We carried out a review of the data available to us about Harley House Care Home Ltd 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 Harley House Care Home Ltd, you can give feedback on this service.
People’s experience of using this service and what we found
Processes were in place to protect people from avoidable harm and abuse. Staff were trained and aware of their responsibilities in relation to this and knew how to escalate any concerns they identified.
People’s safety was promoted. Potential risks to people’s safety had been assessed and care plans provided clearer guidance for staff to follow to reduce risks. Care plans and risk assessments were monitored and reviewed regularly. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.
People received their medicines as prescribed. Further improvements had been made to the management and storage of people’s medicines, and staff competency to administer medicine was checked regularly.
The provider continued to follow safe staff recruitment processes. Staff training and support had significantly improved to ensure people received effective care and support. Staff used correct techniques to support people to move safely. There were enough numbers of staff available to provide a timely response to people and provide safe care.
People lived in a well-maintained environment that promoted their safety, wellbeing and independence. Cleanliness, hygiene and infection control practices had been enhanced to ensure a good standard of cleanliness to protect people from the risk of the spread of infection.
People’s dietary needs were met and where required, staff supported people to eat and drink in a caring manner. People spoke positively about the quality and choice of meals provided to suit cultural and individual food preferences. People’s health care needs were met, and they had access to a range of healthcare support when needed.
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’s capacity was assessed and any authorisations to deprive people’s liberty and best interest decisions were kept under review and monitored.
The provider's quality assurance systems and processes had been reviewed and improved to ensure they were effective and gave the registered manager and the provider a good oversight of the service. Audits and daily visual checks were carried out by the management team, which promoted everyone’s safety. The maintenance person was on site daily so any required improvement could be swiftly addressed.
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 6 November 2019) and there was a breach 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
This was a planned inspection based on the previous rating and to follow up the breach of regulation found at the last inspection of the service on 17 September 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.
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 of Safe, Effective and Well-led which contains the requirement.
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 coronavirus 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 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 Harley House Care Home Ltd 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.
Harley House Care Home is a care home providing personal and nursing care to up to 28 people aged 65 and over. At the time of the inspection 22 people were using the service.
People’s experience of using this service and what we found
The service does not have a manager registered with Care Quality Commission (CQQ). The manager had begun the process to apply to be the registered manager.
The provider’s quality assurance systems was not effective. There was lack of systems and oversight of staff training, competencies, spot checks, management of medicines and the environment. The shortfalls we found had not been identified through the internal checks and audits. Although the manager was responsive and managed to address some issues further action was needed.
People felt safe and were protected from abuse. Risks associated to people’s health, safety and welfare were assessed, managed and monitored. Care plans provided clear guidance for staff to follow to meet people’s needs. Further checks were needed to monitor staff used equipment correctly to meet people’s needs.
Some people and staff felt staffing numbers could be better, but no one had expressed concerns to the manager about this. Staff recruitment procedures were followed, and all necessary pre-employment checks were carried out. Staff received regular support and supervisions.
People told us they lived in a clean and safe environment, which was homely and welcoming. Further improvements to the signage and adaptations could improve people’s sense of wellbeing with clear signage to access different areas of the home.
People were provided with enough to eat and drink. Observations of the dining experience was positive. People’s cultural and dietary requirements were met. People received their medicines as prescribed. People’s health care needs were met, and they had access a wide range of healthcare support. Procedures were followed to ensure people had the opportunity to express their wishes in relation to end of life care.
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’s capacity was assessed and any authorisations to deprive people’s liberty and best interest decisions were kept under review and monitored.
People received care from kind and caring staff and had developed good relationships with them. People’s privacy and dignity was maintained. A relative described the care home and staff as, “It [the care home] has a good feel about it and it is humane.”
People received care that was responsive to their needs. People were involved in the planning and reviewing of their care. Care plans reflected people’s likes, dislikes and preferences and people’s diverse needs were captured so staff knew how people wished to be supported.
The service ensured people’s social, cultural and religious needs were met. Daily and monthly activities of interest was organised. People’s relatives and friends were welcome to visit anytime. The service had maintained links with the wider community.
People knew how to complain and raise concerns and were listened to. People had opportunities to express their views about the service.
We identified a breach in relation to the governance and management oversight of the quality of care, medicines management, staff training and competency, the environment and effectiveness of audits and checks. More information is in the full report.
Why we inspected
This was a planned inspection based on the previous rating.
Rating at last inspection
The last rating for this service was outstanding (published 6 January 2017). The overall rating for the service has changed to requires improvement. 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 Harley House Care Home on our website at www.cqc.org.uk.
Follow up
We will request an action plan for the provider to understand what they will do to improve the 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.
There was a registered manager in post at the time of our inspection. 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.
The registered manager was inspiring and dedicated to providing care which met the highest of standards. They strived for excellence through consultation, research and reflective practice. They were passionate and dedicated to providing an outstanding service to people. They led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans.
The service was exemplary in responding to people's needs and preferences. People were supported by a service that was devoted to getting to know the people and family's they supported. Relatives told us the service was responsive and well managed. Relatives knew the registered manager. The service sought people's views and opinions and acted upon them.
All of the staff team had an exceptional understanding of people’s social and cultural diversity which enhanced people’s sense of wellbeing and ensured every person living in the home was valued.
People were supported with care and compassion and there was an ethos of care which was person centred, valuing people as individuals. People received a personalised service which was responsive to their individual needs and there was an emphasis on each person's identity and what was important to them from the moment they moved into the service.
There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.
Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks. People were supported to take their medicines as prescribed and medicines were obtained, stored, administered and disposed of safely. People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person and people were actively involved in decisions about their care and support needs.
Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people's rights. There was guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, registered provider and staff ensured that people were supported in ways that did not restrict their freedom and were supported appropriately to uphold their rights.
A variety of choices of food and drinks were offered at the home. Staff supported people to eat and drink with patience and dignity. People told us they had good access to their GP, dentist and optician. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare. People who used the service were supported to obtain the appropriate health and social care that they needed.
Care plans were written in a person centred manner and focussed on giving people choices and opportunities to receive their care how they liked it to be. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. The service provided outstanding end of life care. People experienced a comfortable, dignified death in line with their wishes. People were able to raise complaints and there was an easy read guide to support people through the process.
Robust quality assurance reports had been developed, incorporating all elements of requirements relating to legislation, Care Quality Commission guidance, best practice guidelines, along with evidence of how each area was being met. Continual auditing was carried out to ensure the safety and quality of care that was provided, using information from the audits to drive continual improvement.
We looked at the records for three people who used the service. We found people's needs were regularly assessed and reviewed and people's treatment and care was recorded within individual care plans. People were supported by staff that had undergone a robust recruitment process and who had received regular training which enabled them to promote people's health and welfare.
Records showed the provider had an effective quality assurance system in place which monitored the service provided to people and focused on people's health and welfare including medication, the maintenance of equipment and systems, staff recruitment and training.