We undertook our comprehensive inspection of Harper Villas on 17 and 22 August 2018. The first day of the inspection was unannounced, the second announced. We previously inspected the service on 12 January 2017 and the rating after this inspection was ‘good’. At this latest inspection we found there were areas where the provider needed to improve the service. We rated the service as ‘Requires Improvement’ at this inspection.

Harper Villas 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.

Harper Villas accommodates a maximum of 26 older people that may have dementia. People live in one building that was adapted to meet the needs of people living there. There were 23 people living at the home at the time of our inspection. The provider was also offering day care provision, this not an activity that is regulated by CQC. There were no additional staff employed to provide care for people attending for day-care.

The service has a registered manager who was present during our inspection. 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.

Our inspection was prompted following by concerns from local authority commissioners, which had led to several safeguarding alerts.

This is the first time the service has been rated Requires Improvement

We found areas where the provider was in breach of regulations. We found the provider’s systems for governance were not always effective in identifying and addressing risks to people promptly and needed improvement. In addition, the provider had not notified us of allegations of abuse as required by the law. You can see what action we told the provider to take at the back of the full version of the report.

We have also made recommendations. We have recommended that the provider considers how they could improve the environment for people living with dementia in line with national recognised guidance. We have also recommended that the provider improves people’s access to information in a way that consistently reflects their individual communication needs and in accordance with the Accessible Information Standard.

Despite the lack of notification to CQC of allegations of abuse, staff demonstrated a good understanding of safeguarding procedures. Following local authority visits, several risks to people were identified. Audits in place had failed to identify some risks to people that had not been assessed by the provider. People were satisfied with how their medicines were managed, but there were areas were medicines management could be safer. We found there was not sufficient staff available at night to ensure the provider was able to follow their fire procedure. The provider has stated more night staff will be employed. There was an impact on staff time during day time hours due to the additional dependency levels of people attending for day-care. We saw prospective staff were subject to checks prior to their employment.

People’s consent was sought consistently by staff and the registered manager had made applications to the local authority for any restrictions that may be a deprivation of a person’s liberty. People were supported by staff on a day to day basis to have maximum choice and control of their and we saw staff supported them in the least restrictive way possible; the policies in the service supported this practice but some systems did not. Some care plans were agreed by people’s relatives and it was not clear whether these relatives were legally able to make these decisions.

People were confident in staff

Our inspection took place on 12 January 2017and was unannounced. We last inspected the service on 12 and 13 November 2015. We found the service required improvement in the areas of safety in respect of staffing levels and leadership in respect of feedback on the service. We found that improvements had been made.

Harper’s Villas Care Centre provides accommodation for up to 26 people requiring personal care who may have dementia. At the time of the inspection there were 22 people living at the service.

There was a registered manager 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 supported by a staff team who knew how to keep people safe from the risk of harm and abuse. Potential risks had been assessed and staff supported people in a way which reduced these risks. People were supported by sufficient numbers of staff who had been recruited safely. People received the medicines they needed to support their health.

Staff ensured people were consenting to their care before supporting them and the provider worked within the principles of the Mental Capacity Act 2005. The provider had consulted with the local authorities to ensure, where people’s liberties were deprived in order to keep them safe, the appropriate legal process was followed.

People were provided with the appropriate support to eat and drink. People received food which was in line with their beliefs or health needs. Staff sought the assistance of outside healthcare professionals in order to keep people well.

People were treated with kindness and respect. People’s privacy and dignity was promoted.

People’s individual care needs and preferences were understood. Staff used appropriate care planning in order to deliver care which met people’s individual needs. Records showed and people confirmed staff consulted them regarding their needs.

People and their relatives were provided with opportunities to give feedback on the service. The registered manager had systems and processes in place to monitor and audit the quality of care. Where appropriate, the provider took action to improve identified areas for development.

This unannounced inspection took place on 12 and 13 November 2015.

Harpers Villas Care Centre accommodates up to 26 people most of whom have dementia related conditions. At the time of the inspection there were 25 people living at the home.

The home had a registered manager 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 harm by staff who understood their responsibilities in identifying and reporting potential abuse. Most staff considered there were enough staff to meet people’s care needs. People did not always receive the support they required at meal times. Some staff felt that people would benefit from an increase in staffing numbers as this would provide people with opportunities to take part in activities that interested them outside of the home. People’s medicines and given as prescribed and stored safely. However, people did not always receive their medicines at a time that suited them.

People were supported by staff who had the skills and knowledge required to meet their care and support needs. Staff felt supported in their work. Staff gained people’s consent before providing care and support and people were involved in making decisions. People’s healthcare needs were monitored by staff and referrals were made to appropriate healthcare agencies when required.

People and their relatives spoke highly of the staff. Staff had a good understanding of people’s needs. People’s privacy and dignity was protected by staff.

People and their relatives were involved in the planning of their care. Most people felt they were supported to take part in activities that interested them. Where people’s needs changed staff responded appropriately. People knew who to speak with if they were not happy with the service they received.

Systems to gain people’s feedback about the service were not effective. Audits were regularly completed to monitor the quality of the service, but these were not always used to drive improvement. People knew who the registered manager was; and people, relatives and staff expressed confidence in the registered manager and provider.