Harvey House

Harvey House is a residential care home providing accommodation and personal care to up to 44 people. At the time of our inspection there were 40 people using the service.

The service provides support to older people, some of whom are living with dementia, or have mental health needs, physical disabilities, and/or sensory impairment.

The service is also registered to support younger people and people with a learning disability but was not providing support to people in these categories at the time of our inspection. The registered manager said that if they did, proper arrangements would be put in place to ensure people’s needs were met.

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

People were happy with the care they received and felt safe at Harvey House. Relatives praised the registered manager and staff and said they would recommend the service with many giving it ‘10 out of 10’ for quality. A relative said, “The [staff] I’ve met are brilliant, the care is great.”

The service had a friendly, calm atmosphere. Staff continually interacted with people and engaged them in activities. A relative said, “The staff are never sitting around, they’re always doing something, they speak beautifully to the residents." The service was well-staffed and although staff were busy, they ensured people’s care and support needs were met promptly.

The premises were being upgraded at the time of our inspection to ensure the environment was homely and personalised throughout. The registered manager said the service had an on-going refurbishment plan and the provider was committed to ensuring the quality of the premises continued to improve.

Staff followed care plans and risk assessments which were up to date and regularly reviewed. People were supported to take their medicines safely as prescribed and to access healthcare services to monitor and maintain their health and well-being. Staff encouraged people to maintain a healthy diet and if people had specific dietary requirements these were catered for.

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.

Staff and relative spoke highly of the registered manager who they said was approachable, helpful, and kind. A staff member said, “[Registered manager] is the heart of this home. She is 100% committed to our residents and fantastically supportive of the staff.”

The operations manager and registered manager monitored all areas of the service to ensure it was running safely and effectively. People, relatives, and staff were listened to and encouraged to share their views on the service with changes and improvements made where necessary.

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

Rating at last inspection

The last rating for this service was good (published 5 October 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service and when the service was last inspected.

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.

This was a focused inspection, and the report only covers our findings in relation to the Key Questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

Harvey House is a residential care home providing accommodation and personal care to 41 people aged 65 and over at the time of the inspection. The service can support up to 44 people accommodated over two floors.

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

The provider had quality control systems in place, however these were not always effective in driving the required improvements. Action plans were not always effective as the provider failed to assign the resources required to maintain the environment to an acceptable level.

People felt safe and staff understood their responsibilities to protect people from abuse and avoidable harm. Risks were assessed and managed and lessons were learnt when things went wrong. Staff were recruited in a safe way and there were enough staff to meet people's needs. People received their medicines in a safe way.

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, staff and relatives said managers were supportive, accessible and approachable. People had their needs assessed and staff considered their protected characteristics under the Equality Act to make sure these could be met. Staff knew people well and communicated with people effectively and provided person centred care and support.

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 (6 October 2021) and there were breaches of regulation. The provider completed an action plan after the last 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.

Why we inspected

We carried out an unannounced inspection of this service on 9 August 2021 and 1 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment of people and good governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harvey House 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.

Harvey House is a residential care home providing accommodation and personal care to 40 people aged 65 and over at the time of the inspection. The service can support up to 44 people accommodated over two floors.

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

The provider had quality control systems in place, however these were not robust enough to ensure the quality and safety of the service was maintained.

Risk was not always safely managed. As a result, people were left at increased risk of contracting and transmitting COVID-19 due to poor practice around safe entry to the service for visitors and staff.

Environmental safety concerns were found in people’s bedrooms. Wardrobes were not fixed to walls and topical creams had been left in people’s bedrooms. This increased the risk of harm to people.

There were not always enough skilled and experienced staff to meet people’s needs, particularly at night-time and at weekends. Permanent staff were adequately trained and had regular competency checks, however assurances were not provided agency staff had undertaken all relevant training to carry out their roles safely.

The provider did not always learn lessons when things went wrong. Audits had identified issues but effective action plans were not always developed and did not always result in improvements being made.

People’s relatives were not always involved in developing and reviewing their family member’s care.

People’s relatives and staff provided mixed feedback about the support provided by the management team and the quality of communication.

People were supported by staff who had been recruited safely and who were caring, respectful and knew people well. Staff demonstrated a good understanding of safeguarding and the signs of abuse and were able to describe how and who to report concerns to.

People were supported to receive their medicines when they needed them by staff who had received appropriate training in administering medicines.

Accidents and incidents were documented and reported on appropriately, with trends and themes being identified to prevent risk of re-occurrence.

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.

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

Rating at last inspection

The last rating for this service was good (published 5 April 2018).

Why we inspected

We received concerns in relation to how incidents between service users were managed, recurrent falls, allegations of neglect and lack of COVID-19 testing for visitors. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harvey House 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 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 breaches in relation to infection prevention and control, the environment and governance at this inspection. We issued the provider with warning notices relating to the safety of the service and the governance arrangements in place. Please see the actions we have told the provider to take at the end of the report.

