Harwood Court

We found the following examples of good practice.

• Staff had completed training in infection prevention & control (IPC) and were able to explain what personal protective equipment (PPE) they were required to wear when completing different tasks.

• A cleaning log was available to evidence the cleaning undertaken each day to reduce the risk of spreading infections and cross contamination. Additional housekeeping hours were in place to support more frequent cleaning of touch points.

• Systems were in place to support visitors to access the service safely. Posters were situated around the building advising on appropriate hand washing techniques and how to put on and take off PPE.

• Staff spoke positively about the support they received from the manager and deputy manager. They knew how to access information to support their emotional wellbeing.

• Quality assurance audits were completed to ensure safe infection control practices were being followed and to identify any improvements. The manager had a folder for staff which contained information and resources relating to the management of the pandemic.

Further information is in the detailed findings below.

Harwood Court provides care for up to 35 people. There were 30 people living in the home at the time of the inspection, some of whom were living with dementia.

At our last inspection on 24 May 2016 we awarded an overall rating of good and rated the key question ‘is this service caring?’ At this inspection we found the service remained good, we have therefore rated it good.

A registered manager was in post. 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.

There were safe procedures in place for the safeguarding of vulnerable adults, and recruitment procedures helped to protect people from abuse.

Risks to people and the premises and equipment were assessed and plans were in place to mitigate these. A record of accidents and incidents was kept and reviewed by the registered manager to help prevent reoccurrence.

Suitable systems remained in place for the management of medicines.

The home was clean and well maintained and had recently been refurbished. New signs were due to be put up to help people with finding their way around the home.

Staff received regular training, supervision and appraisals and told us they felt well supported by the provider to complete training they considered mandatory.

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 were supported with eating and drinking and told us they enjoyed the food at Harwood Court. Specialist advice was sought when there were concerns about people’s nutrition.

There were numerous examples of kind and compassionate care being provided. People told us they appreciated the atmosphere and the relationship and fun they had with care staff. People were also treated with dignity and respect.

Person centred care plans were in place which aimed to put people at the centre of their care. Care plans we read were up to date and regularly reviewed.

A variety of activities were available and people had access to outdoor space in better weather.

Close attention had been paid to supporting people at the end of their lives. A chaplain was employed who supported this, and resources were provided to promote the comfort of people and their relatives at this important time.

We received positive feedback about the registered manager, deputy and administrator, who were found by people, staff and relatives to be approachable and helpful.

The registered manager undertook a range of audits on the quality and safety of the service and sought the views of people using the service and their families.

There were close links with the local community.

This inspection took place on 24 and 27 May 2016 and was unannounced. This means the provider did not know we would be attending. At our last inspection of the service in November 2014 we rated the service as ‘Requires Improvement’ overall. This was because we identified four breaches of the Health and Social Care Act 2008 related to staffing, care and welfare of people who use services, records and assessing and monitoring the quality of service provision.

At this inspection we found improvements had been made and the provider had achieved compliance with each of the regulations that had previously been breached. The service has a new registered manager in post. 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.

People living at Harwood Court told us they felt safe and comfortable with the support they received. Relatives we spoke with confirmed this. Policies and procedures were in place, such as those about safeguarding and whistle blowing, to protect people from harm and to ensure staff understood their responsibilities.

Risks associated with the health, safety and wellbeing of the people who lived at the home were well managed and included the provider carrying out checks of the premises in line with their legal responsibilities. People’s care needs had been assessed and we saw evidence in records that new care planning documentation had been drafted. These were evaluated and reviewed regularly. Accidents and incidents were investigated in a timely manner and where appropriate the manager had informed the local authority and the Care Quality Commission (CQC) of significant incidents. These records were analysed and used to review people’s care needs, risk assessments and implement preventative measures. All other records related to the management of the service were well maintained.

Medicines were managed safely and medicine administration records were completed and accurate. Medicine was stored safely and in line with best practice guidelines. Senior staff followed policies and procedures with regards to receiving, storing and disposing of medicines safely.

People and relatives told us there was enough staff deployed by the service to operate safely and to meet people’s needs. The manager used a ‘needs dependency’ tool to monitor staffing levels. The recruitment process was safe and staff had been appropriately vetted. Training was up to date, and staff had a variety of experience, skills and knowledge. Competency checks were undertaken to ensure staff remained suitable for their roles. Staff had been given the opportunity to progress their career through access to qualifications.

Evidence showed the manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities to apply this act in their work. The provider had assessed people’s mental capacity and reviewed it. Care records showed that wherever possible people had been involved in making decisions, but significant decisions regarding people’s care were made in people’s best interests and had been appropriately taken with the involvement of other professionals and relatives.

Records showed that supervision and appraisals were held regularly and staff confirmed this. Staff and relatives’ meetings were held and notes were taken. This demonstrated that everybody involved with the service had an opportunity to speak with the manager.

Staff encouraged people to maintain a healthy, balanced diet. We observed people in the dining room at lunchtime and teatime; staff ensured this was a positive experience and they interacted well with people. People made choices around their meals and selected options from the planned menu. We saw some people choose an alternative meal or snack which the chef prepared.

People’s general healthcare needs were met by staff and external healthcare professionals were involved when necessary. We reviewed care records which demonstrated people had input into their care from GP’s, district nurses, diabetic screening nurses and dentists. Staff worked closely with healthcare professionals and followed their instructions to care for people appropriately.

Staff showed caring and kind attitudes and people told us staff were nice and friendly. We observed people’s privacy being respected and their dignity was maintained. Staff told us they were happy working at the service and it had improved a lot in the last 12 months. They said they felt “valued and appreciated.”

People engaged with activities on a one to one basis and in groups. A programme of activities had been developed which included day trips and bringing local services into the home.

During the inspection, people and their relatives told us they had nothing to complain about but they knew to tell staff or the manager if something was wrong. We reviewed complaints records and saw they were promptly investigated and resolved.

Quality monitoring took place which involved people, relatives and staff being asked for their opinions via surveys and meetings. The manager had undertaken audits to ensure the quality and safety of the service. There was evidence of provider oversight as they also audited the service. The manager drafted action plans to improve the service following audits and surveys.

People's care needs were assessed and care was planned and delivered safely. People spoke highly of the care at the home. One person said, "It's so good here when you come through the door you feel welcome, it is just like home." People commented very positively about activities and care. A relative said, "The activities organiser thinks up some really good ideas" and "My Mum is over 100 and she is so happy, they take care of her and have her looking so nice, I can go away confident that she is content here. They look after her how I want her looked after."

People were safely supported to move around the home and the equipment the staff used was suitable and safe.

Staff recruitment ensured people were cared for safely by suitable people. One relative said the following about the staff, "The girls are so caring, so sincere, good humoured."

The provider had an effective complaints system and people felt able to raise concerns. One person said, "The main thing here is everyone takes everyone's position into account. If we do not like a thing all we need to do is talk to the ladies in the office."

We found the provider had arrangements in place for asking for people's consent and staff asked permission before providing care. However we noted significant decisions had been made without the service provider fully considering the capacity of people to make these decisions.

People had their care needs assessed with risks to their safety and welfare taken into account. Care was planned and delivered to meet people's needs and ensure their welfare. People felt cared for. One person said, "I felt at home as soon as I moved in." Another person said, "The staff are really nice, they have always been so kind."

We found in records, and people confirmed, that the organisation assessed the quality of the service and identified risk by asking the opinions of people who use the service and their representatives.