This inspection took place on 07 and 08 August 2018 and was unannounced. At our last comprehensive inspection completed in March 2017, we rated the service as ‘requires improvement’ and identified three breaches of regulation regarding safe care and treatment, staffing levels and the overall management and quality control within the service. We returned in August 2017 and found improvements had been made and the legal requirements were being met. The service remained rated as ‘requires improvement’.

Harden Hall is a ‘care home’. People in care homes receive accommodation and 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 care home accommodates up to 54 older people in one purpose built building. At the time of our inspection there were 52 people living at the service. Many of the people living at Harden Hall are living with dementia.

A registered manager was in post. 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 provider and registered manager were making improvements to the layout and utilisation of the building in order to meet people’s needs effectively. Positive changes were being made including the introduction of a pub area and redecoration within the service. At the time of the inspection some people had insufficient access to outdoor space which impacted on their wellbeing.

Staff knowledge around the Mental Capacity Act 2005 had improved, however, there were inconsistencies in the effective use of this Act. Appropriate consent and best interest decisions were not always consistently made.

People were supported by a staff team who understood how to minimise the risk of abuse and injury from accidents. Lessons were learned from any accidents or incidents that arose. This was used to drive improvements and minimise future risk. People received their medicines safely and as prescribed and were protected appropriately from the risk of infection. People were supported by sufficient numbers of staff who had been recruited safely.

People enjoyed the food and drink they received. People were supported to maintain their day to day health. A healthcare professional gave positive feedback about the support provided by staff. Improvements had been made to the quality of care people received.

People were supported by a staff team who were kind and caring towards them. People felt valued and important. People were supported to make choices about the care they received. People’s independence was promoted. People were supported to received visits from their friends and family.

People were involved in the development of their care plans and were consulted about the care they received. Where appropriate, people’s relatives or representatives were involved.

People enjoyed access to a range of leisure opportunities and further improvements were underway. People were consulted about how they wished to spend their time and staff respected the differences between individual people.

People felt able to raise complaints and concerns. Where complaints had been raised an appropriate investigation had taken place and response sent.

People were cared for by staff who were supported, motivated and worked well as a team. People were involved in the development of the service and had a voice which was heard and acted upon.

The provider and registered manager had made improvements to quality assurance systems in the service. Where further improvement was required this had been identified and work on remedial action was underway. The provider was committed to providing a quality service to people and appropriate support s

This focused inspection took place on 15 August 2017 and was unannounced. At the last inspection completed on 01 and 02 March 2017 we identified improvements were required within the service. We gave a rating of ‘requires improvement’ and found the provider was not meeting the regulations around safe care, staffing levels and the governance of the service. We carried out this inspection to see if the provider was now meeting these regulations. We found improvements had been made and the regulations were now being met, however, some further improvements were still required.

Harden Hall is a residential home providing accommodation and personal care for up to 54 people. At the time of the inspection there were 48 people living at the service, most of whom were older people living with dementia. The registered manager had left the service following the last inspection. A new manager was in post who was going through the process of applying to register as the manager with CQC. 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.

People were supported by a management team who were committed to driving the required improvements within the service. Quality assurance and governance systems had been improved and resulted in improved standards of care for people. Some further improvements were required to ensure records were accurate, well maintained and that these systems were consistently effective.

People were protected by a staff team who understood how to protect them from potential abuse and mistreatment. Where any concerns had been identified plans were put in place to protect people from further harm. People were also protected by a staff team who understood how to reduce the risk of harm that may be caused by accident or injury.

People were supported by sufficient numbers of staff who had been recruited safely. People received their medicines safely and as prescribed.

People were happy in their homes, they felt listened to and heard. People felt the service was well managed and could see the improvements being made. People were supported by a staff team who also felt supported by managed and were motivated in their roles.

