Harborne Lane Nursing Home

About the service

Harborne Lane Nursing Home (also known as Harborne Lane Specialist Centre) is a care home providing personal and nursing care to 41 people, some living with dementia at the time of the inspection. The service is registered 68 people.

Harborne Lane Nursing Home is a purpose built, specially adapted home across three units over three floors, Birch, Oak and Willow. All rooms are en-suite. One of the units specialises in providing support and care for people living with dementia.

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

Since the last inspection there have been some changes to the management of the service and restructuring of its processes. We found overall there had been an improvement to the systems in place to monitor the quality within the home. However, there was room for further improvement. The feedback we received from families was consistent, happy with the care given, the cleanliness of the service, staff levels and attitude. The common area identified as an improvement was around communications and visibility of the new management team.

People were protected from abuse and relatives we spoke with were assured the home environment was safe for their family members to live in. Staff knew how to report any suspicions of abuse. Risks to people were reviewed every month and supported to remain as safe as possible. On the day of inspection, there were enough staff employed to meet people's needs and there were recruitment procedures in place to check staff were safe to work with people. People were supported to take their medicines in a safe manner. There were no issues with the recording and storage of medicines. We were assured the provider had safe infection prevention and control procedures in place, including in relation to the management of COVID-19. The home environment was very clean, tidy and no clutter. Incidents and accidents had been reported appropriately and reviewed for any trends to mitigate future risk.

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 requires improvement (published 06 February 2020).

Why we inspected

This was a planned inspection based on the previous rating. We undertook a focused inspection to review the key questions of safe and well-led only.

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 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 Harborne Lane Specialist Centre on our website at www.cqc.org.uk.

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.

Harborne Lane Specialist Centre is a care home registered to provide personal and nursing care for up to 68 people living in one purpose-built building, divided into three separate units. The home accommodates people living with dementia at different stages in its progression and people living with a range of complex health care needs that included those diagnosed with a brain injury, stroke, Parkinson’s disease and diabetes. At the time of our inspection, there were 35 people living at the home and one unit, on the first floor, was not in use.

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

Since the previous inspection in July 2019, there had been further changes to the management of the home. The current management team had only been in place for just over four months and we could see they had implemented changes and were working hard to address the concerns we had identified at our last three inspections.

The provider’s governance systems to monitor the delivery and quality of the service provided for people had improved. However, some concerns identified on the inspection had not been recognised by the management. Additionally, there were some inconsistencies in documentation. The provider must ensure they sustain those improvements alongside the ongoing work currently being completed, to embed and sustain these improvements for the home to achieve a good rating.

People said they felt safe and appeared comfortable around staff. Their relatives told us they felt their family members were safe. Staff understood how to recognise the signs of abuse and knew the processes to follow to manage any allegations of abuse.

Assessments had been completed to ensure the service could protect people from risks associated with

their care. Where issues were found during the inspection, the management team was responsive and took

immediate action to mitigate these. Systems managing the administration of medicines had improved although there was further improvement required.

Staff spoke positively about the improvements they had experienced with the training provided. There was some improvement to be made to ensure monitoring checks relating to staff competencies were consistently recorded. There were enough staff on duty to meet people's needs. Staff were recruited in a safe way.

People were supported to access external healthcare professionals to maintain their health and wellbeing. People were supported to have enough to eat and drink and appropriate referrals had been made to healthcare professionals where people had specific dietary needs.

Staff knew 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 were cared for by kind and caring staff and treated in a respectful way and their privacy and dignity was maintained. People were supported to retain their skills and their independence as much as practicably possible and supported to make decisions about their care.

Staff were responsive to ensure people’s needs were being met. There was work currently ongoing to the improvements being made to the home environment, to try and make it more dementia friendly and present information to people in a way they would be able to understand it. People were provided with support with their emotional and social needs. There had been improvements made to the provider’s complaints process. Where concerns had been raised, these had been investigated appropriately. People were supported to plan for and receive appropriate end of life care. There were systems in place for people and relatives to give their feedback on the service.

