Archived: The Harefield Care Home

The inspection took place on 15 March 2016 and was unannounced.

The last inspection of the service was on 1 September 2015 when we found breaches in five Regulations relating to person centred care, privacy and dignity, staffing, consent and good governance.

The Harefield Nursing Centre is a care home with nursing for up to 40 older people. At the time of our inspection 33 people were living at the home. Some people living at the home were living with dementia. The home was run and managed by Bupa Care Homes (ANS) Limited. 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 and associated Regulations about how the service is run.

Although the provider had reassessed and improved the staffing levels and deployment at the service, there were times when people’s needs were not being met and they were placed at risk because there were not enough staff deployed to support them.

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

The environment was well maintained and clean.

There were appropriate procedures for safeguarding people.

People received their medicines in a safe way and as prescribed.

The provider’s recruitment checks were designed to ensure the staff were suitable to work at the service.

People’s capacity to consent had been assessed and the staff made sure people consented to their care as it was offered. Where people lacked the capacity to make specific decisions the provider had acted in the person’s best interest and had consulted with those who were important to the person.

The staff received the training, supervision and support they needed to care for people safely and meet their needs.

People’s nutritional needs were met.

The staff worked with other healthcare professionals to make sure people’s healthcare needs were met.

People told us they had positive relationships with the staff. The staff were kind, caring and respected people’s privacy. However, some people felt that there were long periods of time when they did not have sustained or meaningful interactions.

People’s care needs were met in a way people wanted. Although some of their preferences and personal wishes were not recorded in care plans.

People had access to a range of organised activities, but some people wanted more opportunities for things to do.

There was an appropriate complaints procedure and the provider responded to complaints.

People living at the service, staff and visitors found the manager approachable and felt the service was well managed.

There had been improvements to the service and the manager had a plan for on going and continuous improvements.

Records were well maintained, accurate and up to date.

There were a number of different audits and checks which enabled the manager and staff to monitor the quality of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was safe. People were cared for in a safe environment, which was subject to regular checks and audits. There were enough staff on duty to make sure people's needs were met. People's needs had been assessed to make sure they were not at risk and the equipment people needed had been provided to make sure they were safe and comfortable. There were systems in place to ensure any money people had was looked after safely.

Is the service effective?

The service was effective. People's needs had been assessed and their care had been planned to meet these needs. The staff demonstrated a good understanding of people's individual needs and the support they required. The staff were provided with training and support so they could care for people appropriately.

Is the service caring?

The service was caring. The staff were kind and considerate of people's choices, preferences and individual needs. With the exception of a small number of incidents, the staff treated people with respect.

Is the service responsive?

The service was responsive. At our visit we observed that some people had not consented to their care and treatment and their capacity to make a decision had not been assessed in accordance with the Mental Capacity Act 2005. Since our visit the provider has taken appropriate action to address this and supplied us with evidence of this.

The service had responded appropriately when people's needs had changed or they had become unwell.

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Is the service well-led?

The service was well led. The manager was not registered with the Care Quality Commission at the time of the inspection, however she had made an application to be registered. The staff were supported and well trained so they could meet the needs of people living at the home. The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We looked at the care records of eight people, spoke with five people, two people's relatives and six members of staff. People we spoke with talked positively about the service, one person told us " I enjoy living here, the staff are kind and caring and we have good selection of food, there is activities for us to do". Another person told us " they do there best, sometimes you have to wait to go to the toilet but that is not often".

Relatives of people we spoke with also spoke positively about the service, one person told us " I never worry about my relative being here, I come every day and the care is very good, people are treated with respect and staff show themselves to be caring".

We found that people were not always involved in decisions regarding their care and treatment and therefore arrangements for obtaining consent were not always appropriate. The deputy manager acknowledged our concerns and told us they would take steps to improve matters.

People's care was planned and delivered in accordance with their assessed needs. Staff had a good understanding of people's needs and care plans contained sufficient information to ensure people's safety and welfare.

We looked at the arrangements in place for the safe handling of medicines and found people were given their medicines as prescribed, the service carried out daily and weekly audits and medication was stored correctly. This meant the service had suitable arrangement in place for the handling of medication.

We looked at the provider's records and found people's care records were maintained to ensure they were protected from the risks of receiving inappropriate or unsafe care. We also found where the service had recruited new members of staff appropriate checks had been carried out and the service maintained staffs' individual files to demonstrate they had appropriate processes in place for the safe and effective recruitment of staff.