The Harefield Care Home

The Harefield Care Home offers accommodation and personal or nursing care for up to 40 people, some of whom are living with the experience of dementia. The accommodation is provided in 2 ground floor units in a purpose-built building. There were 39 people using the service at the time of our inspection. The service is part of HC-One No.1 Limited, a large organisation which operates over 300 care homes across the United Kingdom.

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

People received their medicines safely and as prescribed, but we found several minor shortfalls in relation to the management of medicines. The provider took immediate action to make the necessary improvements.

Where people required closed monitoring or repositioning to avoid skin damage, there were monitoring charts in place for staff to complete. We saw the recording of these was mostly accurate and regular. However, for one person, there were gaps in recording. The provider took appropriate action with the relevant staff to make improvements.

Although the provider’s monitoring checks had not identified the minor issues we found on the day of our inspection, we saw evidence of a continued and marked improvement since our last inspection. The registered manager was in the process of auditing all records to help identify and address any further shortfalls.

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.

Risks to people's safety and wellbeing had been appropriately identified, managed, and mitigated. The provider had processes for recording and investigating incidents and accidents. We saw that these included actions taken and lessons learned.

There were enough staff on duty to meet the needs of people who used the service. There were procedures to help make sure staff were suitable and had the skills and knowledge required. These included recruitment checks, regular training, and supervision.

There were systems in place for the prevention of infection and cross contamination.

Care and support plans were comprehensive and contained the necessary information about the person and how they wanted their care provided. People’s end of life wishes were recorded in their care plan. This included their religious and cultural needs and how they wanted their care when they reached the end of their life.

People and relatives were happy with the care they received and spoke highly of the registered manager and staff whom they said were kind and caring. People were supported to take part in activities they liked.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 September 2022) and there were 2 breaches of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, further improvements were needed. We made a recommendation in relation to the management of medicines.

Why we inspected

We carried out this inspection to check if the provider had made the necessary improvements since the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Harefield Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Harefield Care Home offers accommodation and personal or nursing care for up to 40 people, some of whom are living with dementia. The accommodation is provided in two ground floor units in a purpose-built building. There were 39 people using the service at the time of our inspection. The service is part of HC-One No.1 Limited, a large organisation which operates over 300 care homes across the United Kingdom.

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

Not all the risks to people's safety and wellbeing had been identified. During our inspection, we found some cleaning products, prescribed thickener and toiletries including razors were not locked away safely. This meant people may have been at risk of avoidable harm.

People’s monitoring charts were in place where these were needed. However, the recording of these was not always accurate or regular. This meant we could not be sure if this was a recording issue, or if people were not always supported with repositioning as required.

There was usually enough staff on duty to meet the needs of people who used the service. However, on the day of our inspection, all permanent staff were on training and the home was staffed by agency staff, some of whom had never been at the service before.

Although there were systems in place for the prevention of infection and cross contamination, and we saw cleaning taking place, there was a malodour in one of the units which persisted throughout the day of our inspection.

Care and support plans were comprehensive, although at times difficult to navigate and find information. However, they contained the necessary information about the person and how they wanted their care provided. People’s communication and healthcare needs were recorded and met. People’s end of life wishes were recorded in their care plan. This included their religious and cultural needs and how they wanted their care when they reached the end of their life.

Although the provider’s monitoring checks had not identified the safety concern we found on the day of our inspection, we saw evidence these had continued to improve since our last inspection. The registered manager took immediate action to ensure these concerns were addressed promptly.

People who used the service received their medicines safely and as prescribed. The provider had processes for recording and investigating incidents and accidents. We saw that these included actions taken and lessons learned.

There were procedures to help make sure staff were suitable and had the skills and knowledge required. These included recruitment checks, regular training and supervision. People and relatives were happy with the care they received and acknowledged there had been improvements since the new registered manager had been in place. They said the care staff were kind and met their individual needs. People were supported to take part in activities they liked.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 July 2021) and there was one breach of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out this inspection to look at the key questions we had not inspected at our last inspection and to check if the provider had made the necessary improvements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Harefield Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified two breaches of regulations in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Harefield Care Home offers accommodation and personal or nursing care for up to 40 people, some of whom are living with dementia. The accommodation is provided in two ground floor units in a purpose-built building. There were 27 people using the service at the time of our inspection. The service is part of HC-One Oval Limited, a large organisation which operates over 300 care homes across the United Kingdom.

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

Not all the risks to people's safety and wellbeing had been identified, assessed and managed. We found a safety concern on the day of our inspection which meant people may have been at risk of avoidable harm.

