This inspection took place on 15, 16 and 21 May 2018. It was unannounced and was carried out by one inspector.

Harrington House provides residential care for up to 12 people. 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. Harrington House is registered for adults living with learning disability and/or mental health needs. At the time of this inspection 12 people were living there.

Accommodation at Harrington House is provided over three floors with bedrooms located on the ground and first floors; A self-contained flat housing one person was located in the basement. The ground floor and garden were wheelchair accessible. One bedroom had en-suite facilities, all bedrooms were equipped with a sink and adapted communal bathrooms were available to all. A shower was situated on the first floor. People had access to the kitchen and the open plan communal areas, including the lounge, dining area and conservatory. The garden was enclosed and complete with a barbeque and strawberry patch. Parking was available at the front of the house.

At our last inspection in 2015 the home was rated Good. The management of the home changed twice since our last inspection. The new manager has been in post since January 2018 and has applied to become registered manager of the home. 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”

During this inspection we identified one breach of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. The service has been rated 'Requires Improvement' overall.

Principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had not always been adhered to. Not all people living at Harrington House could consent to the arrangements in place to keep them safe; Continuous supervision and control, combined with lack of freedom to leave, indicated a deprivation of liberty for some people. However applications to authorise these arrangements under DoLS had not been made for all people who may require this. It was evident the restrictions in place were appropriate and in people’s best interests and would have been legally authorised under the MCA had DoLS authorisations been requested.

People’s support plans did not always reflect their needs and these were in the process of being updated. When people’s needs changed, a referral for re-assessment by a health care professional had not always been requested to ensure they remained safe. Some improvements had been made since the new manager came into post. However, when shortfalls had been identified by the provider prompt action had not always been taken to ensure the required improvements were made.

People benefitted from a caring staff team who knew them well. They were supported to access appropriate health care. Staff took a personalised approach to meeting people's needs and outcomes for people were good. People's preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People's privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. People received good end of

The inspection took place on 29 June 2015 and was unannounced.

Harrington House can accommodate up to 12 people who live with a learning disability or who have mental health needs. At the time of the inspection there were 12 people receiving care and treatment.

At the last inspection on 16 September 2014 we asked the provider to take action to make improvements in how they notified us of significant events and in how they managed and checked stocks of medicines. The provider told us they would meet this action by November 2014. During this inspection we found these actions had been completed.

There was a manager in post who was not yet the registered manager. 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 provided with personalised care which meant they were at the centre of any care planning and decisions made about them. The service’s main aim was to help people live a full and meaningful life and to achieve their goals and aspirations. Where people required more support, because they had complex needs, staff made sure they had access to all the help they needed. People who lacked mental capacity were protected because staff made sure their care and treatment was delivered in their best interests.

People’s personal risks and environmental risks were managed in order to keep them safe. Risks were not seen as a hindrance to ensuring people lived their lives in the way they wished to. Where needed, strategies were put in place and people’s risk were managed in the least restrictive way possible. People were helped to recognise their goals and aspirations and given support to achieve these. They were given opportunities to express their views and make day to day and longer term choices and decisions. There were sufficient staff to provide personalised care and to support people in activities and social events of their choice. People’s medicines were managed safely. People were provided with a choice of meals, drinks and snacks and given appropriate support to maintain a healthy intake.

People were cared for by staff who had received appropriate training. In most cases staff had additional knowledge and experience specific to the needs of those they supported. Staff competencies and on-going training needs were monitored and met by the manager and provider. People’s health care needs were met and they were support to attend health care appointments. Where needed referrals were made to appropriate health care professionals to help meet people’s needs.

Staff were caring and compassionate and maintained people’s dignity and privacy. They made sure people were cared for and helped them to feel secure. Staff used different methods to communicate with people and they made sure people were listened to, however difficult it was for a person to express themselves. Staff knew people well and were able to help people avoid situations which caused distress. Any distress exhibited was quickly responded to. People were supported to maintain friendships and their right to private life and family life respected.

The service was well-led and both the manager and provider had arrangements in place to monitor the quality of care and support people received. Information about people was kept secure and only shared with appropriate and relevant people. People’s views about the service were sought and these combined with any concerns or complaints received were listened to, taken seriously and used to improve the services provided.

The inspection was carried out by one adult social care inspector. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The service is safe because people were treated with respect and dignity by the staff. When people displayed behaviour, which challenged others, staff dealt with it effectively and respected people’s dignity and protected their rights.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions whilst ensuring their welfare.

Systems were in place to make sure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and were having discussions with local authorities about this. This meant people were protected from discrimination and their human rights were protected.

Staff kept the home clean and hygienic in order to protect people against the risk of acquiring healthcare associated infections.

Prescribed medicines were stored and administered safely in line with current and relevant regulations and guidance. However, we found one medicine to be two tablets short, and another medicine was one tablet short. Seven members of staff were in the process of completing medicines training. Two members of staff had out of date medicines qualifications.

The skill mix and experience of staff were considered when arranging the staffing of the service.

Is the service effective?

The service is effective because there was an advocacy service available if people needed it. This meant when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. People’s health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people’s needs changed. People’s identified needs were monitored and managed.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people’s diverse care, cultural and support needs.

Is the service caring?

The service is caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be. One person told us, “I’m quite independent and I have my personal allowance given to me; I can go out alone.”

Is the service responsive?

The service is responsive because, where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation. People told us, “Staff ask what I want to do” and “I can choose what I do” and “I go out in the car.”

We found staff had not notified us of an injury sustained by a person using the service. The provider must tell us how they plan to address this.

Is the service well-led?

The service was well led because there was a manager who had been registered with us to manage the service. At the time of the inspection a new manager had been appointed and it is planned they will apply to us to become the new registered manager of the service.

Staff worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. Where required, action plans were monitored to ensure they were delivered. Quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement. Staff knew and understood what was expected of them.

We looked at the accident records and found a notification about an injury to a person using the service had not been made to us.

We used a number of different methods to help us understand the experiences of people using the service. Because people using the service had complex needs which meant they were not always able to tell us their experiences. We observed staff interacting with people and spoke with staff about people's needs and examined their care records. We were able to speak with six people but because of their complex needs we were not able to discuss aspects of their care with them. All people told us about the activities they enjoyed inside and outside of the service and some were waiting for the music class which took place during the afternoon of the inspection. We observed positive interactions between people and staff especially where people had limited verbal communication. People told us they were happy at the service and liked the staff.

The registered manager who was also one of the providers was in the process of handing the role of the manager over to a new manager. Both managers were present for the inspection. The new manager took the lead during the inspection because they wanted to us show the changes they had made to the service. The new manager plans to apply to us to be considered for the role of registered manager.

We found the three compliance actions we issued at the last inspection in relation to the environment, infection control and staff training had been met.

Arrangements were in place to monitor the quality of service provision people received.

We spoke to five people who lived at Harrington House. They told us they were happy living there and that the staff looked after them well. All people we spoke with said they liked the staff. People told us about the activities they undertook. Some people told us they were able to go out alone where as other people required staff supervision and guidance.

We found a large number of environmental concerns that needed to be addressed. Radiators required covering and window restrictors needed to be fitted.

The procedures in place for the control and management of infection need to be reviewed and changes made to protect people from the risks of cross infection.

Staff supervision sessions were not being recorded and some staff required updates and training in specific areas to meet the needs of people who used the service.