Harmony House

Harmony House is a care home in Salford which is registered with CQC to provide care for a maximum of 12 people. There were 9 people using the service at the time of the inspection.

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

At our last inspection in April 2022 we identified concerns regarding the safe management of medication (particularly storage), infection control procedures relating to COVID-19, the environment and governance systems. We found some of these concerns had now been addressed.

Although we found some improvements had been made, appropriate action had not been taken to ensure the environment was properly maintained. A registered manager had not been in post for over 6 months which is a requirement of the home’s registration.

There were enough staff to care for people safely and correct staff recruitment procedures were followed. Staff understood about safeguarding and how to report concerns.

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 in the service supported this practice.

There were systems in place to seek feedback from people living at the home, including the use of satisfaction surveys. Out of hours spot checks were also undertaken and staff supervisions held. Audits were carried out by both the provider and acting home manager.

Rating at last inspection

The last rating for this service was requires improvement (published May 2022) and the provider was in breach of regulations relating to good governance and safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of certain regulations.

Why we inspected

We carried out a focused inspection of this service in April 2022. Breaches of regulations 12 and 17 were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected (Effective, Caring and Responsive) we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harmony House on our website at www.cqc.org.uk.

Recommendations:

We have made a recommendation that the provider continues to monitor the quality of the environment to ensure improvements continue and are sustained.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Harmony House is care home which provides personal care and accommodation for people with mental health difficulties and is located in Salford, Greater Manchester. The home is registered with the Care Quality Commission (CQC) and can care for up to 12 people. At the time of this inspection there were 10 people living at the home.

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

Medicines were not managed safely and storage arrangements needed to be improved. There was no process in place to monitor the lateral flow test (LFT) results of people visiting the home and in particular, visiting professionals and relatives. Staff said although they completed LFT prior to their shift, the results were not always checked by management. There was inconsistent use of personal protective equipment (PPE) from staff.

A safeguarding alert had not been made for one person who had returned home from hospital with unexplained bruising. We asked the acting manager to complete this immediately. We have made two recommendations regarding staff recruitment and staffing levels and at the home in the evenings and overnight.

Our inspection had been carried out in response to concerns raised by both environmental health and infection control teams at Salford City Council. Although, we found the building required modernising throughout, an action plan was in place and the provider was working towards completing the required renovations needed. The front garden/car park area in particular had not been properly maintained and created a poor first impression of the home, with lots of weeds and stray litter scattered on the floor.

Governance systems needed to be improved to ensure they provided a focus on and also identified the concerns from this inspection. Accurate records of care were not maintained and people did not always have appropriate care plans in place. Staff meetings and supervisions had not taken place for some time and confidential information was not always stored securely.

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 in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was good (published September 2017). The rating at this inspection had deteriorated to requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to environmental health and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from good to requires improvement. This is based on the findings from this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to people's safety and leadership of the service.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Harmony House provides 24 hour care and support to people living with mental health needs. The home is located in Eccles, Salford and is registered with the Care Quality Commission to provide accommodation to up to 12 people.

We last inspected Harmony House in February 2017 when the home was rated as ‘Requires Improvement’ overall and for the key questions ‘Safe’ and ‘Effective’. ‘Caring’ and ‘Responsive’ were rated as ‘Good’, however the well-led key question was rated as ‘Inadequate’. This was due to the home remaining as Requires Improvement at consecutive inspections and for on-going governance and quality monitoring issues at the service. As a result, we issued warning notices for regulation 17 (regarding good governance) to the registered manager and provider telling them they must improve.

Following our February 2017 inspection, the provider sent us an action plan detailing the changes and improvements they intended to make to improve the quality of service provided to people living at the home. We took this into account when planning this inspection to ensure these actions had been completed.

At this inspection, we found the provider had made all the required improvements and addressed all our concerns that had been highlighted last time we visited the home.

People told us they felt safe living at the home. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

Improvements had been made to ensure medicines were handled safely. Cream charts and risk assessments for people who were able to take their own medication were now in place which had been an area of concern at our last inspection.

In February 2017, we had observed parts of the building to be in a poor state of repair. This included a wall and gate at the front of the home having fallen down, as well as dirty and worn arm chairs and settees in the lounge area. Since then, the wall and gate had been repaired and furniture replaced where necessary.

Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken. The home had not recruited any new staff since our previous inspection.

There were enough staff working at the home to meet people’s needs. Feedback from people living at the home and staff was that staffing levels were sufficient. Several staff had left since our last inspection including a support worker and a member of kitchen staff. The manager told us recruitment for these vacancies was currently ongoing.

Staff received an induction when they started working at the home, providing them with an insight to working at Harmony House. Improvements had been made with regards to staff training, supervision and appraisal which had been a concern at our last inspection.

At the time of this inspection there was nobody living at the home subject to a DoLS (Deprivation of Liberty Safeguards). People were free to leave the home when they wanted and went in to the community independently. People’s mental capacity was reviewed and we saw people were not being unlawfully deprived or detained.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. Meal times were flexible and we observed people entering the kitchen and making their own meals. Staff cooked an evening meal and several people told us they enjoyed going shopping with staff for meal ingredients and snacks.

All of the people we spoke with during the inspection, including people living at the home made positive comments about the care and support provided.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible. People told us they enjoyed being independent and being able to go out on their own.