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 31 August 2019) and there were breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service has improved but remains rated requires improvement overall. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harborne Lane Specialist Centre on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Harborne Lane Specialist Centre is a care home registered to provide personal and nursing care for up to 68 people living in one purpose-built building, divided into three separate units. Two units accommodate people living with varying stages of dementia. There were also people living with a range of complex health care needs that included those who have been diagnosed with a brain injury, stroke, Parkinson’s disease and diabetes. At the time of our inspection, there were 41 people living at the home.

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

Since the previous inspection in June 2018, there had been changes in the management of the home. We could see that the current management team were working hard to address the concerns we identified at our last two inspections. Further development was required to ensure people were assured of consistently receiving safe, effective care and treatment. During this inspection we found that the registered provider was in breach of regulations in relation to safe care and treatment, governance and record keeping.

Oversight and auditing of the service needed to improve as issues we found had not been identified or addressed by the provider. We did find some improvement in the governance within the service which meant some shortfalls were being identified. However, there was further work to be done to embed and sustain these improvements for the service to achieve a good rating. This included making sure people were receiving their medicines safely or as prescribed. The nominated individual acknowledged some improvements were needed and was committed to making these happen.

On the first day of our visit there was insufficient numbers of staff on duty to make sure people remained safe. The provider brought in additional staff and the situation had improved on the second day of our visit.

At our inspection in February 2018, we made a recommendation to the registered provider to ensure the service was adapted to meet the needs of people living with dementia. Although there had been some improvement, further improvement was required.

Plans to manage risks to people were in place to ensure they received appropriate care and treatment. The provider was working with two systems, one electronic and one paper based. Therefore, people's care records varied; some provided detailed up-to date information about people’s needs, whereas others did not. People lived in an environment that was cleaned to a satisfactory standard.

People were supported by staff who were kind and caring but this was not a consistent approach from all staff. Some staff promoted people’s independence as much as practicably possible. Staff were aware of people's privacy and dignity.

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.

There was a complaints process in place and people and relatives knew how to raise a complaint. Some people were supported to take part in a variety of activities but the activity provision did not meet everyone’s needs. People's needs were assessed and responded to. There were end of life care plans in place for people in the event of their health deteriorating.

Staff understood how to recognise the signs of abuse and knew the processes to follow to manage any allegations of abuse. Recruitment processes were adequate to employ staff although there was room for some improvement to ensure staff were suitable to work in the home.

Staff training was planned. All staff completed training and felt they had the skills to care for people, although some staff said they would benefit from additional training in managing behaviours that challenge. People's dietary needs were assessed and food provided was tailored to their individual needs.

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 comprehensive rating for this service was requires improvement (published 05 July 2018) and there were breaches of regulations. Conditions were imposed on the provider’s registration to submit a monthly report to us documenting action taken to improve and sustain the improvements to the service. A focused inspection was conducted in June 2018 and the rating for the service remained requires improvement (published 25 August 2018). At this inspection we found there had been some improvements made but not sustained and the provider has remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This was a planned inspection based on the previous rating. However, the inspection had been brought forward due to concerns received about:

Staffing numbers

Assessing and managing risk

Medicine administration

Infection control

Staff training

A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led question sections of this full report.

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

In response to our findings, the provider has taken the following action:

Implemented clearer staff rotas and maintained consistency of staff to unit ratio. Introduced floating support staff member with the flexibility to work between units according to the dependency needs of people. Continuing with the recruitment programme.

The new clinical lead has taken responsibility for managing and monitoring medication processes.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harborne Lane Specialist Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the way medicines are managed and the provider’s record keeping and auditing processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

We carried out a responsive, comprehensive, unannounced inspection of this service on 20 and 26 February 2018. Breaches of legal requirements were found. After the comprehensive inspection, we received further concerns in relation to:-

• Unsafe medicines management

• Protecting people from avoidable risk of harm ie falls

• Allegations of neglect

• Staff shortages and high use of agency staff

As a result, we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harborne Lane Specialist Centre on our website at www.cqc.org.uk

Harborne Lane Specialist Centre 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.

