The inspection took place on 3 and 8 November 2018 and was unannounced.

Harbour House is a residential care home for up to 35 older people. The building offers accommodation over two floors with lift access to each floor and two adjoining cottages. People have access to communal lounge and dining areas, an accessible garden and outside space. There were 29 people living at the home at the time of inspection.

Harbour House 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.

Harbour House is a Quaker Home. The home was built in 1964 by a Quaker who had an innovative vision to build individual rooms for residents with en suite bathrooms and kitchenettes, with a focus on maintaining people’s independence. All decisions are made with consideration about the Quaker ethos: ‘Thinking with an open mind rather than following strict rules and regulations.’ The founder of the home ensured that a committee of both Quaker and non Quaker volunteers would be involved in decisions about the service and this is still in place. Although some people at Harbour House are Quaker, the home is inclusive and people have a diverse range of cultural and spiritual beliefs.

Harbour House provided outstanding person centred care. Feedback from people, relatives and professionals was that support provided was exceptional and that the home was extremely well managed.

The management of the service was cohesive and driven to ensure that people received extremely high quality support. Staff spoke with enthusiasm about their role and the staff team. Suggestions and ideas were welcomed and staff were encouraged to work autonomously.

Harbour House had strong links with the community and people were encouraged and enabled to maintain their independence. Support was respectful and staff consistently referred to Harbour House and the people they supported as their family.

Harbour House had a strong ethos and considered the spiritual and cultural needs and preferences of people when making any decisions. People were engaged and involved in changes at the service and enabled to communicate in different ways which were reflective of people’s individual needs.

Harbour House worked with people and staff to ensure that people were treated equally and that their protected characteristics under the Equality Act were respected and promoted.

People received high quality end of life care which respected and supported people’s wishes and also provided support for other people and staff when a person died.

Professionals spoke extremely highly about the service and the effective communication and engagement. Training opportunities were inclusive and we saw examples of training being given to visiting health professionals, people and other local providers as well as staff.

The registered manager had strong links with local organisations and was involved in considering innovative options for improving people’s lives by reducing acute hospital admissions. They also provided support for other local providers and registered managers.

Harbour House had been nominated for two national care home awards and had been finalists for an award in 2017 also.

Staff were aware of their responsibilities in protecting people from harm and knew how to report any concerns about people's safety or wellbeing. People had individual risk assessments giving staff the guidance and information they needed to support people safely.

People were supported by staff who were recruited safely and were familiar to them. People, relatives and professionals felt that staff had the sufficient skills and knowledge to support them and we saw that staff had access to relevant training for their role. Staff received regular supervision and appraisals and we saw that they also had competency checks to monitor their

The inspection took place on the 24 and 27 May 2016 and was unannounced. We last inspected Harbour House on the 24 June 2014 and found they were meeting all requirements.

Harbour House provides residential care without nursing for up to 35 older people. There are 30 rooms with the facility for two rooms to be shared by couples and one room is booked in advance for short stays. There were 32 people living at the service when we visited. The service’s website states, “Harbour House is a purpose built residential home for active elderly people”.

A registered manager was employed to manage the service. 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. The service is a not for profit organisation supported by a management committee to meet people’s needs in line with the Quaker philosophy of care the central idea being that by living together in organised and caring environments, individuals' health, emotional and spiritual well-being can benefit hugely.

People told us they were safe and happy living at Harbour House and were looked after by staff who were kind and treated them with respect, compassion and understanding. All staff expressed a commitment to the values of providing only good care and to continue to improve the service.

People were in control of every aspect of their care. People’s medicines were administered safely and they had their nutritional and health needs met. People could see other health professionals as required. People had risk assessments in place so they could live safely at the service. These were clearly linked to people’s care plans and staff training to help ensure care met people’s individual needs. People’s care plans were written with them, were personalised and reflected how people wanted their care delivered. People’s end of life needs were planned with them. People were supported to end their life with dignity and free of pain.

