About the service:

Harwood House is a 35 bed nursing home in Maidenhead. Some people were living with dementia. At the time of our inspection the service supported 29 people.

People’s experience of using this service:

People were safe. There were enough staff to meet people’s needs. Staff were aware of their responsibilities to report concerns and understood how to keep people safe. We saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed.

People had their needs assessed prior to receiving care to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People continued to be supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team.

People were supported to meet their nutritional needs and maintain an enjoyable and healthy diet.

People were treated with respect and their dignity was maintained. People were also supported to maintain their independence. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights. The provider had processes in place to maintain confidentiality.

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.

People and their relatives knew how to complain, and a complaints policy was in place. People’s input was valued, and they were encouraged to feedback on the quality of the service and make suggestions for improvements. People had access to a wide range of individual, meaningful activities.

The service was well-led. People, relatives and staff were complimentary of the registered manager and the management team. The registered manager promoted a positive, transparent and open culture where staff worked well as a team. The provider had effective quality assurance systems in place which were used to drive improvement. The provider worked well in partnership with other organisations.

The service met the characteristics of Good in Safe, Effective, Caring, Responsive and Well-led.

Follow up:

We will monitor all information received about the service to understand any risks that may arise and 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

Harwood House provides accommodation and nursing care for up to 35 adults, some of whom have a diagnosis of dementia. At the time of our visit there were 29 people using the service.

The location was last inspected under the 2010 Regulations on 28 May 2014, where the five outcomes we inspected were compliant. This is the first inspection of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the rating of the service under the Care Act 2014.

At the time of the inspection, there was a 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 received care that was compassionate, patient, kind and person-centred. People and their relatives spoke positively about the impact the care had on them. Comments included, “They (staff) manage to maintain an air of normality while helping mum with the everyday activities of life we all take for granted” and “They (staff) have also made our family welcome and relieved our stresses and strains that all relatives have when having to move their loved ones into care.”

People’s relatives were encouraged to play an integral part in the service and this was observed during our visit and supported by the testimonials we had received. This was captured in the words of one relative who stated, “Harwood House works very hard to involve the family of those in their care with events throughout the year that add an element of community.”

People and their relatives were involved in care decisions; treated with respect and felt overwhelmingly positive about the care, treatment and support received. People were supported at the end of their life by staff who were compassionate, understanding and who had the skills in this aspect of care. One relative commented, “We feel very lucky to have found you (the service) and for mum to have been cared by you (staff) so well in the final stage of her life.”

People were protected from the risk of harm because staff were fully aware of their responsibilities in regards to safeguarding. Necessary recruitment checks and procedures were in place and followed. Where risks to people’s welfare and safety were identified, appropriate risk management plans were in place. People were given their medicines safely by appropriately trained staff.

People and their relatives felt staff were competently trained and skilled to look after their care needs. We heard comments such as, “I feel that they (staff) are well trained sufficiently so that they’re able to look after me correctly” and “Yes, the staff are correctly trained so the care that mum gets is definitely the right care that she needs.” We found staff were appropriately supported through induction, supervision and professional development. One staff member commented, “I would never have contemplated, let alone succeeded in re-qualifying as a registered nurse.” This meant people were cared for by service who supported its staff learning and career development.

The service took on a pro-active approach in regards to staff training when dealing with people who had complex health needs. Staff records confirmed specialist training was undertaken. This was further supported by the person’s relative who explained the rare medical condition their family member had; how the registered manager ensured staff understood the condition and its impact on the person.

People had access to healthcare services and the service ensured they worked in collaboration with other health professionals to ensure best outcomes for the people they cared for. This was supported by a testimonial received from the local GP who commented, “I cannot speak highly enough about the team at Harwood Hou

One inspector visited the care home and gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, speaking with the staff, speaking with relatives of people who use the service, and from looking at records. We also requested the provider to send more information to us after the inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

The care home had a person-centred approach in their delivery of care and this was evidenced at the inspection. Care workers who provided care to people ensured that people’s needs were taken care of, which included checking that their needs were addressed. Care staff knew each person at the service as an individual and what their preferences were.