Harborne Lane Specialist Centre is registered to accommodate 68 people in one adapted, four storey building. There are three independent units. The ground floor, known as Oak, contained 18 bedrooms to provide a service to people with complex nursing needs. The first floor, known as Willow and the second floor, known as Birch both with 25 bedrooms on each and provided a service to people primarily living with dementia. The home has a range of communal spaces including lounges, dining areas, quiet areas and a large landscaped garden. All the bedrooms are single occupancy with en-suite facilities. There were 49 people living at the home at the time of our inspection. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities, including those living with dementia, learning disability and mental health difficulties.

Since the last inspection, the registered manager had left their employment. There was a new manager in post who told us they intended to apply to become the new registered manager. The 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.

Systems in place to monitor and improve the quality of the service were not always effective in ensuring people received a good quality of service. Where there were audits, they had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Improvement was required with the monitoring and recording of incidents to ensure people were protected from risk of avoidable harm. Where risks were identified, we found that staff were not always following the guidance to minimise that risk. Staff understanding and training on how to support people whose behaviours may be challenging required improvement.

People told us they felt safe and staff understood their roles in safeguarding people from abuse. There were sufficient numbers of staff present to meet people's needs. Checks had been undertaken on new staff as well as agency staff to ensure they were suitable for their roles. There were improved processes in place to ensure medicines were safely stored and administered to people. People were protected from the risk of infection.

Harborne Lane Specialist Centre 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.

Harborne Lane Specialist Centre is registered to accommodate 68 people in one adapted, four storey building. There are three independent units. The ground floor with 18 bedrooms to provide a service to people with complex nursing needs. The first and second floors both with 25 bedrooms on each, to provide a service to people primarily living with dementia. The home has a range of communal spaces including lounges, dining areas, quiet areas and a large landscaped garden. All the bedrooms are single occupancy with en-suite facilities. There were 39 people living at the home at the time of our inspection on the 20 February and this number had increased to 41 people on the 26 February. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities, including those living with dementia, learning disability and mental health difficulties.

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.

Systems in place to monitor and improve the quality of the service were not always effective in ensuring people received a good quality of service. Where there were audits, they had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Where risks were identified, we found that staff were not always provided with the relevant information in people’s risk assessments to keep people safe. There were sufficient numbers of staff present to meet people's needs. However, we observed that where people required one to one support, as a part of their care plan, staff were not always able to provide this due to being busy elsewhere.

People's medicines were not always managed safely. We found shortfalls in the way that medicines were stored and monitored. Nursing staff did not consistently receive the clinical supervision that they needed and there was a lack of oversight from the provider.

Checks had been undertaken on new staff as well as agency staff to ensure they were suitable for their roles. Staff understood their roles in safeguarding people from abuse, but possible safeguarding issues had not been reported to the appropriate authorities. Where complaints or concerns were raised, the provider responded to them. However, there was no analysis of complaints to identify and monitor for trends to reduce the risk of reoccurrences.

Although there was a contingency plan in place in the event of an emergency, we had identified some issues with the placement of some fire-fighting equipment. We made a referral to the fire service to review the fire procedures and equipment for the service.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Where people lacked the mental capacity to make informed decisions about their care, it was not always clear how relatives, friends and relevant professionals were involved in best interest's decision making. Mental capacity assessments and best interests decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Some applications had been submitted to deprive people of their liberty, in their best interests; however, we found applications were not always submitted in a timely manner.

Most people spoke positively about the choice of food available and people who were on food supplements received them. People were offered a choice of foods that reflected their dietary needs. We saw evidence that people were being supported to access healthcare professionals when required. Relatives told us the communication from the management team had improved at keeping them informed about their family member’s care.

People received care and support from staff that had received training but their working practices and knowledge demonstrated that the training provided was not always effective and required improvement. Staff received supervision and appraisals and they felt supported to carry out their roles.

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

Some care plans contained person centred information, but we also found personal information was incorrect or missing in their care plans. This meant people did not always receive person-centred care. People told us that they often felt bored. We observed some activities taking place and saw evidence of some good practice in this area.