Staff knew how to keep people safe from harm and abuse. Staff were recruited safely and underwent training to ensure they were able to carry out their role effectively. Staff were trained to meet people’s specific needs. Staff promoted people’s rights to be involved in planning and consenting to their care. Where people were not able to consent to their care, staff followed the Mental Capacity Act 2005. This meant people’s human rights were upheld. Staff maintained safe infection control practices.

Activities were provided to keep people physically and cognitively stimulated. People’s faith and cultural needs were met.

There were clear systems of governance and leadership in place. The registered manager and management committee ensured there were systems in place to measure the quality of the service. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously. Regular audits made sure aspects of the service were running well. Where issues were noted, action was taken to put this right.

Our inspection set out to answer five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living in the home, and with the staff supporting them, and on looking at records.

Is the service safe?

People told us they felt safe. One person said, “you never [need to] think about it really.” Another person told us that they were completely comfortable there, describing it as “home from the first day”.

The home had procedures and training in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS), although no applications had been submitted. Staff knew about DoLS, and how to obtain further advice and support.

Recruitment practice was thorough, and staff worked with supervision until they had received training to make sure they were safe to work alone.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, and complaints. Policies and practices were in place to make sure that unsafe practice was identified, and people were protected.

Is the service effective?

People’s health and care needs were assessed with them and they were involved wherever possible with their care plans. Specialist support and care was identified in care plans. People at risk of falling were monitored closely to reduce the risk of further falls.

The service provided a home for people who needed differing levels of support and care. There were opportunities for people were able to remain independent if this was what they wished.

Is the service caring?

People praised staff for being caring and supportive. One person said that staff “delight in helping you.” A relative told us that it was the quality of staff that had helped them choose Harbour House. They said that staff had sorted everything quickly at the time when the person was ready to leave hospital. They said, “I couldn’t speak more highly about it.”

People’s preferences, interests and needs were recorded, and care and support was given in accordance with their wishes.

Is the service responsive?

The home responded to complaints and suggestions. Staff responded to people’s changing care needs in a timely manner. People told us that staff responded to being asked for help. One person said, “It’s always easy to go and talk to staff.” Another person told us that staff were “extremely helpful” in assisting them to make decisions.

Staff worked closely with other agencies and services to make sure that people received the most appropriate care and treatment when their needs changed.

Is the service well-led?

The service had a quality assurance system that was in the process of being strengthened. Management accountabilities were clear. Staff told us that they understood their roles and accountabilities. There was evidence of ongoing change and improvement.

People living at the home, and staff, expressed confidence in the leadership.

Our inspection of 4 June 2013 found that provider had not always completed current assessments of some people’s needs. We saw the provider did not have an effective system to review people’s care records, and that records were not accurate.

During this inspection, we found that the home had completed new care records for people that showed their individual needs and risks.

The provider now had an effective system to monitor and review people’s care records.

We found that people’s records were accurate and reflected their current needs and risks.

We spoke with eight people during our inspection. All spoke positively about the home, the care they received and the staff that provided their care and treatment. One person told us, “They (the staff) are fabulous, they couldn’t do any better” and another person said, “I’m as happy as I can be, the girls (staff) are lovely.” However, we saw that the provider had not always completed an assessment of people’s needs to fully protect people from the risk of receiving inappropriate or unsafe care or support.

People were protected from harm as there were appropriate safeguarding procedures, and staff told us they felt supported by the provider through regular training.

The home had some suitable systems to monitor the quality of service provided. However, the absence of care plan documentation auditing had not ensured that care records were correct or had been accurately completed.

We found that some care records were not completed and did not contain appropriate information and some records were incomplete.

We spoke with people who use the service and they told us that “the food was very good” and that staff were “friendly and jolly”. People said they felt “very safe” and one person told us “there is nothing I would like to change” when asked about their views on the service.

During our inspection we found that people were involved in their care and their needs were being met. However, staff did not have any training files to monitor their training and the staff had not received training in key areas for about two years. We also found that the home did not undertake quality assurance checks and policies and procedures were out of date.