This focused inspection took place on 25 and 27 June 2018 and was unannounced. At the last inspection on 20 and 26 February 2018, the provider had not met some of the legal requirements. The service required improvement in all of the key questions: is the service safe, effective, caring, responsive and well-led and conditions were then imposed on the provider’s registration. This inspection was in response to continued concerns about the service

We carried out a responsive, comprehensive, unannounced inspection of this service on 20 and 26 February 2018. Breaches of legal requirements were found. After the comprehensive inspection, we received further concerns in relation to:-

• Unsafe medicines management

• Protecting people from avoidable risk of harm ie falls

• Allegations of neglect

• Staff shortages and high use of agency staff

As a result, we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harborne Lane Specialist Centre on our website at www.cqc.org.uk

Harborne Lane Specialist Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Harborne Lane Specialist Centre is registered to accommodate 68 people in one adapted, four storey building. There are three independent units. The ground floor, known as Oak, contained 18 bedrooms to provide a service to people with complex nursing needs. The first floor, known as Willow and the second floor, known as Birch both with 25 bedrooms on each and provided a service to people primarily living with dementia. The home has a range of communal spaces including lounges, dining areas, quiet areas and a large landscaped garden. All the bedrooms are single occupancy with en-suite facilities. There were 49 people living at the home at the time of our inspection. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities, including those living with dementia, learning disability and mental health difficulties.

Since the last inspection, the registered manager had left their employment. There was a new manager in post who told us they intended to apply to become the new registered manager. The 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.

Systems in place to monitor and improve the quality of the service were not always effective in ensuring people received a good quality of service. Where there were audits, they had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Improvement was required with the monitoring and recording of incidents to ensure people were protected from risk of avoidable harm. Where risks were identified, we found that staff were not always following the guidance to minimise that risk. Staff understanding and training on how to support people whose behaviours may be challenging required improvement.

People told us they felt safe and staff understood their roles in safeguarding people from abuse. There were sufficient numbers of staff present to meet people's needs. Checks ha

This inspection took place on 20 and 26 February 2018 and was unannounced. It was Harborne Lane Specialist Centre’s first inspection since registration on 25 September 2017.

Harborne Lane Specialist Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Harborne Lane Specialist Centre is registered to accommodate 68 people in one adapted, four storey building. There are three independent units. The ground floor with 18 bedrooms to provide a service to people with complex nursing needs. The first and second floors both with 25 bedrooms on each, to provide a service to people primarily living with dementia. The home has a range of communal spaces including lounges, dining areas, quiet areas and a large landscaped garden. All the bedrooms are single occupancy with en-suite facilities. There were 39 people living at the home at the time of our inspection on the 20 February and this number had increased to 41 people on the 26 February. The home provides care and support to people from a range of ages, gender, ethnicity and physical abilities, including those living with dementia, learning disability and mental health difficulties.

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.

Systems in place to monitor and improve the quality of the service were not always effective in ensuring people received a good quality of service. Where there were audits, they had not identified the issues we found and had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Where risks were identified, we found that staff were not always provided with the relevant information in people’s risk assessments to keep people safe. There were sufficient numbers of staff present to meet people's needs. However, we observed that where people required one to one support, as a part of their care plan, staff were not always able to provide this due to being busy elsewhere.

People's medicines were not always managed safely. We found shortfalls in the way that medicines were stored and monitored. Nursing staff did not consistently receive the clinical supervision that they needed and there was a lack of oversight from the provider.

Checks had been undertaken on new staff as well as agency staff to ensure they were suitable for their roles. Staff understood their roles in safeguarding people from abuse, but possible safeguarding issues had not been reported to the appropriate authorities. Where complaints or concerns were raised, the provider responded to them. However, there was no analysis of complaints to identify and monitor for trends to reduce the risk of reoccurrences.

Although there was a contingency plan in place in the event of an emergency, we had identified some issues with the placement of some fire-fighting equipment. We made a referral to the fire service to review the fire procedures and equipment for the service.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Where people lacked the mental capacity to make informed decisions about their care, it was not always clear how relatives, friends and relevant professionals were involved in best interest's decision making. Mental capacity assessments and best interests decisions were not always applied consistently to clearly show wh