Follow up

We will request an action plan from the provider to understand what they will do to improve 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.

At the last inspection on 30 December 2015 the service was rated Good. At this inspection the service remained Good.

The service 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.

There were enough staff on duty to meet people needs. Staff responded promptly when people requested support from them. We saw that staff were deployed effectively to meet people's needs in a timely manner. We also found that the provider had safe recruitment practices. This assured them that staff were safe to support people before they commenced their employment with the service.

People's medicines were managed in a safe manner. They were supported to have their medicines as prescribed by their doctor. There was sufficient stock of medicines that people required. Medicines were only administered by staff who were suitably trained to complete this task.

People were safe at the service because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to use the provider's policies to report any concerns that they had about people's welfare.

Staff had the skills and experience to support people effectively. They had access to an induction when they started their role and had regular training to maintain their skills and knowledge.

The provider had plans to make improvements in the environment to ensure people had access to the garden as well as the communal areas.

People were supported in accordance with relevant legislation and guidance. Staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People's liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this.

People received sufficient nutrition and hydration. They had access to a variety of meals, snacks and drinks. There were plans to improve the variety and quality of the meals provided.

People's health needs were met. This was because staff supported them to access health care professionals promptly. Staff also worked with other professionals to monitor and meet people's needs and support them to remain well. Where people were at the end of their life staff supported them to remain comfortable and free from pain.

Staff treated people with kindness and compassion, providing care with dignity and respect. People, their relatives and friends spoke positively about the caring attitudes of staff. The registered manager created a culture which promoted kindness and openness.

People had access to a variety of activities of their choice. This included group activities and spending individual time with staff. They were also support to maintain contact and spend quality time with their friends and family.

The provider had systems in place to obtain feedback about the service. The registered manager looked at different methods to ensure relatives and friends were able to make comments about the service.

People, their relatives and friends were confident that the service was well-managed. Staff felt supported by the registered manager to meet the standard expected of them. The registered manager was approachable.

The provider had systems in place to monitor the quality of the service. We saw that they used this to drive continuous improvement in the service.

Harvey House is a residential care home for up to 42 older people. living with dementia, mental health needs and physical disability. Accommodation is on two floors. Communal areas include a dining room, a large lounge, three smaller lounges and `tea room’ where people may entertain their visitors. At the time of our inspection 38 people were using the service.

Harvey House has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People using the service were protected from abuse and avoidable harm. Staff understood and practised their responsibilities to keep people safe without restricting their independence. People’s care plans included risk assessments of routines associated with their personal care and support and included guidance for staff about how to safely support people without restricted their independence.

The provider had recruitment procedures that aimed to ensure that only staff suitable to work at the service were employed. Enough staff were deployed to meet the needs of the people using the service.

People were supported to receive their medicine at the right times. Only staff trained in medicines management supported people with their medicines. Medicines were securely stored and there were safe arrangements for the disposal of medicines that were no longer required.

People were supported by staff who had the relevant training to understand their needs. Staff were supported through induction, training and supervision.

The manager had a working knowledge of the Mental Capacity Act 2005. Staff had awareness of the Act. They understood that care and support could only be provided if a person have their consent, unless a person lacked mental capacity in which case decisions were made in a person’s best interests.

People were supported with their nutritional needs. They had a choice of nutritious meals. People with special nutritional requirements were appropriately supported. People were supported to access health services when they needed them.

Staff developed caring and understanding relationships with people using the service. People or their relatives were involved in decisions about their care. Staff supported people’s privacy and dignity.

People or their relatives contributed to the assessments of their needs. People’s needs were regularly reviewed. People were supported to maintain their hobbies and interests and had access to a range of stimulating and meaningful activities.

People’s care and support was based on the individual needs. Their preference, likes and dislikes were taken into account.

People and their relatives knew how they could raise concerns. They were confident that any concerns they raised would be acted upon.

People using the service, their relatives and staff had opportunities to be involved in developing the service. Their feedback was acted upon. People and their relatives knew who the registered manager was and they told us the registered manager was approachable.

The registered manager regularly monitored the quality of the service. The registered manager also carried out monitoring activity and supported them. Monitoring activity, which included seeking people’s feedback, was used to identify areas where the service could be improved.

Below is a summary of what we found. The summary is based on our observations of over 20 people during the inspection, speaking with three people who used the service, relatives of another person who used the service, speaking with staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the home. One person told us, "I feel safe. I'd tell someone in the office if there was anything I wasn't happy about." Another person told us, "I'm safe here." A relative of another person told us, "I'm happy my father is here."

We saw that staff responded promptly when people called for assistance, including when they used call alarms. The service had an electronic system for monitoring response times to call alarms. This confirmed that staff responded promptly to call alarms.

We that staff treated people with dignity and respect and as individuals. Staff spoke politely to people and offered encouragement when they supported them. Staff offered people choices of meals at lunch-time and provided alternatives if people wanted.

Staff we spoke with knew the forms of abuse recognised in the Health and Social Care Act 2010. Staff knew how to identify and report concerns about people's safety internally within the home and with the relevant outside agencies.

Before our inspection, allegations of abuse were investigated by the local authority social services. The provider had suspended making new admissions to the home pending the outcome of social service's investigations. Fresh allegations were received after our inspection.

Senior staff we spoke with were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. The manager and a director of the service had booked to attend MCA and DoLS training on 14 July 2014.

We saw that people's bedrooms, communal areas, bathrooms and shower rooms were clean and tidy. A relative told us, "It's very clean here. It always smells nice."

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans we looked at included details of people's needs and information about how they were supported with their needs. Care workers made daily notes about how they had supported people. We found from looking at those notes that care workers had supported people in line with their care plans. Care workers we spoke with told us that they regularly referred to people's care plans. The care plans were in the process of being redesigned. At the time of our inspection just over half of the care plans had been redesigned. Care workers we spoke with told us that they found parts of the new design complicated but were getting used to it.

People who used the service told us that they had been well cared for and supported. One person told us, "It's very good here. I'm well looked after. I'd jump on them if not." Other people expressed to us that they felt well cared for. We saw from care records that people's health and well-being had been monitored and that personal care routines had been competed.

Relatives told us they were able to visit the home at times they wanted. They told us they were able to join in with activities and meal times. We saw from the visitors' book that several relatives visited the home at different times of the day. The local authority social services had challenged the provider's decision to place restrictions on one relative's visiting times.

We found from the evidence we gathered that the service had effectively planned and delivered care that met people's needs.

Is the service caring?

People told us they were well cared for. One person told us, "I'm well looked after. Nobody jumps on us. It's easy going. I can do what I want. I'm independent." Another person said, "I can do anything I want." A relative told us, "They [staff] are all very friendly."

We observed nearly 30 people having their lunch in the dining room. We saw that staff spoke to people courteously and offered people choices of three meals. Staff offered and provided alternative meals to people who did not want one of the three meals offered. Staff supported people who required help with eating their meal. We found that staff contributed to the lunch period being a pleasant experience for people.

Most staff referred to people by their preferred name. Staff were attentive to people's needs. We heard one person say, "I don't know what I should be doing" and staff respond "What would you like to do?" Staff the sat with the person and engaged in meaningful and stimulating conversation. We found that staff and people who used the service had a good rapport.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches. People took part in social activities that involved other people and had also been supported to enjoy activities that were of particular interest to them. We found that the provider was further developing a range of activities for people with dementia.

We found that the staff understood people's individual needs and had supported people with those needs in a caring way.

Is the service responsive?

People told us they were well looked after. Records we looked at showed that people had been supported with their personal care needs. People told us that they knew how they could make suggestions or raise concerns. A person who used the service told us, "I would tell someone in the office if there was anything I wasn't happy about."

We saw that the service had responded to changes in people's needs. People's care plans had been updated to show how their needs had changed. We saw in one care plan we looked at a person's care and support routines had been modified to help them improve their walking skills and be more independent. That person told us, "I can do what I want. I'm independent."

We found that the service had been responsive to people's on-going and changing needs.

Is the service well-led?

The provider had a system for monitoring the quality of service. This included checks of documentation and records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The manager regularly sought the views of people who used the service and their relatives. That had been through one to one discussions with people and reviews of people's care plans. We were told that a satisfaction survey to obtain people's views was being planned.

We looked at five care records and found they all included detailed care needs assessments, risk assessments and plans for managing the identified risks. One member of staff told us:' I am a key worker and I always meet with the people I care for and their families. We discuss the care needs and make amendments as necessary'.

Each care record we reviewed included a personalised care and support plan. One person told us:' Some body came to see me before I came here and explained everything to me. I also had a choice of room'. Another person explained that some of the care workers do go through their care plan with them

The care records we reviewed did contain some risk assessments relating to people's individual care needs, but we found there were inconsistencies in the documentation of risk assessments. None of the risk assessments were completed in one of the care records we reviewed.

All the care records we reviewed contained a safeguarding risk assessment, which covered all the types of abuse and all the people we spoke with told us they felt safe.

We randomly looked at three days within the month of March and confirmed that the number of staff on all shifts matched the staffing level standards. We also reviewed three staff files and noted that a new member of staff had not had their induction programme completed.

The manager explained an hourly walk round of the premises was conducted by a senior member of staff. The walk round consisted of observational checks on personal care, staff interaction, activities, general atmosphere and the environment.