People felt the home was responsive to their needs. Each person living at the home had their own care plan, which was person centred and detailed people’s choices and personal preferences.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection.

The home had now taken sufficient action to address the governance concerns we had found at our last two inspections. There was a range of quality audits in place done by both the registered manager and provider. These were up to date and completed on a weekly and monthly basis.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns.

Staff told us they enjoyed their work and liked working at the home and enjoyed their jobs.

Harmony House provides 24 hour care and support to people living with mental health difficulties. The home is located in Eccles, Salford and is registered with the Care Quality Commission to accommodate 12 people.

We last inspected Harmony House on 18 August 2015. The home was rated as ‘Requires Improvement’ overall and in the ‘Responsive’ and ‘Well-led’ key questions. This was due to care plans not being in place and a lack of quality assurance systems to monitor the service effectively. The key questions of ‘Safe’, ‘Effective’ and ‘Caring’ were rated as ‘Good’. A breach of regulation with regards to Good Governance was also identified. The home sent us an action plan following this inspection, detailing the improvements they planned to make.

During this inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment, Premises and Equipment, Good Governance and Staffing. You can see what action we have asked the provider to take at the end of this report.

People living at the home told us they felt safe living at the home. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We looked at how medication was handled. This wasn’t always done safely because we found two missing risk assessments for people who self-medicated and also one cream chart that wasn’t in place, informing staff where this needed to be applied to the person’s body. This meant staff didn’t always have access to sufficient guidance about how people needed to receive their medication safely.

We observed that areas at the home were not always well maintained. For instance, the wall at the front of the home was crumbling and was in a poor state of disrepair. The gate at the front of the home, although not in use, was loose and hanging from the wall. This left the home looking unkempt from an external view and did not create a good first impression. The settee and arm chair in the main lounge were also worn and dirty and needed to be replaced. The manager acknowledged this and said this had been raised with the provider but not yet actioned.

Staff were recruited safely with references from previous employers being sought and Disclosure Barring Service (DBS) checks undertaken.

There were enough staff working at the home to meet people’s needs. Feedback from people living at the home and staff was that staffing levels were sufficient.

Staff received an induction when they started working at the home, providing them with an insight into working at Harmony House. Staff supervisions and appraisals however had fallen behind and were not being conducted in line with the homes policy and procedure which was every three months, with an annual appraisal in addition. The manager acknowledged this could be improved.

We found staff training had lapsed in areas such as Safeguarding and MCA/DoLS. Two members of staff also hadn’t undertaken medication training since 2014. One member of staff, who started working at the home in December 2016 hadn’t yet completed any training apart from medication. This member of staff worked alone at the home at night when we looked at the rotas. The manager said this training would be immediately scheduled following the inspection.

At the time of the inspection we were told there was nobody currently subject to a Deprivation of Liberty Safeguards (DoLS) order. People were free to leave the home when they wanted to and we saw people weren’t unlawfully deprived or detained and went out into the community independently.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. Meal times were flexible and we observed people entering the kitchen and making their own meals. Staff cooked an evening meal and several people told us they enjoyed going shopping with staff for ingredients.

All of the people we spoke with during the inspection, including people living at the home made positive comments about the care and support provided.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible. People told us they enjoyed being independent and being able to go out on their own.

People felt the home was responsive to their needs. Each person living at the home had their own care plan, which was person centred and detailed people’s choices and personal preferences.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection.

The home had introduced quality assurance systems since our last inspection which we had identified as an area of concern. This required further improvement however, due to the concerns we identified in relation to missing risk assessments for people who self-medicated and the fact staff supervision, appraisal and training had lapsed in certain areas. Infection Control audits also hadn’t been completed since November 2016. The manager told us the issues relating to the maintenance of the premises had previously been raised with the provider, but that action had not yet been taken to rectify these issues.

There had also been a failure to improve the overall rating of the service from ‘Requires Improvement’, which was what the home had been rated as during our last inspection, nearly 18 months ago. This meant the quality of service provided to people living at the home was not continuously improving over time as is the expectation.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns.

Staff told us they enjoyed their work and liked working at the home and enjoyed their jobs.

Overall, we found that people were happy and felt well supported by all the staff. We found that people were able to come and go as they pleased, and took part in activities which gave them pleasure.

During our inspection we found there were appropriate systems in place for people to provide consent to their care and support.

We looked at how people living at Harmony House received their medication and looked at the systems in place to ensure this was done safely. One person said to us;' I get my medication on time. I know when I need it anyway but the staff are good'.

We spoke to staff to establish if they felt suitably supported to carry out their job role effectively. One member of staff said; 'This is my first job working in care. I feel I was given a good introduction when I started and there is plenty of support available'.

We found that there were effective systems in place to monitor the quality of service provision at Harmony House.

'The home is excellent; the staff encourages and support people to pursue their own interests'.

'The home is well maintained'.

'The staff have excellent knowledge and understanding of peoples individuals needs'.

'The manager and staff have good contact with both families and residents. This important for the well being of the residents'.

People who lived at the home told us:

'I am very happy here, the staff are lovely'.

'I'm fine with everything'.

'It is great living here, I love it. I have been in other places but this is the best'.