This inspection took place on 08 August 2018 and was unannounced. At our last inspection in July 2017, the service was overall rated as “Good” but the safe domain was rated as “Requires Improvement.” This was because we found that people’s medicines were not always managed safely. We asked the provider to take action to make improvements regarding medicines management. At this inspection, we found that the action has been completed and the service continued to be rated “Good”.

Harts House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or 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 service is registered to provide care for 61 older people some of which may have palliative care needs. On the day of our visit there were 53 people using the service.

There was a registered manager in place. 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 who used the service were protected from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening. Risks associated with people's care were identified, and there was sufficient guidance for staff about how to keep people safe.

People were supported with medicines administration by staff who had been trained to do so. The service worked in partnership with other health professionals to ensure people received effective care and support.

There were assessments undertaken and care plans developed to identify people’s health and support needs. Systems were in place to ensure staff were up to date about people’s needs and were aware of people’s preferences.

Staff had a good understanding of the Mental Capacity Act (2005) and sought people’s consent before providing any care and support. They were knowledgeable about people they supported.

Staff were supported through supervision and appraisals. They felt supported to carry out their roles and were in regular contact with the registered manager. There were sufficient numbers of staff to meet people’s needs and staff recruitment processes were robust.

People were able to make choices with regard to their daily lives such as what they would like to wear or to eat or whether they would like to join in any activities. Their privacy, dignity and independence were respected.

People, relatives and staff felt the registered manager was approachable and supportive and felt the service was managed well.

There were systems in place to manage, monitor and improve the quality of the service provided. Survey results from people and their representatives were positive and any issues identified were acted upon. Regular audits were carried out to monitor the quality of the service and drive improvements.

This inspection took place on 5 July 2017 and was unannounced. At our last inspection in September 2015, we found the provider was meeting the regulations we inspected.

Harts House Nursing Home is registered to provide care for 61 older people some of which may have palliative care needs. On the day of our visit there were 46 people using the service.

There was a registered manager in post at the time of the inspection. They were not available on the day of the inspection. The deputy manager, interim manager and area manager facilitated 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 and relatives commented that the service was a safe place and they did not have any concerns regarding how it was managed. However, we identified shortfall in how medicines were administered to people who used the service.

There were enough staff on duty to meet people's needs and the staffing level was kept under review as people’s needs changed. The provider carried out checks on all new employees before they started working at the service and this helped to ensure people were safe.

Staff received training on how to keep people safe and were able to describe the actions they would take if they had any concerns about people’s safety. The provider also had a whistleblowing policy, which staff were aware of and said they would not hesitate to use.

Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met.

Staff had a good understanding of how to support people who lacked capacity to make decisions for themselves. The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff received training in the Mental Capacity Act 2005 and in a number of other areas to ensure they had the skills to look after people who lived at the service.

Staff received regular support through one to one meetings with their line managers. Their work performances were reviewed on a yearly basis.

People were treated with dignity and their choices were respected. Staff encouraged people to be as independent as possible. People received personalised care and support, to ensure their individual needs were met.

The provider had systems in place to monitor the quality of the service provided to people. People and their representatives were able to raise concerns or complaints if they needed to.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We carried out unannounced comprehensive inspection of this service on 5 November 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to supporting staff by means of regular supervision and appraisal and maintaining accurate records of care delivered.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. Secondly we received concerns in relation to poor infection control practices and health and safety procedures not being followed. As a result this focused inspection also looked into those concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harts House on our website at www.cqc.org.uk

At this inspection we found that improvements to record keeping, staff supervision and appraisals had been completed and the service now met legal requirements. We found no evidence to suggest that health and safety and infection control guidelines were not followed.

The service is registered to provide care for 61 older people some of which may have palliative care needs. On the day of our visit there were 41 people using the service.

There was a registered manager who had been in post since March 2015. 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 staff who had attended relevant training and received regular supervision and annual appraisals. This enabled staff to keep up to date with practice and deliver evidence based care.

The leadership of the service had improved with a new manager and a supportive clinical lead. People told us that the registered manager was visible and approachable.

People’s records were kept up to date and reflected their current health needs including any advice given by other healthcare professionals.

We carried out an unannounced inspection on 5 November 2014. At the last inspection on 9 January 2014 we asked the provider to take action to make improvements in supporting staff. At this inspection we found that, although some improvements to staff supervision had been made the provider was still in breach of this regulation. No appraisals had been completed for care staff and there were shortfalls in training. We also identified a breach in regulation 20 which relates to maintaining accurate records of care. People were not always protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them by means of the maintenance of an accurate record. Other records such as fridge temperature checks and food probe checks were not up to date. You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide care for 61 older people some of which may have palliative care needs. On the day of our visit there were 34 people using the service.

Although there was a registered manager in place, at the time of our visit the manager had been on authorised absence for over eight weeks and CQC was made aware that a regional manager was covering for them in their absence.

‘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 told us that they were treated with dignity and respect and that they were involved in planning their day. The service had an “everyday hero award” aimed at encouraging staff to put people’s feelings at the centre of care. Relatives of people receiving end of life care thought staff were caring and supportive towards them and the needs of their loved ones.

People were safeguarded from harm because appropriate guidance in relation to infection control, medicines management and health and safety were followed. There were systems in place to safeguard people from abuse.

We found that people were supported to eat a balanced diet and had access to health care professionals as and when needed. Staff had some knowledge of the Mental capacity Act (2005) and could demonstrate how consent was obtained from people before delivering care. The manager and staff were aware of how to obtain a Deprivation of Liberty Safeguard (DoLs) when required.

There were systems in place to monitor the quality of care provided, maintain the premises and obtain feedback from people who used the service. There was evidence that management responded and actioned people’s requests such as changes to the menu. However, we saw care records were not always up to date and accurate.

The service was not always well led. This is because staff were not always supported by means of regular appraisals and relevant training such as the mental capacity training.

As part of this inspection we spoke with seven people who use the service and five relatives visiting the home on the day of our inspection. There were forty people using the service at the time of our visit. We also spoke to staff working in the home. This included the home manager, three nurses including the head of care, four healthcare assistants, two activity coordinators and one domestic staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People and their relatives told us they were satisfied with the quality of care offered in the home. One person told us, “I can’t fault the care here and all the staff are lovely.” Another person told us, “I think the care here is very good.”

There were effective systems in place to reduce the risk and spread of infection. One person commented, “the place is always very clean and my room is cleaned every day.”

Staff received regular training, however they did not received regular supervision and appraisals.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with four people in detail, about their experiences of living at Harts House. Three of them were very positive and made comments such as, “on the whole I am well cared for, nothing to complain about. Another person said, “people are nice. I have no complaints about it at all. I am well cared for, they do look after me”.

The service employs two activities co-coordinators for 80 hours per week and we saw one of them running a group activity making Christmas decorations during our visit. In addition to the group activities the co-coordinators visit people in their own rooms spending time talking to them. One of the relatives we spoke to felt that more could be done to keep people active.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. When asked people said that they were supported and given the opportunity to make choices that suited them.

We examined personnel records and found that staff had received training and there were enough staff to care for people and keep them safe.

We observed interactions between care staff and people to be sensitive and respectful when needed. People we spoke to said that staff were friendly and caring.

People told us that Harts House offers a cheerful atmosphere and a very well maintained, relaxing environment. One person told us “I feel safe because they (staff) are so good. If you've got any worries you can talk to them and they'll help you out”. Another person living at the service told us “It is so nice here. I think that the quality of the food here is the best. They (staff) are very kind; they are all very good”. A relative told us “I’m just very happy X is here. I have no complaints”.