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Harbour Requires improvement

Reports


Inspection carried out on 7 February 2020

During a routine inspection

About the service

Harbour is a residential care home that provides personal care and support for up to six people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were four people living at the service.

Harbour was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People received individualised care and support from staff who knew them well. People told us they felt safe and liked living at Harbour. One person said, "I do feel safe living here now, it’s a much nicer place to live.”

We found the service had made a number of significant improvements in all areas over the twelve-month period since the last inspection, however some improvements were still required.

Quality assurance and governance systems were in place to assess, monitor, and improve the quality and safety of the services provided. However, we found the systems in place were process driven and were not undertaken robustly, and as such had not identified the issues we found at this inspection. This meant they were ineffective and did not always drive the necessary improvement.

Harbour had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published, we found it followed some of these values and principles. 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.

Whilst we did not find people were being disadvantaged, people were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe. For example, in relation to the management of homely remedies and the environment.

Other risks were well managed. For example, were risks had been identified in relation to people’s complex care and/or health needs, records demonstrated action had been taken to minimise these.

People, staff and relatives felt there were enough staff on duty to support people and keep them safe. However, we were unable to tell from the rota if there were sufficient staff on duty with the right skills to meet people's needs. We have recommended the provider reviews staffing levels.

People were protected by safe recruitment processes. Systems were in place to ensure staff were recruited safely and were suitable to be supporting people who might potentially be vulnerable by their circumstances.

People's privacy and dignity was respected, and their independence promoted. People had access to healthcare professionals when required and were supported to maintain a balanced healthy diet.

People’s medicines were stored safely and staff had received training in the safe administration of medicines and were having their competency regularly assessed.

People using the service receive planned and co-ordinated person-centred support that was focused on them having opportunities to gain new skills and become more independent.

People, relatives, staff and healthcare professionals had confidence in the registered manager and told us the service was well managed. One health car

Inspection carried out on 26 November 2018

During a routine inspection

This unannounced inspection took place on 26 and 27 November 2018. The inspection was prompted in part by the Care Quality Commission (CQC) receiving information from the provider and the local authority of a safeguarding concern. The information shared with CQC about an alleged incident indicated potential concerns about the management and staff culture within the home.

Harbour 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. Harbour is registered to provide personal care and support for up to six people who have a learning disability or autistic spectrum disorder. The home does not provide nursing care. At the time of the inspection there were six people living at the home.

The home did not have a registered manager in post at the time of the inspection. An interim manager had recently been appointed by the provider to oversee the running of the home. However, they were not present during the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered provider, 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 home is run.

The home had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published, we found it followed some of these values and principles. These values relate to people with learning disabilities living at the home being able to live an ordinary life.

Prior to our inspection an incident had occurred which raised concerns about the conduct of one staff member and the culture within the home. During this inspection we looked at the actions taken to minimise the risks of similar incidents taking place. We found the provider had not taken sufficient steps to ensure other people living at the home were protected from similar risks. There was insufficient management oversight to ensure people received the care and support they needed, in a respectful and dignified way that promoted their wellbeing and protected them from harm. Where staff displayed poor practice, this was not always known or challenged by senior staff which impacted on the culture of the home. This had led to one person not having the opportunity to access advocacy, advice and support when they had need it.

We looked at the home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided. Although some systems were working, others had not been effective, as they had not identified the concerns we found during this inspection. This meant the systems in place to manage risk could not be relied upon.

People were not always protected from the risk of avoidable harm. We found risks such as those associated with people's complex care needs, medicines and the environment had not always been assessed or managed safely. Where risks had been identified, guidance had not been provided to staff to mitigate these risks. Although systems were in place to identify and record accidents and incidents, we found staff were not consistently recording accidents and incidents or taking sufficient action to prevent future reoccurrence.

People’s needs were assessed prior to coming to live at the home. This formed the basis of a support plan, which was further developed after the person moved in and staff had gotten to know the person better. We found people were at risk of receiving care that did not meet their needs as support plans were not being regularly reviewed.

There was a staff training programme in place and staff confirmed they received regular training in a variety of topics. These included safeguardi

Inspection carried out on 1 April 2016

During a routine inspection

This inspection took place on the 1st April 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. The service was previously inspected on the 9th January 2014, when it was found to be compliant with the regulations relevant at that time.

