Background to this inspection
Updated
16 January 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection Team
One inspector carried out this inspection on 9 December 2019. One inspector and a specialist nurse advisor returned the following day, 10 December 2019, to complete the inspection.
Service and service type
Harmony House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and the quality and safety of the care provided.
Notice of inspection
The inspection was unannounced on 9 December 2019. We informed the registered manager we would return on 10 December 2019 to complete our inspection.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. This included details about incidents the provider must notify us about, such as serious injury and abuse. We also sought feedback from the local authority and clinical commissioning group. We used all the information to plan our inspection visit.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with nine people and eight relatives. We spent time with people in communal areas, observing interactions and support they received from staff. We spoke with the registered manager, a regional manager, three nurses, seven members of care staff, the activities staff member, the home’s chef, an agency chef, two kitchen assistants and the administrator.
We reviewed a range of records. This included a full review of seven people’s care plans, risk management plans, multiple medication records, accident and incident records and health and safety checks. We also looked at records relating to the management of the home.
Updated
16 January 2020
About the service
Harmony House is a care home, which provides accommodation, personal and nursing care for up to 57 older people, some of whom are living with complex health conditions or dementia. The home has two floors, with numerous communal lounges, and a dining area. People had their own en-suite bedrooms. There is a communal garden area. At the time of our inspection there were 42 people living at Harmony House.
People’s experience of using this service and what we found
People told us they were happy living at Harmony House and described the home as having a happy atmosphere with things to do. Staff demonstrated a kind and caring approach toward people and gave support when needed.
Most risks were well managed, and staff had risk management plans to refer to telling them how to reduce risks of harm or injury to people. However, some risks had not been identified by the provider or registered manager and this posed risks of harm to people.
Staff were trained and offered opportunities to develop their skills and knowledge. However, the provider and registered manager had not ensured staff always had the guidance they needed to use all equipment safely, such as specialist beds.
People had all their prescribed tablet medicines available to them, but staff did not always ensure people had their prescribed topical medicines. Staff did not always follow manufacturer’s guidance in how medicines should be given through the skin.
People had choices about drinks and what they ate for their main meals. However, appropriate nutritional snacks were not always made available to meet people’s dietary requirements.
The home was well-maintained and good cleanliness reduced risks of cross infection.
Staff understood the importance of giving people choices. 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.
People’s needs were assessed, and information was used to form plans of care. Work was ongoing to further personalise people’s care plans.
There were enough staff on shift to meet people’s needs. Improvement had been made to ensure staff consistently worked on one floor of the home so people were cared for and supported by the same staff. Staff were recruited in a safe way.
There were systems in place for people and relatives to give their feedback on the service. The provider’s complaints policy was displayed, and concerns were acted on.
Improvements had been made to staff morale and they felt supported by the registered manager.
There were processes to audit the quality and safety of the service. Some issues had been identified as requiring improvements and were acted on. However, some audits, checks and oversight of staff were not robust enough and had not identified where improvements were needed. Intended improvements were not always sustained by staff or embedded in the culture of the home.
Following our inspection feedback, the regional manager and registered manager took some immediate actions to make improvements. This included increased managerial oversight to ensure people were offered appropriate and nutritional snacks.
We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:
Regulation 17 Regulated Activities Regulations 2014 – Good governance
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for this service was Requires Improvement (published 4 January 2019). The service has been repeatedly rated Requires Improvement since 2015.
Why we inspected
This was a planned inspection based on the rating of the last inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.