Is the service responsive?

People we spoke with were complimentary of the care provided by Harwood House. We also spoke with some of their relatives who told us care was based on people’s health and changes in their conditions. We saw that people’s individual needs were met. The provider ensured that appropriate interventions were taken where people were at risk because of their health.

Is the service safe?

Care provided by the staff to people was safe and people told us they felt safe living at Harwood house. Changes to the way staff were trained, supervised and received support ensured that they were equipped to provide the best possible care to people who use the service. Basic health and safety requirements were handled satisfactorily. The provider had necessary checks in place to ensure that the premises did not pose a risk to people’s health and safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, we saw proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of peoples care needs and that they knew them well. People who use the service and their relatives confirmed our observations. People’s health was maintained and protected. People received care that was specific to their requirements.

Is the service well-led?

The care home had a registered manager who worked with staff to provide management oversight of the care provided. The manager took responsibility for quality and safety that involved risk assessment, care planning and care delivery. This was overseen by a board that met monthly to review the quality and safety of the service. People, relatives and staff could have a say in the operation of the care home, and this was recorded to monitor improvement. There were audits in place and a robust quality system to ensure risks to people and others were appropriately addressed.

People who lived at the care home were satisfied with the care they received. We spoke with three people who use the service about their experiences of the care. One person told us they had a recommendation to live there

During the inspection, we observed the premises and cleaning that occurred. We saw ensuite bathrooms and a shared bathroom were clean and tidy and did not have any malodours. People’s bedrooms were immaculately clean.

The provider did not always undertake the appropriate checks prior to new care staff taking up employment, to ensure that people who use the service were not placed at risk.

Workers received appropriate induction, supervision and appraisal. However, staff were not supported to deliver care to people living at the home to an appropriate standard. Not all staff were up to date with training in the subjects considered mandatory by the provider and in line with the service provided.

At our inspection, we checked the incidents and accidents records on file for the location. We saw records which showed there were two incidents which required reporting under the regulations; one which occurred on 31 May 2012 and one on 24 December 2012. We asked the registered manager to show us how these matters had been reported to us. The manager was unable to provide any records which showed the incidents had been reported to us.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person described Harwood House as ‘'friendly and relaxed, not strict or formal.'' They said ''we are human beings and get to know the staff as people,” also ''I prefer it being human and flexible.'' Another said ''you don’t need to inspect here, it's wonderful.”

Two people told us they had been involved with the assessment of the care they needed. A visitor told us that they were reading their relative's care plan at that moment and would expect that any amendments would be included. Another visitor told us they had a copy of their relative's care plan. Three people we spoke with said they had been asked about their care needs and personal preferences.

Three people said they could spend their days how they chose. This could be either engaging in the activities offered or spending time pursuing their own interests. People we spoke with told us that activities were arranged. These included yoga, quizzes, pets as therapy and massage. One person said they had attended two concerts.

A visitor we spoke with said their relative was being supported to be as independent as possible. Another visitor said ''I would rate this home 99 out of 100. My relative would not be alive now if it wasn't for this place.'' Visitors said they were made to feel welcome when they came to the home.

A relative said ''the food is very good here.'' Three people made the same comment and added that they got enough to eat. Three people told us they had a choice at meal times. One person said they liked having their meal in their room. Two people said they could request food or drink at any time and it would be provided. This was observed happening during a family visit.

We spoke with two care staff about the meals provided at the home. One said the food was ''fabulous.'' The other said it was ''very good.''

A visitor commented positively that their relative had gained weight since coming to live at Harwood House.

One person said that call bells were responded to promptly. They said they were given an explanation if there was a delay.

Two people said that staff understood what was needed to make life as enjoyable as possible.