We carried out a review of the data available to us about Harmony House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Harmony House, you can give feedback on this service.
Harmony House is a care home that provides personal care for up to 37 people on two separate units. One unit provides support to people with mental health needs and the other unit provides support to older people who live with dementia or have a learning disability. At the time of the inspection there were 34 people living in the home.
People’s experience of using this service and what we found
People were safe living in the home. People happily interacted with staff and other people in communal areas around the home. Staff supported people’s social and emotional wellbeing. People were supported to keep in touch with their family members via video or telephone calls as well as window visits.
Fire risks in the home were regularly assessed and actioned to keep people safe. People’s fire safety risks were regularly assessed and Personal Emergency Evacuation Plans (PEEPs) were in place and regularly reviewed to ensure they reflected people’s needs in the event of a fire.
Systems were in place to help prevent people, staff and visitors from catching or spreading infection. The environment was clean. Additional cleaning was taking place around the home, including of frequently touched surfaces. Staff had undertaken training in Infection prevention and control as well as putting on and taking off PPE. There was appropriate guidance on display around the home for staff to refer to.
There was sufficient personal protective equipment (PPE) such as masks, aprons, gloves and visors. The registered manager and deputy manager carried out weekly stock checks to ensure the home always had maximum levels of PPE.
People and staff were taking part in the COVID-19 regular testing programme.
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 March 2020).
Why we inspected
We undertook this targeted inspection to check whether action had been taken following our last inspection, when we made a recommendation relating to fire safety. We also looked at infection prevention and control measures. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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. Please see the Safe section of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harmony House 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.
Harmony House is a care home providing personal care to 33 people aged under and over 65 years. One part of the service provides care to 22 people with mental health needs and another part of the service provides care to 11 people with learning disabilities or associated conditions. The service can support up to 37 people.
People’s experience of using this service and what we found
The service applied the full range of principles and values of Registering the Right Support and other best practice guidance apart from with regard to the size of accommodation. This was because 11 people lived in together in one part of the service, which was larger than current best practice. This ensured people who used the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People received planned and co-ordinated individual support that was appropriate for them.
The home was a large, three storey building. Areas of the building were showing signs of wear and tear. Most risks to people’s safety including any environmental risks were well-managed. Where improvements to manage any risk and the environment were identified at inspection, the provider sent an action plan immediately after the inspection with planned dates for action.
We have made a recommendation that people's personal evacuation plans should be more regularly reviewed. This is in case people’s needs had changed and the building needed to be evacuated in an emergency.
Staff supported people to ensure they received care that helped them develop. Staff received training and support to help them carry out their role. People said they felt safe and were very positive about the care provided. Staff knew the people they were supporting very well. Detailed care plans were in place that documented how people wished to be supported. Staff had developed good relationships with people, were caring in their approach and treated people with respect.
Arrangements for managing people's medicines were safe. People enjoyed their meals and their dietary needs had been catered for. There were opportunities for people to follow their interests and hobbies. They were supported to be part of the local community.
Information was accessible to involve people in decision making about their lives. 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.
Regular audits and checks were carried out. There were opportunities for people, relatives and staff to give their views about the service. Processes were in place to manage and respond to complaints and concerns. People and staff were positive about the management of the service and felt valued and respected.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 9 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
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.
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.