The Harbour is a large Victorian house set within its own gardens in a residential area on the outskirts of Torquay. The service is registered to provide care and accommodation for up to six people with learning disabilities and autism.

On the day of inspection, there were two people living at the service permanently and two people receiving short term support.

The home had 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.

People told us that they felt safe and there were systems in place to help ensure people were protected from all forms of abuse. Staff had received training in how to recognise signs of harm or abuse as well as in whistleblowing, and knew where to get further information if they needed it.

The provider had developed a number of easy read documents and posters which were displayed within the home which told people how they could seek advice or raise a concern.

The registered manager ensured that there were sufficient numbers of staff on duty to keep people safe and meet their identified needs. We reviewed the staffing rota for the month prior to our inspection and found that the registered manager determined staffing levels according to people’s needs and adjusted the rota accordingly. Recruitment procedures were robust and records demonstrated that the registered manager carried out robust checks to help ensure staff employed were suitable to work with vulnerable people. This included checking people’s identity, obtaining references and carrying out DBS checks (police checks).

Staff training records demonstrated that staff had undertaken a comprehensive induction and received regular training. This included training in medication, first aid, autism, mental health, communication, Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DoLS), breakaway techniques, de-escalation techniques; person centred planning and safeguarding of vulnerable adults. Staff received regular supervisions and annual appraisals. Supervision gave staff the opportunity to sit down with their manager and discuss all aspects of their role as well as the opportunity to discuss their professional development.

People were supported by staff who had a good understanding of their needs and were skilled in delivering individualised care and support. Support workers spoke about people knowledgeably and demonstrated during our conversations a clear understanding of people’s needs and preferences.

Harbour provided services to people with multiple complex needs. There were safe systems in place to assess and manage risk within the service. Risks to people’s safety, health and wellbeing were individually assessed and regularly reviewed. People’s support plans included detailed risk assessments with clear guidance for staff on the action they should take to protect people from identified risks. Where appropriate, prompt referrals had been made to health care professionals to ensure the service continued to meet people’s needs safely. Keyworkers reviewed people’s support plans monthly, and recorded the person’s comments, which included details of progress, challenges and any changes in their support needs.

People received their prescribed medicines on time and in a safe way. There was a system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. The service used a m

Inspection carried out on 9 January 2014

During a routine inspection

Three people were living at Harbour during our inspection. During this inspection we observed engagement and interaction between support workers and people who live at the home. We saw that support workers were kind and considerate in their approach to each person and were sensitive to the needs of people.

We found that people's consent had been obtained for care and treatment provided to them by the service. Records showed that people had regular opportunities to be involved in and discuss how they wished to have their care provided. Where people did not have the capacity to make significant decisions their rights had been protected.

People's health and social care needs had been assessed and care was planned and delivered in line with their individual care plan. People had access to community and specialist health services.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. However, the system was not being followed by all support staff.

People were cared for by suitably qualified, skilled and experienced staff.

People who live at the home were aware of how to make it known to support staff if they were unhappy.

Inspection carried out on 18 March 2013

During a routine inspection

Three people were living at Harbour during our inspection and one person was staying on respite care. People told us that support workers were respectful to them. One person said "They are kind." and another said, "Yes, they talk to me OK, yes". We also observed that support workers spoke at each person's pace. People told us they liked living at Harbour. One person said, "I like it here, I like my room."

We found that people's privacy was protected. Information was provided to people in suitable formats. Records showed that people had regular opportunities to be involved in and discuss their care.

People made choices about everyday living, such as what to eat, what to wear and which activities they took part in. Where people did not have the capacity to make significant decisions their rights were protected.

People's needs were assessed and care was planned and delivered in line with their individual care plan. People had access to community and specialist health services. Records showed and people told us that they had made progress at Harbour such as learning new skills. One person told us they would be moving on to live in a flat.

There were effective recruitment procedures and sufficient trained staff were employed to meet people's needs.

People told us they felt safe. The provider had effective systems to prevent, identify or respond to abuse.

The provider had effective quality assurance systems in place which took into account people's views.