Archived: Harriets

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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Harriets is a 41 bedded care home situated in the centre of Distington, a village near to Whitehaven. The home is within walking distance of all the amenities of the village. The accommodation is all on the ground floor. The home has a dementia care unit. Accommodation is in single rooms with ensuite toilet facilities. There are suitable shared areas in the home. Outside there are small patio areas where people can sit out. Parking is in the public car park near to the home.

The home had a registered manager. 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.

Staff in the home were aware of their responsibilities in protecting vulnerable people from harm and abuse. Staff told us that they could report any concerns to management. There had been a number of falls in the home which may have been related to the staffing levels. Some risk management plans did not lessen this and other risk so that people were always kept safe.This was a breach of Regulation 12(1)(2)(a)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because risk was not being managed effectively to keep people safe. You can see what action we told the provider to take at the back of the full version of the report.

Staffing in the home did not keep people as safe as possible. This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because there were not enough staff on duty to ensure people were safe and well cared for at all times. You can see what action we told the provider to take at the back of the full version of the report.

Staff recruitment was being managed appropriately and disciplinary procedures were in place.

Medicines management was adequate and the manager was completing on-going audits of this.

Infection control had been improved and staff were aware of their responsibilities.

Staff had received training with more planned for 2016. All staff had received recent formal supervision with more regular supervision planned.

We recommended that both formal and informal supervision be progressed to ensure staff development was in place.

We also had some evidence to show that communication both internally and with professionals was improving and we made a recommendation that this is progressed.

The staff team understood their responsibilities under the Mental Capacity Act 2005 and took steps when they considered that they were depriving anyone of their liberty. No one in the service was subject to restraint and consent was gained wherever possible before any interventions were in place.

Nutritional planning was in place and staff understood people's needs quite well but this planning needed to be developed a little more with some individuals.

We recommended that nutritional planning be developed further and that more details were recorded in food and fluid charts.

The home was clean but not as tidy and well cared for as it could have been. There was a malodour in the building because there was a problem with plumbing or drainage. One unoccupied wing had no heating. Some bathrooms and toilets needed to be upgraded. This was a breach of Regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the environment was not being maintained appropriately. You can see what action we told the provider to take at the back of the full version of the report.

We saw staff treating people with kindness and respect. Most of the staff supported people's dignity and privacy. We had some evidence that not all staff treated people appropriately. The registered manager was aware of this and was taking steps to deal with it. We recommended that staff were encouraged to reflect and amend their practice.

We looked at a range of assessments and care plans. We saw that everyone in the service had an up to date care plan and some plans were suitably detailed. Some plans needed a little more detail and plans were not written in a person centred way.We recommended that some more detail be added to some plans and that a more person centred approach be taken when writing plans.

The home provided a range of activities and local groups visited the service. Spiritual needs were met through regular church services.

Complaints were suitably managed in the service.

The home had a suitably qualified and experienced registered manager. Staff and service users were happy to have an established manager after going through a period of change and instability.

We had evidence to show that the registered manager and the senior managers of the organisation worked with staff so that they understood the vision and values of the company and the service. We saw that the manager promoted sound values that the staff team could follow.

The organisation had a suitable quality monitoring system in place. We noted that the registered manager and her management team, the operations managers and the chief executive had noted some of the problems we identified. We judged that the organisation was not as proactive as they might be when they were dealing with improving quality.This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because although quality auditing was in place problems in the service had not been dealt with in a timely or appropriate manner.

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. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Harriets’ on our website at www.cqc.org.uk.

The inspection was undertaken by an adult social care inspector. The provider was given 48 hours’ notice because we wanted to discuss the issues around risk management and leadership with the registered manager and with other senior members of the company.

Harriets is a 41 bedded care home situated in the centre of Distington, a village near to Whitehaven. The home is within walking distance of all the amenities of the village. The accommodation is all on the ground floor. Accommodation is in single rooms with ensuite toilet facilities. There are suitable shared areas in the home. Outside there are small patio areas where people can sit out. Parking is in the public car park near to the home.

The home had a registered manager. 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.

We judged that the provider had ensured that risk assessment and risk management had commenced and that issues discovered at our January 2016 inspection had been dealt with in this interim period.

We had evidence to show that staffing levels had increased and that the deployment of staff had been considered so that suitable ratios of staff to people in the home were in place.

Matters around good governance had been addressed by the provider. Senior officers of the company had given the registered manager good levels of support in checking on quality matters in the home.

We judged that the provider had responded to the matters contained in the warning notices but we have not changed the overall rating for the service because to do so requires consistent good practice over time. We will check this during our next planned Comprehensive inspection.