This inspection was carried out on 4 June 2018. The inspection was unannounced. We undertook an unannounced focused inspection of Harpwood Care Home on 4 June 2018. The team inspected the service against three of the five questions we ask about services: is the service well led, is the service effective and is the service safe. This was due to the concerns that had been raised, and the potential risk to others living at Harpwood Care Home. At this inspection the service was rated as requires improvement in safe, effective and well-led, therefore the overall rating for the service is now requires improvement.
Harpwood Care Home 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.
Harpwood Care Home is a privately owned care home providing accommodation for up to 50 older people some of whom live with dementia. The service had three double bedrooms; the remainder of the rooms were single, some with ensuite facilities. There was a large garden for people to use with seating and pathways. There were 43 people living in the service when we inspected.
The service had a manager in post who had started after the full comprehensive inspection in July 2016. The manager had applied to become registered with the Care Quality Commission to manage the service. The manager had attended their registration interview in the week prior to our inspection. 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.
Some people’s care plans were detailed and gave staff guidance regarding how to meet people’s needs. However, some care plans were not always complete and, some contained conflicting information. One persons’ care plan recorded that they did want to receive medical attention in the event of an emergency; however, another page within their plan stated they did not want medical attention. Another persons’ care plan stated there was concern regarding the person’s weight loss, and that meals should be offered frequently. However, in practice staff were supporting this person to manage their weight and offering a low fat diet.
Risks posed to people had not been consistently assessed, recorded and monitored. Some people were at risk of skin damage and used specialist equipment to reduce this risk. However, the equipment had been incorrectly set, leaving these people at risk of skin damage. Another persons’ care plan stated they were at risk of falls; guidance was available for staff to follow to reduce this risk. However, the guidance was not consistently followed by the staff team, leaving the person at risk of falling. Other risks to people had been properly assessed and action was taken to mitigate the risk.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were encouraged to make their own choices and staff gained people’s consent prior to any care or support tasks. However, people’s capacity to consent to specific decisions had not always been sought in line with the principles of the Mental Capacity Act 2005 (MCA).
People felt safe with the staff at Harpwood Care Home. Staff understood their responsibilities to safeguard people from potential abuse. There were enough staff deployed to meet people’s assessed needs. Recruitment procedures had not consistently been followed; gaps in employment had not been explored or recorded. We have made a recommendation about this.
People received their medicines from trained staff as prescribed by their doctor. People were supported to maintain their health and attend appointments with health care professionals as required. The manager had developed professional relationships with external agencies to promote people’s health. People’s nutrition and hydration had been assessed, however, records showed inconsistent guidance for staff. People were offered a range of meals which they enjoyed and were offered regular drinks.
The quality and monitoring systems in place were not always effective. There were regular audits carried out by the manager and senior manager, however, these had not always identified the concerns that were found during this inspection.
The building and equipment was suitably maintained to make sure it was in good working order. Regular checks were made to the fire alarm system and emergency fire-fighting equipment. People’s ability to safely evacuate the building in the event of an emergency had been recorded. The service was clean throughout and people were protected from the potential risk of infection.
Staff were supported in their role by the management team. A variety of training courses were available to enable staff to meet people’s needs, including their specialist needs. New staff completed an induction and worked alongside experienced members of staff before working as part of the care team. There was a visible management team who promoted an open culture within the service.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.