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Inspection carried out on 4 July 2017

During a routine inspection

Harmony House is registered to provide accommodation for people who require nursing or personal care to a maximum of 37 people. At the time of inspection 28 people were using the service. Support is provided to younger adults with mental health needs and older adults who live with dementia or a learning disability. Nursing care is not provided and any needs in relation to nursing care are met by the local community nursing services.

At the last inspection in April 2015 we had rated the service as Good. At this inspection we found the service remained Good and met each of the fundamental standards we inspected.

People said they were safe and staff were kind and approachable. There were sufficient staff to provide safe and individual care to people. We considered more ancillary hours were needed to maintain the cleanliness of the building. This has been addressed and ancillary hours have been increased.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. People were able to make choices where they were able about aspects of their daily lives. We advised people's decision making could be further encouraged with the use of visual prompts where they no longer responded to verbal prompts. People did not always receive a varied and balanced diet to meet peoples’ nutritional needs. This has been addressed and new menus have been devised with people.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

Risk assessments were in place and they accurately identified current risks to the person. People’s privacy and dignity were respected. Records were in place that reflected the care that staff provided. People said staff were kind, patient and caring. Activities and entertainment were available for people.

There was a good standard of record keeping to help ensure people received person centred care. Communication was effective amongst staff but we considered a written handover would assist in ensuring people's health and well-being were appropriately monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff and people said the management team were approachable. They were positive about the changes that were being made within the home. Communication was effective to ensure staff and people were kept up to date about any changes in the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.

People had the opportunity to give their views about the service. They were supported to maintain some control in their lives. There was consultation with people and staff and their views were used to improve the service. People had access to an advocate if required.

Further information is in the detailed findings below.

Inspection carried out on 30 April and 1 May 2015

During a routine inspection

This inspection took place on 30 April 2015 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 1 May 2015 and was announced. We last inspected the service on 7 May 2013 and found the provider was meeting all legal requirements we inspected against.

Harmony House is a care home managed by Pathways Care Group Limited and is registered to provide accommodation for people who require nursing or personal care. Any needs in relation to nursing care are met by the local community nursing services.

The service has two wings, one supporting people with mental health needs called Harmony; the other wing, South View, supports older people living with dementia or a learning disability. All rooms on South View are on the ground floor. The service is set in a mainly residential area with good access to shops and local amenities. A maximum of 37 people can live there and it has good access both into and outside of the property.

There was a registered manager in post at the time of the inspection however they work at a regional level within the organisation. There was a manager based at Harmony House who had responsibility for the day to day management of the service. They told us they were in the process of registering as a 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.

10 people were living in South View and 14 in Harmony at the time of the inspection.

People told us they felt safe living at the service and were well looked after. Staff had attended training in safeguarding vulnerable adults and were able to explain the procedures they would follow if they felt someone was at risk of harm. There was also information on display around the service on how to safeguard people and who to contact. Senior care staff explained that they would raise concerns with the safeguarding team from the local authority if the manager was not available to do so for any reason.

Accidents and incidents were appropriately recorded and the information was analysed to identify any trends or to identify where changes to peoples care may be needed.

Risk assessments were in place which identified relevant risks and how they should be managed. Area’s where people did not need staff support were recorded and we observed staff respected this and gave people the time they needed to maintain their independence. Staff were seen to explain to people what they were doing and why so people were actively involved in the support they received and understood what was happening and why.

Each person had a plan in place for if they went missing from the service which was specific to their needs. Personal emergency evacuation plans were also in place and staff knew how to evacuate the building both during the day and at night. These procedures were different due to the different staffing levels at night. A business continuity plan was in place in case there were emergencies in relation to the building, utilities, staffing crisis or extreme weather conditions.

There was a fire risk assessment and building plan alongside all appropriate checks of fire alerting and firefighting equipment. A range of health and safety risk assessments were in place which identified risks in relation to building safety and security, maintenance, control of substances hazardous to health (COSHH). These documents had all been reviewed appropriately and future review dates had been set.

