About the service: Hargrave House provides accommodation, care and support for up to 58 older people. The service is split into two wings, Hargrave House which provides residential care, and Alice Grace which provided dementia care. The service is situated in Stansted. There were 56 people living at the service on the day of inspection.

People’s experience of using this service:

People and their relatives were complimentary about the care provided at Hargrave House. People received effective care from staff who understood how to recognise and report issues of concern. Staff were recruited safely and there were enough staff to meet people’s needs. Risk assessments were in place to keep people safe which also promoted people’s choice and independence. People’s medicines were managed safely. Incidents and accidents were investigated, and actions taken to prevent any recurrence. The environment was clean, comfortable and safe.

People's needs were assessed prior to them moving into the service to help ensure they were cared for and supported effectively. Staff received relevant training, support and supervision to enable them to carry out their roles and responsibilities. People were provided with a nutritious and varied diet. Staff worked well with external professionals to promote people’s health and wellbeing. End of life planning required further development. We made a recommendation that the service consults a reputable source to further develop end of life planning.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The culture of the service was caring and person-centred. Staff were kind and passionate and supported people with dignity and respect. Positive relationships had been formed between staff and people using the service.

People were supported by competent staff who knew them well and supported them according to their needs and preferences. People were involved in how the service was run and encouraged to be as independent as possible. They had the choice to participate in activities which promoted a good quality of life.

The registered manager was visible and approachable. Staff had a clear understanding of their roles and responsibilities. Audits were completed and there were effective quality assurance systems in place to drive continuous improvement.

Rating at last inspection: Good (report published 27 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

This inspection took place on 18 and 19 August 2016 and was unannounced. We last inspected this service in February 2014 and found that they were meeting the legal requirements in the areas we looked at.

Hargrave House is a residential home in Stansted, providing care and accommodation for people over the age of sixty-five who require personal care. There were fifty-two people living at the home at the time of our inspection, some of whom lived with dementia.

The home has a registered manager in post. 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 who lived at the home were safe because the provider had taken appropriate measures to safeguard them from avoidable harm. These included the safe recruitment and training of staff who supported people, the completion of risk assessments of the home environment and that of the care people received, and the effective management of people’s medicines and healthcare needs.

Everyone agreed that staff were adequately trained, and that they were knowledgeable about people’s care needs. Staff were supported in carrying out their roles by way of regular supervision and appraisal of their performance. They understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and supported people appropriately. People were supported to access healthcare services when required. They had been given food and drinks that was healthy and nutritious.

People were cared for by staff that were friendly, kind and empathetic. Staff supported people in ways that promoted their privacy, dignity and respected their views. They provided the support that was personalised to people and with support from the management team, they ensured people’s complaints and concerns were resolved.

The registered manager with support from the provider and the provider’s senior management team ensured that the service ran appropriately. They provided visible leadership and oversight at all levels. This ensured the provision of a good level of care and support to the people who used the service.

We inspected the service in August 2013 and found that the provider was not compliant with four of the outcome groups. At this inspection in March 2014 we found that the provider had taken action and that overall people experienced care and support that met their needs.

We found that the staff team had attended training to increase their skills and knowledge with regard to caring for people with dignity and respect. During the course of our inspection we observed that the staff team spoke with people in a polite and courteous manner.

We spoke with a health professional during the course of our inspection on 03 March 2014. They told us, “It is a pleasure coming here, the staff are lovely, people are very well looked after and there are a lot of activities.” We spoke with relatives of people who used the service who told us they were pleased with the care delivery and the support provided. One visitor said, “The whole thing, the staff, the food, the cleanliness of the home is all really great.”

We found that the staff team had attended training to increase their skills and knowledge in relation to the safeguarding of vulnerable adults. Staff members with whom we spoke were very clear about the actions they would take should they suspect that any person who used the service was at risk of abuse. They demonstrated awareness of the role of the local authority in the safeguarding of vulnerable adults.

At our inspection on 03 March 2014 we found that new care plans had been developed for all people who used the service. The home manager was in the process of working with the staff team to further develop the care plans to ensure that they accurately reflected each person’s individual needs and that any risks to their health, safety and wellbeing were identified and planned for.

People using the service at Hargrave House told us they were happy overall with the care they received and the food they were provided with. Comments included, “I have no complaints. I am happy here and most of my friends are too” and, “They are very kind, they do look after us well”.

We found that some aspects of dementia care did not support people to live with dignity and respect. For example, staff did not sit with people and assist them to eat their meals in a respectful and dignified manner.

Plans of care, treatment and support were not routinely implemented as working documents which meant that staff members did not have accurate information and guidance to follow to support them to care for people safely.

We found that new employees were not all provided with adult safeguarding training within the 12 week time period specified in the provider’s own policy and procedures, and that refresher training was not always provided within the provider’s own timescales of two yearly.

Hargrave House appeared clean and fresh throughout. We saw that people’s rooms contained items personal to them.

We observed the interactions between people using the service and the staff working at the home and listened to everyday events and activities during the course of the day. People using the service initiated interactions, approached staff with confidence and were responded to in a warm and respectful way.

People using the service told us they felt they were well cared for. One person said, “They are all lovely and they do all the things for me that I can no longer do for myself.”

During the course of the inspection we spoke with six family members visiting the home. They told us they felt their relatives were safe and comfortable at Hargrave House. One relative said, “Overall we are delighted, it’s a lovely home. The staff are wonderful and it’s always so clean and fresh.”

We saw that people were encouraged to access all areas of the home freely with some people opting to spend time alone in their personal rooms or together with others in the communal areas.

It was clear from our observation on the day of our visit to the service and from discussion with family members during our visit, that the management ethos was open and transparent. This meant people living in the home and their families felt confident to approach the management team about any matter that may be concerning them.

People living in Hargrave House were very complimentary about the care and support that they received. They told us that staff were always polite and respectful and were always happy to do whatever was asked of them. People living in the home told us that being cared for in Hargrave House was like being looked after in a high class hotel.