About the service: Harker House provides care for up to 38 people. This includes a separate wing which supports people living with dementia. The service was providing personal care to 29 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

There were enough, suitably recruited staff who worked well as a team to ensure people received the care and support they needed.

Staff received an induction and ongoing training and support to fulfil their role and extend their knowledge.

Staff had a good understanding of how to recognise and report potential harm or abuse and were confident the acting manager and provider would take action in line with local safeguarding procedures.

Staff were very kind and caring and had good relationships with people. They understood people's needs and preferences and provided personalised care. People had a choice of meals and enjoyed a varied and balanced diet.

People made their own choices about where they spent their time and had the opportunity to participate in a range of recreational and social activities.

People and their relatives were fully involved in developing and updating their planned care. People who lacked capacity were supported to have maximum choice and control of their lives.

There was a registered manager who was away from the service; it was being managed by an acting manager and deputy manager. People and their relatives were positive about the management of the service and knew how to raise any concerns and complaints should they have had any.

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

Rating at last inspection: The rating at the last inspection was ‘Good’. The last report for Harker House was published on 15 July 2016.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Follow up: We will continue to monitor the service through the information we receive.

The inspection took place on 4 and 5 May 2016 and was unannounced.

Harker House provides care for up to 36 people. This includes a separate wing which supports people living with dementia. The building was purpose built, offering accommodation over two floors.

There was a registered manager and a deputy in place. The deputy was responsible for the day to day management of 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.

People benefited from being supported by staff who were safely recruited, trained and who felt supported in their work. However, we received mixed feedback about staffing levels. People who required the assistance of more than one member of staff did not always receive the care they needed in a timely way.

Staff understood how to protect people from abuse and knew the procedure for reporting any concerns. Medicines were managed and stored safely and adherence to best practice was consistently applied. People received their medicines on time, safely and as the prescriber had intended.

Staff knew and understood the needs of people at Harker House, although they did not receive regular supervision. However staff said they were in regular communication with the deputy manager and team leaders. The management team was aware of this short fall and was arranging supervision for staff, which they said they would receive on a regular basis.

Staff told us they were happy working at Harker House. They assisted people with kindness and compassion. People’s dignity and privacy was maintained and respected.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was not depriving people of their liberty unlawfully and worked within the principles of the MCA. Staff’s knowledge of MCA was good and people told us staff always asked for their consent before assisting them.

People’s care plans were detailed and individualised. They contained important and relevant information to assist staff in meeting people’s needs in a way that was personalised. People and their relatives had been involved in their care assessment and care plans. People’s needs had been reviewed and people’s records were up to date.

The service had good links with community healthcare teams. People were supported to maintain good health and wellbeing. Some people had complex health needs; these people’s needs were closely monitored. The service reacted positively to changes in people’s health and social care needs.

People and staff told us there was a lack of social activities. Some people told us they felt isolated and bored at times. The issue of staffing levels was also relevant here and sometimes contributed to people not feeling socially stimulated. The service was making efforts to address this issue by planning to increase planned activities; however people did not have regular daily social stimulation throughout the day.

People were encouraged to maintain relationships with people who were important to them, and the service actively welcomed family members and visitors to the home.

There was a homely feeling to the communal areas. The home had benefited from an ongoing refurbishment programme, which had also contributed to the light and homely feel to the service.

People felt listened to and were confident that any concerns they may have would be addressed. There were systems were in place to monitor the quality of the service. Staff and the deputy manager was very committed to providing a good service for people living in the home.

During our inspection in November 2013, we found that where some people had fallen or had developed a pressure sore, the service had not always been responsive to this information to protect people from the risk of future injury.

The provider sent us an action plan to tell us what they would do to meet this regulation. We returned to the service to see if improvements had been made.

We found that improvements had been made. The service had taken steps to protect people from the risk of falls and pressure sores and to protect them from injury.

We had received a concern regarding the care received by the people living at Harker House. We conducted an inspection in response to these concerns.

During the inspection, we spoke with three people living at the service, two staff members and the registered manager.