Although the provider’s monitoring checks had not identified the safety concern we found, these had improved since the last inspection. The provider took immediate action to ensure this was addressed immediately.

People who used the service received their medicines safely and as prescribed. There were systems in place to protect people from the risk of infection and cross contamination. The provider had processes for recording and investigation incidents and accidents. We saw that these included actions taken and lessons learned.

There were procedures to help make sure staff were suitable and had the skills and knowledge they needed. These included recruitment checks, regular training and supervision. People and relatives were happy with the care they received. They said the care staff were kind and met their individual needs. People were supported to take part in activities they liked.

Care and support plans were comprehensive. They contained the necessary information about the person and how they wanted their care provided. People’s communication and healthcare needs were recorded and met. People’s end of life wishes were recorded in their care plan. This included their religious and cultural needs and how they wanted their care when they reached the end of their life.

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. We undertook a focused inspection on 12 August 2020, to check if improvements had been made. We found the provider had met regulation 18 but were still in breach of regulations 9 and 17. At this inspection we found further improvements had been made but the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Responsive and Well-led which contain those requirements. We also looked at Safe.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Harefield Care Home on our website at www.cqc.org.uk.

The Harefield Care Home offers accommodation and personal or nursing care for up to 40 people, some of whom are living with dementia. The accommodation is provided in two ground floor units in a purpose-built building. There were 25 people using the service at the time of our inspection. The service is part of HC-One Oval Limited, a large organisation which operates over 300 care homes across the United Kingdom.

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

Although improvements had been made in the way the service was run, and there were more effective quality monitoring systems in place, further improvements were required. Monitoring systems had not identified that some records were still not written in a person-centred or effective way, and the management had failed to take prompt action about a safety concern.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

There were systems and processes in place to protect people from the risk of harm. There were enough staff to meet people’s needs. Covid-19 risk assessments were also in place for each person using the service to minimise risks associated with the infection.

People were supported by staff who were suitably trained, supervised and appraised. Staff told us they felt supported in their role.

People’s records about personal safety checks such as repositioning charts and pressure mattress checks were completed appropriately and as stated in their care plans.

People and relatives told us the staff met their needs and they felt listened to. They were offered a range of activities of their choice and staff knew how to communicate with them.

The provider had appropriate arrangements for visiting to help prevent the spread of Covid 19. Visitors had their temperature taken before being allowed to enter the home. They were supported to wear a face covering when visiting, and wash hands before and after mask use. There was sanitizing gel available at the entrance of the home and visitors were requested to use this.

The provider had appropriate arrangements to test people and staff for Covid 19 and was following

government guidance on testing. All staff received appropriate training on Covid 19, infection control and the use of PPE.

There were two designated infection control champions who monitored and carried out regular checks and audits to help ensure staff followed the correct guidelines. Staff were provided with support when they became unwell and when they returned to work.

The provider ensured that people using the service could maintain contact with family members and friends. People were supported to have visits from their relatives and friends in designated areas where social distancing was observed. They also used technology so people could see and communicate with their loved ones.

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

Rating at last inspection

The rating for the service at the last inspection was requires improvement. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safety of the environment and the leadership at the service.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe, effective, responsive and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Harefield Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At the last inspection we found breaches of regulations 9, 17 and 18 and imposed requirement notices. At this inspection we found they have met regulation 18 but were still in breach of 9 and 17. You can see what action we have taken against the provider at the back of the report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• The Harefield Care Home offers accommodation and personal or nursing care for up to 40 older people, some of whom are living with the experience of dementia. The accommodation is provided in two ground floor units in a purpose-built building. There were 37 people using the service at the time of our inspection.

• The Harefield Care Home is part of HC-One Oval Limited, a large organisation who owns over 300 care homes across the United Kingdom.

People’s experience of using the service:

• People were supported by staff who did not always receive training the provider identified as mandatory. The training records confirmed that some training was out of date.

• Staff stated they did not always feel supported by the management. We saw that, although they received supervision, this was not always regular.

• People’s records showed that staff did not always use respectful language and did not always demonstrate an understanding about the person’s needs. Some staff did not know about a person’s individual communication needs although these were recorded in the person’s care plan.

• People’s records about personal safety checks were not always completed appropriately and as stated in the care plans. These included repositioning charts and pressure mattress checks.

•The provider had systems in place to help ensure people who used the service received quality care and were safe from avoidable harm. However, these were not always effective because they had failed to identify the above shortfalls we found during our inspection.

