Harbour House

Harbour House is a care home providing accommodation and personal care to up to 20 people. At the time of our inspection there were 19 people using the service.

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

CQC had received concerns regarding poor communication, management and staff not responding to guidance and advice and the management of some medicines.

People were supported to access healthcare services. Staff reported changes in people's health and sought professional advice. However, communication between the staff, the manager and external healthcare professionals was not always effective.

Guidance and direction provided to staff and the registered manager was not always carried out as requested. Audits were not always effective and management oversight was not robust.

Harbour House was using an electronic system to manage people’s medicine requirements. The system helped ensure people received their medicines as prescribed. However, the administration and recording of some medicines was not always carried out appropriately.

Medicines that required stricter controls were not always accurately recorded. Oversight and auditing of medicines management was not effective.

Staff had not always been recruited safely. Gaps in employment history were not always explored. The dates provided on some returned references did not always match with the dates provided on the person’s application form.

References were not always received before staff began working unsupervised. The provider was aware of this, and immediate action was being taken to obtain these.

Several people living at Harbour House had lost weight recently. There was no clear process in place for responding to these concerns.

Risks were not always effectively reviewed when care plan reviews took place. Weights were not checked along with Malnutrition Universal Screening Tool (MUST) assessments and care plans were signed off as ‘no change’ when checks had not always taken place to confirm this.

Care plans did not always contain clear accurate guidance. One person’s care plan stated information that was contradictory. We asked for some care plans to be reviewed by the registered manager to ensure they provided up to date, accurate and clear guidance to staff.

There were enough staff to respond to people's needs. Staff had been provided with training and support to enable them to carry out their role.

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 were no Deprivation of Liberty Safeguards (DoLS) authorisations in place at the time of this inspection.

People told us that they felt safe in the service. Visitors told us they felt their family member was safe and protected living at Harbour House. Comments included, “Yes, it seems very nice. Lovely room and the staff are kind.”

The premises were clean and well decorated. People had filled their rooms with familiar items and photographs. People enjoyed the food provided at Harbour House.

People had been asked for their views and experiences at residents meetings and via a questionnaire. Responses were mostly positive.

The provider had systems in place to monitor equipment and utilities. Systems were in place to support people in the event of an emergency.

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 (4 November 2021).

Why we inspected

This inspection was prompted by concerns received by CQC regarding a lack of staff skill and knowledge in some areas, poor communication, guidance and advice not always being followed, poor management response to changes in people’s needs and the storage of some medicines.

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 COVID-19 and other infection outbreaks effectively.

We inspected Safe, Effective and Well-led only at this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Notice of inspection

This inspection was unannounced.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Harbour House provides accommodation with personal care for up to 20 people. There were 17 people using the service at the time of our inspection. The service is in one adapted building over two floors.

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

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.

There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions.

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training, and this had ensured all staff received the training and updates needed to provide safe consistent care.

Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by senior staff and the manager.

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 living at Harbour House had care plans which detailed their needs and preferences. Staff knew people's care needs well. People were supported to engage in activities, although these had to some extent been impacted by the COVID-19 pandemic. The service had recently employed another activity coordinator to ensure activities were expanded.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities as a registered manager.

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 30 April 2019)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We found the following examples of good practice.

Staff were following current infection prevention and control guidance to help people to stay safe. All staff had received training on the appropriate use of personal protective equipment (PPE) and additional training on infection control practices. Staff were using PPE effectively during our inspection and this equipment and guidance on management of infection control risk was readily available throughout the service.

The service had good stocks of PPE and the provider had purchased additional equipment including higher specification masks and visors for use in the event there was an outbreak within the service. The new manager and deputy manager regularly worked alongside care staff and ensured best infection control practices were followed.

The service was clean and well maintained. Housekeeping staff were now on duty every day and there were appropriate cleaning procedures in place. High contact areas were cleaned regularly throughout all shifts and night staff were also completing additional cleaning of the service’s communal areas.

The service was closed to visitors at the time of the inspection as there was a national lockdown in place. Appropriate arrangements were available to enable relatives to visit the service safely. Garden and window visits had been used effectively during the summer and a full height clear screen was available to enable visits to be completed in the service’s lobby area while minimising infection control risks. Visits were by appointment only and the visiting area was cleaned thoroughly between each use. In addition, staff regularly supported people to make video calls to relatives and friends.

Appropriate admission procedures had been developed and everyone who moved into, or returned to the service from hospital was initially cared for in isolation. Regular testing of staff and people who used the service was completed in accordance with current guidance.

People were able to access the service’s communal areas if they wished, however most people chose to spend their time in their rooms. The service’s infection control policies had been reviewed and updated in response to the Covid-19 pandemic and appropriate plans and procedures had been developed detailing how an outbreak of the infection would be managed.

The new manager communicated regularly with people, staff and relatives make sure everyone understood the precautions being taken, and how to keep people safe.

People’s experience of using the service:

¿ People told us they felt safe living at Harbour House. Staff were knowledgeable about identifying and reporting any safeguarding concerns they may have.

¿ There was a positive approach to risk taking to enable people to maintain their independence.

¿ 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.

¿ People received personalised care and support specific to their needs and preferences. Each person was treated as an individual. One person told us, “I sleep more these days, but the staff support me to enjoy activities in the lounge from time to time”

¿ One visiting healthcare professional told us, “Staff make such an effort with residents, they go out, they don’t just sit around, and care is always consistent in my opinion”.

¿ People were provided with some activities by the care staff. These were planned and advertised in the service. Some people went out independently others were supported by staff on trips out in the providers mini bus. However, people were not able to access outside space without staff being present. A fence was required to secure the area and we were assured this was being provided.

¿ Relatives told us they had chosen Harbour House for its ‘reputation within the community’ and for its ‘quality of service to older people and their families.’

¿ Throughout the inspection visit we saw many positive interactions between people and the staff and management.

¿We received varied feedback from staff about working at the service. All said they felt able to approach the management team. Comments included, “I love my job here, it is hard sometimes but we all pull together, it has been very tough recently in the afternoons.” and “I sometimes feel that issues I raise do not always get a response, things all take time. On the whole we support each other, and I am pretty happy here.”

¿ Some staff raised that they were feeling particularly ‘pressured’ between 4pm and 8pm when only two staff where on shift. Some people required two staff to support them when needed. This meant that there were no staff available to support other people if needed at that time. The provider assured us this was being addressed.

¿ Harbour House used electronic care plan records. The provision of assessed care was recorded in a timely manner.

¿ The service was due some maintenance with damaged paintwork and some floor covering that showed its age. The provider assured us the service was due to be re-decorated.

Rating at last inspection: This is the first inspection of this service since the provider changed their legal entity and became a limited company.

Why we inspected: This was a planned inspection. The service was rated Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk