Harbour Rise Rest Home

We found the following examples of good practice.

Personal protective equipment was readily available to staff and all staff were following the latest guidance. Where possible staff maintained social distance from people.

The provider ensured staff received appropriate training to help prevent the spread of infection. All staff had received training on infection control and the use of PPE.

The provider had appropriate arrangements to test people and staff for COVID- 19 and was following government guidance on testing.

There was a regular schedule of cleaning and we noted the premises were clean, well-aired and smelt fresh. The provider had recently purchased a 'fogger' cleaning machine in order to complete deep cleans of the environment. Use of the machine meant areas that were difficult to clean by other techniques, would be thoroughly sanitised.

Staff focused on maintaining a safe environment for people whilst keeping life as normal as possible. The provider arranged entertainment and activities in a safe way, such as, music in the garden, in order to promote wellbeing.

People who preferred to spend their time in communal areas, were supported to do so whilst maintaining social distancing.

The provider had appropriate arrangements for visiting to help prevent the spread of infection. Visitors had their temperature checked, were asked to sanitise their hands and wear a mask.

The provider had created a ‘visiting pod’ to ensure people could receive their visitors comfortably and safely. A large Perspex screen was used in the ‘pod’ to separate the area whilst allowing people to see and talk to their relatives clearly. This helped to keep people safe, reduce people's levels of anxiety and maintain social distancing.

For people not receiving visitors, staff helped people to stay in touch with family and friends through phone and video calls.

The registered manager and provider were communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

The provider had developed policies and procedures to promote and maintain safe infection control procedures at the service. The management team kept up to date with all guidance and this was disseminated to staff.

The provider had detailed contingency plans in place for any outbreak or suspected outbreak of COVID-19 and had plans in place should people need to isolate. Staff knew about these plans and what action they needed to take in the event of an outbreak or if they needed to isolate themselves or a person living at the service.

Further information is in the detailed findings below.

People’s experience of using this service:

People and their relatives told us they received outstanding care from staff who were passionate about delivering a high-quality, person-centred service. Without exception everyone we spoke with told us the home was exceptionally well led and consistently said they would recommend the home to others.

The provider was passionate about providing a service which was caring, compassionate and reflected the values of the organisation. They told us how Harbour Rise was like one big ‘family’ where everybody was respected and treated equally. These values were imbedded within the culture of the home and evident throughout all our interactions with people, relatives and staff who consistently referred to being part of a ‘family’.

People were treated with dignity and respect in a way that truly valued them as individuals. Staff continually looked for new ways to enhance people's lives and understood what was expected of them; they were motivated, hardworking and enthusiastic.

The home delivered outstanding end of life care to people. The management team were passionate about ensuring people received dignified and respectful end of life care which met their personal needs and preferences.

People were protected from potential abuse as staff had received training and were confident in raising concerns. People were empowered to take positive risks and 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 had confidence in the staff who supported them and felt safe in their care. Staff were well trained and skilled at supporting people living with dementia to lead independent, active and fulfilling lives. People's care plans were detailed and accurate, ensuring staff consistently knew how to support people.

People and their relatives told us they knew how to complain, and any complaints received were used to improve the service.

The provider had a strong and effective governance system in place. The management team continued to carry out a regular programme of audits to assess the safety and quality of the service and identify issues. Strong leadership put people first and set high expectations for staff. Staff were exceptionally positive about the management of the service and felt truly valued and respected.

Harbour Rise met the characteristics of Outstanding in Caring, Responsive and Well Led.

Rating at last inspection: Harbour Rise Rest Home was previously rated as ‘Good.’ The report was published on the 5 September 2016.

Why we inspected: This was a planned inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

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.

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

Harbour Rise Rest Home is a long established care home without nursing, accommodating up to 44 people. People living at the home were older people, some of whom were living with dementia, or physical frailty. The home also provides day care for people, but this was not under a regulated activity regulated by the Care Quality Commission, so did not form a part of this inspection. The home had been undergoing a programme of expansion following the purchase of the adjacent property, and this was almost complete. The programme had involved extensive remodelling of the interior to provide wider corridors and doorways, en-suite facilities for all rooms and improved service and communal areas.

There was a 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.

Risks to people’s care were being assessed and mitigated, however, some risks in the environment had not been identified. Some of these were addressed at the time of the inspection. We have made a recommendation about this. People were being protected from the risks associated with medicines and a new medicines management system had been implemented.

Staff understood how to safeguard people from abuse. Staff told us they had no concerns over the quality of care or safety people were experiencing at the home, but would report them if they did. They had received training in how to identify abuse and what actions to take. The home had complaints policies and procedures for people to use to raise any concerns.

We saw that people’s needs were being met in a timely way on the day of the inspection, and records showed that call bells were responded to quickly. The provider told us they had recently increased staffing levels. Although we received some conflicting information about whether there were enough staff on duty to meet people’s needs, the provider told us that members of the management team would always provide additional cover if it were needed and the home would not be short of staff.

A clear recruitment process was in place to identify risks in relation to staff employment. This was reflected in the staff files we saw. There was not a system in place for the recording of decision making in relation to risks identified during the staff recruitment process, however we saw that where risks had been identified they had been assessed. The registered manager agreed to record this in future.

Staff told us they had the skills and training they needed for their job role and we saw they were knowledgeable about people’s care needs. Spot checks were carried out on their performance, and they told us they felt supported. The registered manager told us that systems for recording training, learning and competency were under further development.

Care files and plans reflected people’s needs or wishes about their care and how this was to be delivered. Plans were updated regularly, and contained information about how people wanted to be supported and their life history where this was possible to obtain. Some plans would benefit from additional information being available to support people with behaviours that might be challenging. People received good support from community healthcare services, and referrals were made to appropriate agencies if people’s health deteriorated. Some people with long term health conditions found these had improved since being at the home. People were supported to make choices about meals and they told us they ate well.

The service was supporting people in line with the Mental Capacity Act, and protecting their rights. Assessments of people’s best interests were being carried out where they lacked the capacity to make a decision.

Work was being undertaken on the premises to provide a more comfortable environment for people. This included people living with dementia. The provider had made considerable internal changes to the building to provide bright en-suite bedrooms, wider corridors and doorways and improved service areas. Additional work was being planned to include changes to the dining room and a new café area where people could spend time with families or prepare drinks for themselves.

Good relationships had been built up between people living at the home and the staff supporting them. People told us they liked the staff and were happy with the service they received. Staff took time to understand people’s wishes and spoke with them discreetly about their care. They demonstrated respect for people’s dignity and individuality.

Activities provided were aimed at meeting people’s individual needs and wishes as well as those who enjoyed them in groups. Some activities were being developed to better meet the needs of people living with dementia.

Staff and people respected the registered manager and management team. There was a clear vision for the development of the home that was shared with stakeholders. We identified a lack of robustness in some of the management systems and auditing practices in place, but this was mainly minor issues that were resolved at the time of the inspection.

Quality assurance and quality management systems were in place to ensure people had a chance to share their views and experiences. Records were well maintained, but some policies and procedures needed updating.

We looked to see if the improvements identified as needing to be made following our inspection in January 2014 had been addressed. During this inspection we also followed up on information of concern we had received about the service. The information we had received related to staffing levels, care and welfare of people who used the service and meeting people's dietary needs. We found that the home had made improvements in the areas we looked at.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe and comfortable.

There were enough staff on duty to meet the needs of the people living at the home and staff had the skills and knowledge to safely support people. Comments included, 'The staff always check on me, I have a nice feeling of safety here'; 'I come at varying times throughout the day to visit my Mum and there's usually a lot of staff around' and 'I feel since my Mum has been here she has improved a lot, she is safe and secure'. People's care plans provided staff with sufficient information to safely manage people's needs.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant the provider had taken steps to demonstrate that the staff employed to work at the home were suitable to work with vulnerable people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS aim is to ensure people are protected from the risk of inappropriate restraint in any form. The Registered Manager demonstrated that before our inspection was completed, all persons who used the service had been reviewed under DoLS and where necessary applications had been made.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was evident from what we observed and from conversations we had with staff that they understood people's care and support needs and they knew them well. Comments included, 'I can't fault this place in anyway at all, I think it's marvellous and I'm saying this from the bottom of my heart' and 'All the staff know my mum well, when her dog needs walking, the staff really comfort her during this high period of anxiety'

We saw that care plans reflected people's individual need and professional advice was sought and followed by staff to ensure people who used the service received effective and appropriate care that met their needs.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff were patient when supporting people and displayed compassion when offering support. Comments included, 'The staff are cheerful, friendly and willing, they really care about you' and 'Everything is amazing, they are all very caring, I think my Mum is very lucky to be here'.

Is the service responsive?

People's needs had been assessed and monitored. Care plans were reviewed regularly when changes occurred and reflected people's current needs.

The home had taken account of published research and guidance to reduce the risk of unsafe or inappropriate care. The home responded quickly where risk was identified and sought specialist advice where appropriate to meet people's changing needs.

Is the service well-led?

Staff felt supported by the management structure. Comments included, 'If I had any concerns about anything I would speak to the manager, she really listens and action gets taken' and 'The management are very approachable and supportive.'

There was an effective quality assurance system in place. Staff and people who used the service were regularly consulted about the quality of care provided. Learning from incidents took place, complaints and concerns were taken account of and action was taken to improve the service.

We saw no evidence to confirm that people had been asked for their consent or how the provider acted in accordance with their wishes before they received any care or treatment.

People we spoke with were positive about the support they received. People who lived at the home told us they were well looked after and were happy. One person said 'I can assure you we are all well looked after'.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The home did not operate a robust recruitment to ensure suitable and properly qualified people had been employed by the home.

People told us that they felt safe and knew what to do if they had concerns. One person said "If I was unhappy about anything I would speak to staff or the manager." A visitor told us they would feel comfortable making a complaint if they needed to.

Accurate and appropriate care records had not always been maintained. This meant that people were not always protected from the risks of unsafe or inappropriate care and treatment.