• There was evidence that people were offered a range of activities and an activity plan was displayed. However, we saw that most people stayed in their room and were not aware of activities on offer because they were not informed.

• Care and support plans were comprehensive and detailed. They contained all the necessary information about the person and how they wanted their care provided. However, they did not always evidence people’s involvement in their care.

• Risk assessments were in place. These identified all risks that people faced and included guidelines for staff to follow to help ensure people were safe from harm.

• People’s healthcare needs were met because staff took appropriate action when concerns were identified.

• Medicines were safely managed. There were systems for ordering, administering and monitoring medicines. Staff received training in the administration of medicines and had their competencies checked.

• People’s end of life wishes were recorded in their care plan. This included their religious and cultural needs and where they wanted to be when they reached the end of their life.

• Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

• People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean and staff were provided with protective equipment.

• The environment was homely and bright and was suited to the individual needs of people, such as people living with the experience of dementia.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA). Where people lacked the capacity to make particular decisions about their care, their mental capacity was assessed. Where necessary, people were being deprived of their liberty lawfully.

• The provider had processes for the recording and investigation of incidents and accidents. We saw that these included actions taken and lessons learned.

• Rating at last inspection: The service was registered in 2017 and had only been inspected once before. At the last inspection the service was rated requires improvement in the key questions of ‘safe’ and ‘well led’ and overall (19 and 20 March 2018). During this inspection we found the service had not made the required improvements and remained requires improvement.

• Why we inspected: This was a planned inspection based on the previous rating.

• Improvement action we have told the provider to take: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing, person centred care and good governance. You can see what action we have asked the provider to take at the end of the full report.

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 any concerning information is received, we may inspect sooner.

The Harefield Care Home is a ‘care home’. 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.

The Harefield Care Home is registered to accommodate 40 people, however they currently accommodate a maximum of 33 people in single rooms. The service was purpose built and there are two units. Each unit has communal lounge and dining facilities and all the accommodation is on the ground floor. There were 32 people using the service at the time of our inspection. This was the first inspection of the service since it was registered under this provider in February 2017. At this inspection we have rated the service Requires Improvement in the key questions of Safe and Well-Led and overall.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 manager has been working at the service since November 2017 and had applied to CQC to become the registered manager for the service.

We found a few issues with the quality of the premises that although they had been identified, some since August 2017, had not been addressed to be made good. There were processes for auditing and monitoring the quality and safety of services people received, but in a few cases they had not always been effective in identifying shortfalls so action could be taken to make the necessary improvements.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe living at the service. Risk assessments were carried out for individuals and safe working practices were being followed. People were safeguarded from the risk of abuse and staff were confident to report concerns. Recruitment procedures were followed to ensure only suitable staff were employed at the service, There were enough staff available to meet people’s needs and where agency staff were used efforts were made to have consistent staff. Medicines were being safely managed at the service. We have made a recommendation around the disposal of medicines.

With the exception of the emergency lighting and ill-fitting doors and windows, systems and equipment were serviced at the required intervals and being maintained in working order. Processes were followed to learn from incidents and accidents and to improve practice where necessary.

People had been assessed and their needs and wishes identified prior to coming to the service. Training provided staff with the skills and knowledge to care for people effectively and further training was being planned. People’s dietary needs and preferences were identified and being met. People’s health was monitored and any concerns were reported to the GP and other relevant healthcare professionals for input.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The accommodation was appropriate to meet the needs of the people who lived there and bedrooms were personalised and homely.

People and their relatives were happy with the care people received. Staff were caring and kind and showed people respect, maintaining their privacy and dignity. Staff understood the care and support each person required and provided this in a gentle and friendly way. People’s religious needs were identified and respected.

Care records were person centred and reviewed monthly to keep them up to date. Activities were planned to meet people’s individual abilities and interests and people enjoyed taking part. There was a complaints procedure in place and was followed to address any concerns that were raised. Processes were in place for ensuring people received the end of life care they wanted and work was ongoing in this area.

The manager had been in post for five months and had applied for registration with CQC. They were approachable and staff and relatives felt confident to go to them with any matters they wished to discuss, which the manager actively encouraged. The manager was visible around the service and took time to get to know people, relatives and staff.

Apart from the shortfalls identified, the manager had responded to any areas identified for improvement and action plans to address them were clear with timescales for completion. Policies and procedures were up to date and reflected legislation and good practice guidance.

Further information is in the detailed findings in the main body of the report.