Archived: Harriets

Updated 6 May 2015

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 was an unannounced inspection to check whether the provider had carried out the required improvements to the safety and quality of the service identified following our visit in November 2014.

Two adult social care inspectors visited the home to carry out the inspection. We spoke with two people living at Harriets Care Home, one relative, three care staff and the manager. We also received information from and gained the views of social workers, the quality monitoring officer and the health protection specialist at Cumbria County Council.

We observed care and support in the communal areas of the home and looked around the home, including the bedrooms of eight people and the communal bathrooms. We reviewed a range of records about people’s care and how the home was managed. The records we viewed included the care records of five people, the staff training records and the quality assurance audits that the manager had started to complete. We also looked at the systems in place for managing medicines in the home. This included the storage and handling of medicines as well as a sample of the Medication Administration Records (MARs), of five people living at the home.

Prior to our inspection visit we checked the information we held about Harriets Care Home. This included notifications sent by the provider and information that had been sent to us by the local authority. We also checked whether we had received comments from people who used the service or members of the public.

Updated 6 May 2015

We carried out an unannounced inspection on 2 February 2015. We did this to check whether the provider had addressed the breaches of the regulations which we identified at our previous inspections.

Prior to this inspection we visited the home on 28 August 2014, where we found that the provider was not meeting six of the regulations we looked at.

We issued Warning Notices requiring the provider to be compliant with Regulation 9, care and welfare of people who use the service, Regulation 10, assessing and monitoring the quality of the service provision, Regulation 12, cleanliness and infection control and Regulation 13, management of medicines.

Compliance actions were set for the remaining two breaches, which were; Regulation 14 HSCA 2008 (Regulated Activities) Regulations 2010 - Meeting nutritional needs and Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010 – Records.

We carried out a further unannounced inspection on 18 November 2014 to check that the provider had addressed the breaches identified in the Warning Notices and the compliance actions.

We found that although the provider had met the requirements of Regulation 13, management of medicines, the three other Warning Notices had not been met. We also found that the compliance actions set had not been met either. We spoke with the service provider about the continuing breaches. They gave us assurances that these breaches would be dealt with effectively and quickly.

Two adult social care inspectors visited the home on 2 February 2015. We found that the provider had made significant progress in meeting the requirements of the Warning Notices and the compliance actions we had set previously. However, some areas of concern remain and the provider must continue to make the required improvements in order to become fully compliant with the regulations.

We spoke with two people living at Harriets Care Home, one relative, three care staff and the new, temporary manager. We met again with the provider following this inspection visit to discuss the improvements made and to discuss their plans for the improvements that were still required to meet the regulations. We also received information from social workers, the quality monitoring officer and the health protection specialist from Cumbria County Council. All reported that the service had made improvements.

Harriets Care Home has not had a manager registered with the Care Quality Commission since October 2013. 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 the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Harriets Care Home provides care and accommodation for up to 41 older people some of whom may be living with dementia. On the day of the inspection there were 17 people living at the home.

We observed care and support in communal areas, spoke to people in private and looked at care and management records.

Between May and November 2014 the Care Quality Commission (CQC) had been alerted to a significant number of safeguarding allegations, accidents and incidents occurring at the home. The information we had about this service, including the findings of this inspection (February 2015) and comments from the local authority, showed a vast reduction in these incidents. There had also been changes to the management team at the home. The provider had appointed a temporary manager and a senior member of the organisation had been providing oversight on a daily basis.

We found that work had been carried out by the new manager to monitor and manage the instances of falls. This included reviewing people’s care plans, risk assessments and ensuring staff were aware of their responsibilities of keeping people safe. Staff had been updated with regard to adult protection and safeguarding. However, we found that staff had not routinely been provided with training to help them support people living with dementia, including supporting people experiencing distress. This meant that people who used this service were placed at risk of receiving inappropriate and unsafe support.

We have made a recommendation about staff training on the subject of dementia.

We found that the processes in place for obtaining consent and assisting people with decision making was inconsistent and confusing. We found that staff had a lack of understanding with regard the requirements of the Mental Capacity Act.

Improvements had been made in the way the service managed infection prevention and control. Advice and staff training had been provided by the health protection specialist from the local authority.

We observed, and people told us, that staff treated them with kindness and respect. People were supported to maintain their independence and we saw many positive interactions between staff and people living at the home.

We found a breach of Regulation 18 Health and Social Care Act 2008 (regulated activities) Regulations 2010 in relation to obtaining valid consent from people who used this service or their legally appointed representative.

The service was not effective because staff and management lacked understanding and knowledge with regards to decision making, consent and the Mental Capacity Act.

We found a breach of Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 because the provider had not ensured that the planning and delivery of care met the individual needs of people who used this service. This placed their welfare and safety at risk because not all staff had the knowledge and training in caring for people that were living with dementia.

We also found a breach of Regulation 5 Health and Social Care Act 2008 (Registration) Regulations 2010 because the provider did not have a registered manager in place at the home.

The provider needed to make improvements to the way in which the service was led. The home has been without a registered manager for over a year. The lack of a registered manager can impact on the quality of services people receive.

We found that the areas of “safe”, “effective” and “well-led” required improvement.

The information we held about Harriets Care Home identified that the service had a recent history of not providing safe care and support to people who lived at the home.

Although the provider has made significant improvements to the ways in which care and support are provided, we (CQC) will check the improvements are maintained and sustained in the long term.

You can see what action we told the provider to take at the back of the full version of this report.