Archived: Harrington House

Harrington House is a care home operated by Raynsford Limited. The service provides support, personal care and accommodation for up to 12 people. It provides care to adults living with a learning disability, autism and behaviours that may challenge. 12 people were living at the home at the time of our inspection.

People's experience of using this service and what we found

Since our last inspection the service had made changes to the management team at Harrington House. The managers of the service worked alongside staff to ensure that any identified issues were managed. Priorities in relation to the quality of support were identified and acted upon promptly.

Documentation relating to individual risks was inconsistent. Risk assessment documentation had started to be reviewed by the home manager and guidance for staff was being developed at the time of our inspection. We questioned staff in relation to individual risks to people and found that staff knew people well.

There were systems in place to check the quality of the service. However, these systems were not always robust. For example, where issues had been identified, these had not been prioritised into an action plan with identified timescales for completion.

People's independence was respected and promoted. The support provided to people focused on them having opportunities to personally develop and maintain relationships. People received a consistent level of care from a team of care workers. There were enough staff employed to meet people's needs.

Staff communicated with people effectively to ascertain and respect their wishes. Safe recruitment practices were followed to protect people from unsuitable staff.

People received personal care that was person-centred and individualised. People's communication needs were identified, recorded and highlighted in care plans.

People were supported to access health services when needed. People's care plans provided staff with information about people's preferences and ways in which staff could support people emotionally and effectively when attending their healthcare visits.

Staff at the home supported people with the activities they enjoyed. Staff were responsive to people and their social health needs and people were encouraged to be as independent as possible.

People were supported to take their medicines safely as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection

The last rating for this service was Requires Improvement (published 20 July 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Harrington House provides residential care for up to 12 people. 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. Harrington House is registered for adults living with learning disability and/or mental health needs. At the time of this inspection 12 people were living there.

Accommodation at Harrington House is provided over three floors with bedrooms located on the ground and first floors; A self-contained flat housing one person was located in the basement. The ground floor and garden were wheelchair accessible. One bedroom had en-suite facilities, all bedrooms were equipped with a sink and adapted communal bathrooms were available to all. A shower was situated on the first floor. People had access to the kitchen and the open plan communal areas, including the lounge, dining area and conservatory. The garden was enclosed and complete with a barbeque and strawberry patch. Parking was available at the front of the house.

At our last inspection in 2015 the home was rated Good. The management of the home changed twice since our last inspection. The new manager has been in post since January 2018 and has applied to become registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”

During this inspection we identified one breach of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. The service has been rated 'Requires Improvement' overall.

Principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had not always been adhered to. Not all people living at Harrington House could consent to the arrangements in place to keep them safe; Continuous supervision and control, combined with lack of freedom to leave, indicated a deprivation of liberty for some people. However applications to authorise these arrangements under DoLS had not been made for all people who may require this. It was evident the restrictions in place were appropriate and in people’s best interests and would have been legally authorised under the MCA had DoLS authorisations been requested.

People’s support plans did not always reflect their needs and these were in the process of being updated. When people’s needs changed, a referral for re-assessment by a health care professional had not always been requested to ensure they remained safe. Some improvements had been made since the new manager came into post. However, when shortfalls had been identified by the provider prompt action had not always been taken to ensure the required improvements were made.

People benefitted from a caring staff team who knew them well. They were supported to access appropriate health care. Staff took a personalised approach to meeting people's needs and outcomes for people were good. People's preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People's privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. People received good end of life care.

People's views about the service they received were sought and these were used to improve the service. People were able to raise complaints and these were responded to promptly. The culture at the home was person centred and the manager as open about improvements needed. Staff and managers worked together to provide a friendly service where people told us they felt at home.

This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The service is safe because people were treated with respect and dignity by the staff. When people displayed behaviour, which challenged others, staff dealt with it effectively and respected people's dignity and protected their rights.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions whilst ensuring their welfare.

Systems were in place to make sure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and were having discussions with local authorities about this. This meant people were protected from discrimination and their human rights were protected.

Staff kept the home clean and hygienic in order to protect people against the risk of acquiring healthcare associated infections.

Prescribed medicines were stored and administered safely in line with current and relevant regulations and guidance. However, we found one medicine to be two tablets short, and another medicine was one tablet short. Seven members of staff were in the process of completing medicines training. Two members of staff had out of date medicines qualifications.

The skill mix and experience of staff were considered when arranging the staffing of the service.

Is the service effective?

The service is effective because there was an advocacy service available if people needed it. This meant when required people could access additional support.

Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people's needs changed. People's identified needs were monitored and managed.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people's diverse care, cultural and support needs.

Is the service caring?

The service is caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be. One person told us, 'I'm quite independent and I have my personal allowance given to me; I can go out alone.'

Is the service responsive?

The service is responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation. People told us, 'Staff ask what I want to do' and 'I can choose what I do' and 'I go out in the car.'

We found staff had not notified us of an injury sustained by a person using the service. The provider must tell us how they plan to address this.

Is the service well-led?

The service was well led because there was a manager who had been registered with us to manage the service. At the time of the inspection a new manager had been appointed and it is planned they will apply to us to become the new registered manager of the service.

Staff worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. Where required, action plans were monitored to ensure they were delivered. Quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement. Staff knew and understood what was expected of them.

We looked at the accident records and found a notification about an injury to a person using the service had not been made to us.

The registered manager who was also one of the providers was in the process of handing the role of the manager over to a new manager. Both managers were present for the inspection. The new manager took the lead during the inspection because they wanted to us show the changes they had made to the service. The new manager plans to apply to us to be considered for the role of registered manager.

We found the three compliance actions we issued at the last inspection in relation to the environment, infection control and staff training had been met.

Arrangements were in place to monitor the quality of service provision people received.

We found a large number of environmental concerns that needed to be addressed. Radiators required covering and window restrictors needed to be fitted.

The procedures in place for the control and management of infection need to be reviewed and changes made to protect people from the risks of cross infection.

Staff supervision sessions were not being recorded and some staff required updates and training in specific areas to meet the needs of people who used the service.