This inspection took place on 1 and 2 March 2017 and was unannounced. At the last inspection that took place on 11 July 2016 we rated the service as being ‘good’ however we found improvements were needed in the management of medicines. At this inspection we found these issues had been addressed and the required improvements made. However, we identified concerns with how risks were managed, the number of staff available, how people’s dignity was maintained and the leadership of the service and the provider was not meeting all of the requirements of the law. Harden Hall is registered to provide accommodation for up to 54 people who require nursing or personal care. At the time of our inspection there were 49 people living at the service. Most people were living with dementia.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were not supported by sufficient numbers of staff. People had to wait for care and support and they were at risk of harm due to the lack of staff. People were sometimes exposed to harm such as injury due to the ineffective management of risks. People told us they were supported to take their prescribed medicines safely and as prescribed. People felt safe and we could see there was a system in place to take action to investigate where signs of abuse were identified.

People were not always supported by staff that had knowledge and skills to provide effective care. Staff were not aware of how to manage behaviours that challenged and did not follow the training received for reporting safeguarding incidents. People’s capacity was assessed where people lacked capacity staff were making decisions on their behalf in their best interests in line with the principles of the mental capacity act. People had a choice of meals and received sufficient food and fluids to meet their needs. People were supported to maintain their health and could access support from professionals when required.

People were not always supported in a way that promoted their dignity and privacy. Dignity was not always promoted due to the insufficient numbers of staff available. People were not always supported with the right equipment to maintain their independence. Some people needed access to equipment to help them eat their meals. People received support from staff that were caring. Staff spent time getting to know people and people told us they had good relationships with staff. People were supported to make choices about their care and support.

People were involved in their care and support. People were able to identify their preferences and these were understood by staff. Staff could tell us about peoples preferences and this was reflected in peoples care plans. People had access to a range of activities and chose how to spend their time. People could make a complaint and complaints were responded to in line with the policy.

The service was not always well led. Some staff felt unable to approach the registered manager and felt action was not always taken to address areas of concern. The registered manager had systems in place to check on the quality of the care people received but they were not always effective.

During this inspection we found the provider was not meeting the requirements of the law regarding safe care and treatment, sufficient numbers of care staff and the effective management of the service. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 11 and 12 July 2016 and was unannounced. At the last inspection completed on 18 February 2014 the provider was meeting all of the legal requirements that we looked at.

Harden Hall is a residential home that provides personal care and accommodation for up to 54 older people, most of whom are living with dementia. At the time of the inspection there were 54 people living at Harden Hall. A registered manager was in post. 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.

People were protected from potential abuse by a staff and management team who knew how to identify and report any potential concerns. Staff members understood the potential risks to people and how to reduce those risks in order to keep them safe. The provider had safe recruitment processes in place to ensure only suitable staff were employed.

People were not always protected by safe medicines administration and recording practices. People did not always have sufficient quantities of their medicines made available to them. Staffing levels were not always sufficient to ensure people’s needs were met responsively.

People were supported by a staff team who had access to regular training and support from their manager. People were supported to consent to the care they received. People’s nutritional and hydration needs were met effectively. People were supported to access healthcare professionals in order to maintain their day to day health.

People were supported by a staff team who were caring in their approach and understood their needs. People were enabled to make day to day choices about their care. People’s privacy, dignity and independence were promoted and they were treated with respect. People were supported to maintain important relationships with friends and relatives.

People and their representatives were involved in planning and reviewing their care. The care people received met their needs and preferences and this was reflected in their care plan. People were supported to take part in leisure opportunities. People told us they knew how to complain and felt confident their concerns would be addressed by management.

People were involved in sharing views about and developing the service. People were supported by a committed, motivated staff team who felt supported by the registered manager. The registered manager was visible in the service and understood their legal responsibilities. Quality assurance checks were completed across the service to identify areas for improvement and further develop the service provided to people.

We visited Harden Hall in October 2013 and found improvements to the service were required. We carried out this inspection to see if these improvements had been made since our last visit. We had previously asked the provider to send us an action plan giving details of how improvements to the service would be made. To date we have not received a copy of this action plan.