People told us that they were happy with the care they received. One person said, “I get good care.” Another person said, “This is a nice home.”

We checked ten people’s care records. We found that most of them had received a full assessment of their individual needs. Risks to people’s safety during their day to day living had in most cases, also been assessed. However, we found that where some people had fallen or had developed a pressure sore, the service had not always been responsive to this information to protect people from the risk of future injury. Where an injury had occurred, we saw that other healthcare professionals such as doctors, nurses or paramedics were contacted in a timely manner.

People had access to a choice of food and drink. The service closely monitored people for the risk of dehydration and malnutrition.

People were receiving their medication as prescribed.

At the time of our inspection, there were 22 people living at Harker House.

We spoke with four people about living at the service. One person said, “The care is ok.” Another person said, “They look after me well, they treat me nicely.” A further person said, “Everything is good, the staff are very kind, I couldn’t wish for better.”

We saw that staff interacted with people in a kind, caring and respectful manner. People who lived at the service had the opportunity to give their views on their care and we saw that these were acted upon.

Care plans and risk assessments were in place. This meant that staff had access to information to enable them to provide safe and appropriate care. People had access to other healthcare professionals such as doctors, speech and language therapists and district nurses when needed. This showed that the service responded to changes in people’s health needs.

The service was clean and tidy on the day of our inspection. We saw that there were cleaning schedules and audits in place to monitor the standards of cleanliness within the service.

Medication was being stored securely and risk assessments were in place to ensure that people only received ‘as required’ PRN medication when needed.

Records kept at the service were up to date, clear, easily accessible and stored securely. This meant that people living at the service were protected from the risk of receiving inappropriate and unsafe care through good record keeping.

During the inspection we spoke with four people who used the service and one relative. One person told us "Staff are wonderful." A relative told us “They (the staff) really are excellent.” Two people were unhappy with the time it took staff to answer their call bells. One person said “They (the staff) take a long time to see me when I push my bell.”

Care plans were in place that detailed people’s needs. Various risk assessments had been completed however, those relating to falls were not being adequately managed. Also, the risk of people developing pressure areas had not been assessed. This meant that people were at risk of injury.

Policies and procedures were in place in relation to medication management however, discrepancies were found in relation to the medication records. This meant that we could not be assured that medicines had been administered as prescribed and intended by the prescriber.

We found that the staff were experienced and knew the people they cared for well. Staff told us that they felt supported and that they had received enough training to meet the needs of people who used the service.

People who used the service knew how to complain if they wanted to and we saw that complaints had been deal with appropriately.

During this visit we spoke with a number of people who live in this home about the care support they received. All the people we spoke with, as we toured the building, gave us positive comments about the way they lived their lives. They told us the staff supported them well, that they were offered choices and that they were content with their lives.

We were told that the meals were good and that they always had a choice. They told us you can have as little or as much as you require. All those observed having their midday meal appeared content, with smiles and lots of friendly banter between staff and the people receiving assistance.

We spoke with some of the people who live at this home but some appeared unsure of how involved they were with the home or the choices made about the care and support they received. They told us that staff talked to them respectfully and were always polite. They said they always knocked on their bedroom door before entering.

One person who was able to voice their views told us that although they would like their breakfast earlier it did not arrive until 10am.

We were told by one person how much they had improved since living in the home and how many tasks can now be managed independently.

Another person told us that they were not offered a choice of their lunchtime meal. Although there was an alternative on the menu this was not offered at the time of the meal therefore this person could not make their choices at the time the meal was presented .

People we spoke with told us that the care they received was good but that they had to wait to get help sometimes.

Three people we spoke with told us the food was not as good as it used to be.

One person told us there is always plenty to drink and that they can have a choice. We noticed a number of different drinks around during this visit.

The people we spoke with told us the staff team are all very supportive and caring. “They are very encouraging and help me with things I cannot manage.” Two people who were able to talk to us told us that, “Staff are just too busy trying to help a lot of poorly people so we have to wait sometimes.”