Archived: Harriets

Updated 11 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 28 and 29 July 2016 and was unannounced. We also went back to the home on 2 August 2016 to give feedback to the operations manager and to complete our evidence gathering.

The inspection was conducted by an adult social care inspector. On the first day of the inspection they were accompanied by an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience of the care of older adults and of people living with dementia. On 2 August the lead inspector was accompanied by another adult social care inspector.

Prior to this visit we had gathered evidence from adult social care and health professionals. The service had been subject to a Quality Improvement action undertaken by the local authority commissioners of care. This meant that social workers, occupational therapists and some health care professionals had visited the home along with quality assurance officers from the local authority. This was done to help and support the service to improve the quality of care and services delivered. We were updated at the Quality Improvement meetings and were copied into extensive minutes. We also received sight of a quality monitoring report written by a local authority officer.

The provider had also written to us with regular updates and we were sent action plans in relation to the breaches we discovered in January 2016. We also received updates from the registered manager and the operations manager. We also reviewed the notifications of incidents in the home that the service must inform us of by law.

When we visited the home we met with all sixteen people living there. The expert by experience spoke to eleven of the service users and the inspectors spoke to some of these people and to those who were unable to speak with the expert. We also spoke with six relatives or friends. We also observed the way people received care and support. We spoke to a visiting GP on one day and had contact with other medical professionals during the inspection.

We spoke with seven members of the care staff team, the registered manager, the new manager and the operations manager. We spoke briefly with the maintenance person and with two members of the housekeeping team. We also spoke at some length with the cook and with the administrator for the home.

We looked at ten care files and all of the medication records. We looked at six care plans in some depth. We also looked at daily notes, handover sheets, shortened versions of care needs and records of personal care and nutrition.

We also looked at six staff records. These included information about recruitment, induction, training, supervision and appraisal. We looked at the information about newer recruits and long standing members of staff. We were sent copies of the record of training received and some training courses planned for the rest of 2016.

We reviewed a number of documents related to the operation of the home. We looked at information related to quality monitoring and we received copies of the audits done by the operations manager. We received a copy of a document called "Home development plan 2016". We checked on money kept on behalf of people living in the home, the fire log record and food safety information and records of food taken.

Updated 11 January 2017

This was an unannounced inspection which took place on 28 and 29 July 2016 with a short visit on 2 August 2016 to give feedback to the operations manager.

We carried out an unannounced comprehensive inspection of this service on 5 and 6 January 2016, at which four breaches of legal requirements were found. This was because quality monitoring had failed to resolve issues related to good governance, staffing levels were inadequate and risk management was not appropriate. We also found that there were problems with the environment. We rated the service as Inadequate. We served the provider with a warning notice in respect of Safe Care and Treatment, Staffing and Good Governance.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches contained in these warning notices. We undertook a focused inspection on the 7 April 2016 to check that they had followed their plan and to confirm that they had started to progress the actions to meet legal requirements. We judged that by April there had been enough progress to consider the warning notice to be met but we did not amend the rating as we were unsure of how well these changes would be sustained. You can read the report from our last two inspections by selecting the 'all reports' link for ‘Harriets’ on our website at www.cqc.org.uk.

Harriets is a single story building situated in the village of Distington. It is registered to provide care and support to older people and people living with dementia. Accommodation is in mainly single rooms with ensuite toilet and wash hand basin. There are suitable shared areas in the home. There is a small garden area. Parking is in the public car park next to the home. The village has a regular bus service.

The home had a registered manager who had tendered her registration. A new manager had come into post and was preparing to apply for registration. 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 who lived in the home told us that they felt safe. Staff had a good working knowledge of how to protect vulnerable people from harm and how to report any potential safeguarding.

Staffing levels had improved but we made two recommendations about retention, deployment and competence issues in the staff team.

The service remained in breach of regulation 12 because we had evidence of failures in managing the risks related to infection control, medication, health and safety and falls.

We noted that staff had received training and were being encouraged to attend further training. No one in the home was suitably trained to support the management of moving and handling matters. Staff supervision lacked detail and appraisal had been planned but not carried out.

This was a breach of Regulation 18 (2) because staff needed further support in order to develop in the roles.

The registered manager was aware of her responsibilities under the Mental Capacity Act 2005. We learned that people were not always asked for consent. Staff asked families about decisions without being clear on who had the legal right to support people. People were unfamiliar with the content of their care plans and were unsure of what they had consented to.

This was a breach of Regulation 11: Consent because consent was not always appropriately sought prior to care and support being given.

Good quality food was bought and suitable meals made. We saw that care files lacked detailed nutritional plans and that records of food taken by people at risk of malnourishment were not always completed with sufficient detail of food taken and had not been analysed. Some people needed more support to take a healthy diet.

This was a breach of Regulation 14: Meeting nutritional and hydration needs because not everyone was given suitable levels of support to access good nutrition.

There were problems noted both inside and outside the building. People could not safely go outside because of the lack of garden furniture, uneven paving, overgrown gardens and a missing fence next to the road. Some parts of the building needed to be more secure. Some work had been done on boilers, fire safety and sewerage. Some decoration had been completed but more work needed to be done on general standards of décor in the building. Maintenance of the environment needed to be improved on.

This was a breach of Regulation 15: Premises and equipment because the home had a number of problems related to security, maintenance and improvement.

We observed staff treating people in a caring and kind way and some people felt the staff were caring and considerate. Several people felt that staff did not spend enough time with them. Not everyone in the home was supported to be as dignified as possible. Staff tried to support people to be independent but this was not done through detailed care planning. We made a recommendation about this.

End of life care was done jointly with the local community nurses and G.Ps and was done appropriately.

We had identified issues around assessment of need and care planning when we inspected in January 2016. At this inspection we saw that some care plans had been improved but that some plans lacked detail and guidance. Staff told us that they did not have time to read the care plans. People in the home were unsure of the content.

This is a breach of Regulation 9: Person centred care because care plans did not always meet needs or preferences.

The registered manager had resigned and left the service part way through our inspection. The home had a new manager who was applying to register with the Care Quality Commission.

There had been a number of changes of manager in the last few years and this had led to some inconsistencies and a problem in establishing a suitable culture and approach in the home that was person centred.

There was a good quality monitoring system in place but this was not being operated effectively enough to ensure that good standards of care and services were being given. Some recording was of a good standard but care records needed to be improved.

This was a breach of Regulation 17: Good governance because the established systems had not identified or managed some of the problems identified through inspection.

At the last comprehensive inspection this provider was placed into special measures by CQC. The overall rating for this service is ‘Inadequate’'. This inspection found that there was not enough improvement to take the provider out of special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.