Archived: Harewood House

Updated 18 August 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 checked 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 27 February 2017 and was unannounced. The inspection was carried out by two adult social care inspectors and one adult social care inspection manager.

Before the inspection we reviewed all the information we held about the service which included notifications submitted to CQC by the registered provider. We requested feedback from the local authority commissioning team and two professionals about the service.

The registered provider had completed a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help plan for the inspection.

During the inspection we reviewed a range of records. This included five people’s care records including care planning documentation and medicines records. We also looked at five staff files relating to their recruitment, supervision, appraisal and training. We viewed records relating to the management of the service and a wide variety of policies and procedures.

During the inspection we spoke with three members of staff including the registered manager and deputy manager and one relative. Following the inspection we contacted two relatives to gain their views. We were unable to speak with people who used the service to gain their views due to communication needs.

We used the Short Observational Framework for Inspection (SOFI) during this inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at all the facilities provided including communal lounges and dining areas, bathrooms and people's bedrooms.

Updated 18 August 2017

This inspection took place on 27 February 2017 and was unannounced which meant the registered provider and staff did not know we would be visiting. Two adult social care inspectors and one inspection manager attended this inspection.

Harewood House is registered to provide accommodation for up to 29 older people, almost all of whom are living with dementia or a dementia related condition. Many of the people at the service have specialist needs relating to their behaviour and wellbeing. Accommodation is provided over three floors. There were 17 people living at the service when we inspected.

There was a registered manager in post who had registered with CQC in November 2016. 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.

At the last comprehensive inspection on 25 August 2016, we identified breaches of regulations. The registered provider had failed to provide appropriate supervision to staff, manage risks to people, implement adequate care documentation and monitor and govern the service. The service was rated at that time as inadequate overall and placed into special measures. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation. The registered provider agreed to a voluntary suspension on new admissions. This voluntary suspension was still in place at the time of this inspection.

The service was placed into the collective care process with the local authority in September 2016 due to the number of concerns which had been raised by visiting professionals and CQC. At the time of this inspection Harewood House was still in the collective care process and meetings were ongoing, which CQC had attended.

At this inspection we found the registered provider and registered manager had begun to implement their action plan but we found many concerns still outstanding. We found continued breaches of three regulations relating to safe care and treatment, good governance and staffing.

Risk assessments contained limited information and did not always match care plans. The risk assessments were not regularly reviewed. Some people did not have risk assessments in place when they needed them.

A fire risk assessment had been completed but appropriate action had not been taken to address concerns raised by the fire authority. There were no personal evacuation plans in place. Smoke alarms were not in place where required and regular fire drills had not taken place. The testing of fire alarms had not been recorded appropriately. There were a number of fire doors that did not close correctly and no action had been taken to correct this. Hot water temperatures were not checked to reduce the risk of scalding.

Throughout the inspection we identified several items such as old beds and moving and handling equipment stored in bathrooms and unoccupied bedrooms. Doors had not been secured and these rooms were accessible to all people. Items of furniture and moving and handling equipment were also stored in communal areas. We found broken and damaged furniture in people's bedrooms which could not be cleaned properly.

Accidents and incidents had not been adequately recorded. There were no clear audit trails and the registered manager did not review accidents and incidents. We could not be sure if appropriate action had been taken when an accident or incident had occurred.

Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place. The provider had a policy in place to minimise the risk of abuse occurring. Safeguarding alerts had been submitted to the local authority when needed and appropriate action had been taken.

Medicines were managed appropriately. The provider had policies and procedures in place to ensure that medicines were handled safely. However, this did not contain information on medication that was prescribed ‘as and when required’ or homely remedies. Medication administration records were completed fully to show when medicines had been administered and disposed of.

There was sufficient staff on duty to support people and rotas that we looked at corresponded with staffing levels on the day of inspection. Safe recruitment processes had been followed.

The induction process for new staff was not sufficient to enable them to be fully prepared for their new role. Staff had received training to enable them to support people safely but no practical training had been provided. For example, staff had been shown how to use equipment, such as hoists, by the registered manager who was not an accredited trainer. Staff had begun to receive one to one supervisions to support them within their roles but appraisals had not taken place.

Some best interest decisions lacked professional involvement and it was not clear from the information that was recorded who had been involved in the decision making. The principles of the Mental Capacity Act 2005 were not always followed by staff. People who were subject to a Deprivation of Liberty Safeguard had all relevant documentation available in there care files and DoLS renewal applications had been submitted in a timely manner.

People were encouraged to eat a varied and balanced diet. The meals that were served on the day of inspection matched what was on the menu. Observations showed that people enjoyed the food on offer at the service. Food and fluid monitoring forms had not always been completed fully and contained several gaps in recordings. Records showed that requests for other professional's involvement, such as dieticians, had been recorded appropriately.

Some staff demonstrated caring support but did not always speak to people appropriately to achieve positive outcomes. Relatives told us staff treated people with dignity and respect. Relatives told us they felt they had an input into their relative's care but this was not recorded.

People did not always receive care that was responsive to their needs. We found that some care plans were person centred although this was inconsistent. Others did not always contain details of what was happening in practice. There were no planned activities on offer at the service and we saw very little interaction between people and staff.

The registered provider had a complaints policy that was displayed at the service. This did not contain all the relevant information and required updated information. Relatives told us they were aware of their right to make a complaint.

The service was not well-led. The registered manager did not receive sufficient support from the registered provider. Many quality assurance systems were not in place and the registered manager did not effectively monitor the safety and quality of the service.

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘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 could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.