Archived: Harwich House

Updated 22 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by one Inspector.

Service and service type

Harwich House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the Care Quality Commission. This means that they and the provider, are legally responsible for how the service is run and the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection because it was a small service and people were often out. We announced the inspection on 11 March 2020 and inspected the home on 12 March 2020. We spoke to relatives on 13 and 16 March 2020.

What we did before the inspection

We reviewed information we had received about the home since the last inspection. The registered manager had submitted a provider information return (PIR) since the last inspection. A PIR is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We contacted six external health and social care professionals for their feedback about the service and received four responses. We used all this information to plan our inspection.

During the inspection

We spoke with one person, four members of staff, the registered manager and the locality manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records about people’s care and how the service was managed. These included the individual care and medicine administration records for three people. We looked at four staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, which included policies and procedures, were also reviewed.

After the inspection

We sought assurances from the registered manager in relation to the care people received. We spoke to two relatives to enable them to share their feedback about the service people received.

Updated 22 April 2020

About the service

Harwich House is a residential care home that provides support for up to nine people who are living with a learning disability or autism. The service is based in Littlehampton, West Sussex and is provided by a national provider, Aitch Care Homes (London) Limited.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with a learning disability and/or autism to live meaningful lives that include control, choice and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercoms, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people. At the time of inspection seven people were using the service.

People’s experience of using this service and what we found

Risks to people’s safety had been assessed yet there were insufficient measures used to ensure the guidance provided to staff had been followed. Two people had not been supported in accordance with their assessed needs in relation to modified diets and fluids as well as a known health risk. Medicines management was not always safe.

There was a lack of oversight to assure the registered manager and provider that people were receiving safe and effective care that met their assessed needs. Issues found as a result of the inspection had not been identified by the quality assurance processes used.

Staff had received training specific to people’s needs yet issues found at the inspection raised concerns about the quality and effectiveness of training and the understanding of some staff. Staff were provided with clear guidance based on people’s assessed needs yet had not always implemented this in practice.

People’s goals and aspirations had not been fully considered. We have made recommendations that the registered manager and provider seeks advice and guidance from a reputable source in relation to ensuring people's needs and aspirations are appropriately considered and planned for.

People were provided with choice about what they had to eat, and drink and were observed enjoying the food that was provided. Changes to the menus had been made to ensure people received a balanced diet to support their health and well-being. People’s needs had been considered in the adaptation and design of the building. Changes had been made to communal spaces to ensure there were areas for people to use should they prefer time away from others.

Without exception, relatives told us staff were kind and caring. People were comfortable in the presence of staff and were observed holding staff’s hands and showing affection. Staff responded appropriately, reminding people of boundaries whilst showing people they cared. People’s independence was encouraged. People were asked their opinions and were supported to retain and develop skills such as gathering laundry. One person sometimes supported staff when preparing food or drinks. People were treated with respect and their privacy and dignity was maintained.

Staff were mindful of the importance of supporting people to enjoy new experiences. People were supported to play an active part in the local community and enjoyed trips to local areas, cafes, shops and places of interest. People and their relatives were able to share their concerns and make complaints if they were unhappy with any aspect of care. Relatives told us when they had raised concerns these had been listened to, acted on and changes made as a result.

The registered manager supported staff to implement the provider’s values in practice. People, relatives and healthcare professionals worked together to ensure people were supported in their best interests and valued as individuals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems supported this practice.

There were enough staff to meet people’s assessed needs. Lessons had been learned from incidents and accidents and practice was changed to ensure people’s safety and well-being. People were protected from the spread of infection.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this home was Good (Published 14 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to oversight of risks and safety and the leadership and management of the service. Please see the action we have told the provider to take at the end of this report.

Follow-up

We will continue to monitor the intelligence we receive about this service. We will request an action plan from the registered manager to understand what they will do to improve the standards of safety and governance. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.