The manager in post at the time of the inspection was not registered with the Care Quality Commission (CQC). We had been told that registration was being completed. At the time of this inspection CQC had not received a registered manager's application. We are addressing this with the provider outside of the inspection process.

We involve people who use services who have unique knowledge and experience of using social care services; we call them experts by experience. Together with the expert by experience, we spoke with five people living at the home, three visitors to the service, seven staff members, the managers and the area manager.

People living at the home were complimentary about the staff and the care and support they provided. One person living at the home told us: “The staff are very nice”. We were also told: “The staff here are lovely”. A visiting relative said: “I can’t give anything but a good report. We were just saying how lucky she is to be living here”. We saw that people’s care needs were assessed and care plans were in place. When a change to care needs was identified a review of the care plan was completed.

Since our last inspection there had been an increase in staff working over night at Harden Hall. The staff we spoke with agreed that this was an improvement to the service. We observed that during the inspection there was sufficient staff to support people with their care requirements. We saw that staff supported people in a calm unrushed manner. One person told us: “I don’t have any problems getting hold of staff at night”.

The manager in post at the time of the inspection was not registered with CQC. We had visited the service in October 2012 and July 2013 and had been told that registration was being completed. At the time of this inspection CQC had not received a registered manager’s application.

In order to target our inspections effectively we continually gather information about services. Before an inspection we review the information we hold. The information directed us to look at the staffing levels at the home.

All of the people we spoke with were complimentary about the staff. One person said; “The staff are very good”. The visitors we spoke with were confident that they were kept informed regarding their relatives welfare.

Care plans were available to inform staff of the care requirement of people living at the home. The guidance recorded was not always followed in a consistent manner, for example we saw there were gaps in fluid and food charts. The risk assessments in relation to moving and handling were not robust and did not ensure staff had the necessary information to deliver appropriate and safe care.

We viewed the rotas and spoke with people about the staffing levels. The staff we spoke with were concerned about the low numbers of staff scheduled to work each shift, particularly at night. We saw, and staff told us that the allocation of staff did not allow for staff dealing with emergences which were reasonably expected to arise from time to time.

The visit was unannounced which meant the provider and the staff did not know we were coming. We were accompanied in the inspection by an expert by experience. Experts by experience are people who have unique knowledge and experience of using social care services. Together we spoke with 13 people living at the home, nine visitors to the service, three staff members and two senior managers.

People we spoke with told us that staff were courteous and treated them with respect. One person said; “I am very happy here, I have been made to feel very welcome”. We saw that care plans and risk assessments were in place and reviewed monthly. The staff we spoke with told us the care plans gave them the appropriate information to deliver care in a consistent manner. One person living at the home said, “I can’t fault the place”.

We looked at the recruitment process at the home. The two staff files we viewed held the appropriate documentation, for example application form, references and disclosure and barring service (DBS) certificates. We looked at staff training for protecting vulnerable adults all of the staff we spoke with confirmed that had received this training.

We found there was a quality monitoring process in place. People living at, and visiting the home had the opportunity to comment on the quality of the service via a satisfaction survey.

We had received concerns about the care and support provided to people who live in this home. These concerns had been raised by the local authority. At the time of our inspection the local authority had stopped new placements of people in this home.

On day of visit there were 36 people living at the home which is registered to accommodate 56 people who require personal care. The manager at the home was newly appointed and had been in post for five weeks. We were told they were in the process of registering as the manager with the Care Quality Commission (CQC).

We observed that staff were courteous and spoke to people living at the home in a polite manner. The care plans we viewed held the relevant information staff required to deliver care in an appropriate and consistent manner.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). The staff we spoke with said they had received training and were able to tell us how they would report concerns.

The staff we spoke with said they had received induction training prior to starting work at Harden Hall. They said further training had been available to them and they felt supported in their role.

Systems were in place to audit and monitor the quality of the service provided to people living and working at Harden Hall.