “There has been a few managers here. I met the current 1 only yesterday. I’m not involved in my care I just accept what they give me.” Some people told us they lacked confidence in raising issues. At least 2 people said they had raised issues but felt they were not listened to because no action was taken. People were complementary of the staff but felt because staff time with them was limited it impacted on day-to-day discussions where some issues could be shared and understood or even addressed promptly.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Based on discussions with staff at all levels and our observations, we saw staff had involved GPs, speech and language therapists to support people’s changing health needs. Care plans included information about people’s health conditions so staff could recognise any signs or symptoms which may indicate a deterioration in their condition. Staff supported people to attend medical appointments although 1 person told us, they had not yet had a meeting with a nurse specialist about their ongoing health needs. From speaking with people, a relative and staff, we were not confident the service was accessible for people who were immobile or had limited mobility. A relative felt there was a lack of wheelchairs to take their family member out of their room. A staff member confirmed this saying there were not enough wheelchairs to mobilise people through the home.

We could not be assured staff and leaders always 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.

We did see some evidence that people’s feedback had been sought and acted upon. For example, the staff completed a ‘You said, we did’ board. This board had 3 suggestions from people, and 2 had been responded to. People and relatives’ comments to us showed where they had raised a concern, there was limited evidence things had changed. One relative said they had shared a concern but there was no improvement. One person told us they had not seen a specialist external nurse about their health condition, and they were not sure how their condition was being managed.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Some care plans we saw contained details of what the person wanted when they were at the latter stage of their life. A staff member said at this time, we would follow the care plan. A relative said they had not been involved in this specific area of their family members care plan yet, but they were confident that conversation would take place.