People and staff told us they were able to meet people’s needs with the current staffing levels. We saw that staffing levels had increased when new people had recently moved to the service. There had been appropriate recruitment which included pre-employment checks such as obtaining at least two references and completing a Disclosure and Barring Service check.

Medicines were managed safely and effectively. Care plans were in place for medicine administration and protocols for ‘as and when required’ medicines had been developed. Senior staff administered medicines and had been trained and competency checked. Regular audits of medicines took place and the senior care staff spoke to each other regularly about ordering and booking in medicines together so everything could be double checked.

Staff told us they were well trained and supported with regular supervisions and an annual appraisal. We saw a training matrix which had been completed in August 2014 which showed that some training was out of date and needed to be refreshed. We spoke with the manager about this who was able to show us the electronic system whereby staff were completing eLearning. This system showed that staff had completed the necessary training.

Team meetings were held regularly and the timing of these had been changed so day staff and night staff could have a meeting together.

The manager and the staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and appropriate applications had been made and authorised in relation to Deprivation of Liberty Safeguards (DoLS). Staff were able to explain the restrictions that authorised DoLS placed on people and how this impacted on the care they received.

People had been involved in planning their care and where they were able to do they had signed their care records and risk assessments. People had also given consent for staff to manage their medicines on their behalf and for photographs to be taken for identification purposes or to display around the service.

People said they enjoyed the food and there were different options for people to choose from. The chef had a good understanding of people’s specific dietary requirements and prepared one person’s food separate to everyone else’s as they chose to have a vegan diet.

Nutrition and hydration care plans and risk assessments were in place and where referrals had been made to dietitians and speech and language therapy in order to ensure people’s individual needs could be met.

Appointments and visits from health care professionals were recorded appropriately and this included contact with district nurses, opticians, chiropodists as well as doctors and community psychiatric nurses.

People had hospital passports which could be used as ‘grab packs’ containing vital information for medical staff should someone need to attend hospital as an emergency.

We observed that staff had positive and meaningful relationships with people based on kindness and respect. Staff were unrushed and were seen to spend time with people chatting or holding their hands to offer reassurance and company. Staff were very aware of people’s right to confidentiality and treated them with respect, maintaining their dignity at all times by offering support in a discrete and compassionate way.

Care records were personalised and included information on people’s life story and their background, as well as their current likes and dislikes, preferences and wishes. Documents supported staff to maintain people’s independence and recognised that there were area’s where people did not need staff support.

People told us there were activities available but also said, “The staff teach me new stuff.” We saw photographs of group outings and events displayed around the service and staff were enthusiastic about fund raising so people could enjoy trips to the theatre or similar events. Staff supported people to maintain contact with their family and friends and we saw that one person had requested staff support them to send cards to their family on special occasions.

Pictorial information on how to complain was available throughout the service and we saw that complaints had been recorded and acted on appropriately with letters of apology sent to complainants as well as the results and outcomes of investigations.

An annual quality assurance questionnaire had been sent out to families, professionals and staff. The results of which were all positive with everyone believing a good service was provided. Staff felt it was a good place to work and they said they were well supported by the manager.

Audits were completed by the senior care staff, the manager and the area manager. We saw that action plans were in place and identified areas for improvement however they were not always signed off as complete. We spoke to the manager about this as we had seen that many actions had been completed, such as a new boiler being installed. The manager said for things that hadn’t been done they kept reporting them and spoke to the area manager about it on their visits. They stated they would sign things off as complete when work was finished so there was an audit trail of actions completed.

Inspection carried out on 7 May 2013

During a routine inspection

A resident we spoke with confirmed he was satisfied with the care he received and had no concerns. People said they liked the manager and the care staff always made them feel at ease. No one we spoke with had needed to use the complaint process. There were regular checks and audits in place as well as consultations with people living at the home to ask if they were happy with the service. Care records were up to date and showed people had been involved in their development. People told us; "everything is provided for" and "the staff are good and friendly".