This comprehensive inspection took place on 15 and 22 August 2018 and was unannounced on the first day. We informed the provider of our intention to return on the second day. Harwood Road is a ‘care home’ for people with mental health needs. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The premises are equipped with 13 bedsits, which offer kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom, and a range of communal areas. At the time of the inspection there were 14 people living at the service and one person was in hospital. The building comprises four storeys and does not have a passenger lift. It is owned by a housing association.

The service had a registered manager, who was present on both days of the inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they 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 registered manager had registered with CQC after the previous inspection, having worked at the service as a team leader and acting manager.

A comprehensive inspection of this service was carried out on 4 and 5 May 2016 and the service was rated overall as ‘Good’. Effective, Caring, Responsive and Well-led were rated as ‘Good’ and Safe was rated as ‘Requires Improvement’.

In June 2017 the provider notified us that two people who used the service had died at the care home on the same day due to expected causes. This was subsequently found to be incorrect, as the deaths of both people were unexpected. In July 2017 we received information of concern from an anonymous source which indicated potential concerns about how the service supported people during very hot weather conditions and the management of risk. These concerns were reported to the local safeguarding team. Prior to the CQC carrying out an unannounced focussed inspection in October 2017 we were informed by the police that they were gathering additional information at the request of the Coroner’s Office, therefore our inspection did not examine the circumstances of the deaths. The inspection had focussed on safe and well-led only, which resulted in safe remaining ‘Requires Improvement’ and well-led being rated as ‘Requires Improvement’. The overall rating for the service was ‘Requires Improvement’. We found breaches of regulation in relation to safe care and treatment, and good governance. The overall rating for the service was ‘Requires Improvement’.

Following the previous inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. At this inspection we found that the provider had made significant improvements and taken appropriate action to meet the two breaches of regulations. We noted that the registered manager had remained in contact with the Coroner's Office and as there were no further investigations or queries, the bodies were released for burial. Staff had attended the funerals and there was a gathering for service users and staff in June 2018 to celebrate the lives of the two people who sadly passed away last year.

At the previous inspection we had found issues of concern in relation to the safety of the premises, which included the need for staff to undertake bespoke training to understand how to properly switch on and off the radiators. The service did not have a current electrical installations check by a competent person and there were issues with the lack of cleanliness and equipment to prevent cross-infection in the communal toilets. At this inspection we noted that staff had received appropriate training for using t

This focused responsive inspection took place on 18, 19 and 20 October 2017 and was unannounced on the first day. We subsequently advised the provider of our intention to return on the following two days. Harwood Road is registered with the Care Quality Commission to provide care and accommodation for up to 15 men and women with mental health needs, and there was one vacancy at the time of the inspection. The most recent comprehensive inspection of this service was conducted on 4 and 5 May 2016 and the service was rated overall as ‘Good’. Effective, Caring, Responsive and Well-led were rated as ‘Good’ and Safe was rated as ‘Requires Improvement’.

The care home provides 13 bedsits, which offer kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom. Communal areas include a lounge, a separate dining room and activities area, a main kitchen, laundry room, and a small courtyard and garden at the rear of the premises. There are offices which people can use for private meetings. The building comprises four storeys and does not have a passenger lift. The property is owned by a housing association.

This inspection was prompted by two notifications in June 2017, which informed us that two people who used the service had died at the care home on the same day. The provider had originally informed us that the deaths of both people were expected. This was subsequently found to be incorrect when we spoke with the provider, as the deaths of both people were unexpected. In July 2017 we received information from an anonymous source which alleged that the deaths were due to neglect by the provider. It was alleged that some radiators were faulty during very hot weather conditions. We reported these concerns to the local safeguarding team and asked the provider to send us a copy of their own investigation report, and copies of the two Coroner’s reports when they were issued. At the time of the inspection we had been informed by the police that they were gathering additional information at the request of the Coroner’s Office. Therefore, this inspection did not examine the circumstances of the deaths. However, the information shared with CQC about the deaths of the two people who lived at this care home indicated potential concerns about how the service supported people during very hot weather conditions and the management of risk. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Harwood Road on our website at www.cqc.org.uk.

The service had a registered manager, who had worked for the provider for several years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the registered manager was no longer working at the service. He had given notice of his resignation and was due to leave the organisation in November 2017. Since the inspection visit to the service, the CQC has received an application for the de-registration of the registered manager and an application from the provider to register the current team leader as the new registered manager.

The provider had addressed a concern identified at the previous inspection, which was a potential risk of a person not receiving the personal care they needed to meet a health care need. Although the person’s support was provided by visiting agency staff, the provider had obtained written guidance for staff and arranged for staff to receive applicable training from a health care professional. This meant that the person’s care could be delivered by staff in the event of unforeseen circumstances preventing agency staff from carrying out their

The inspection took place on 4 and 5 May 2016. Harwood Road is registered with the Care Quality Commission to provide care and accommodation for up to 15 men and women with mental health needs. At the time of our inspection there was one vacancy.

There are 13 bedsits, which provide kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom. Communal areas include a lounge, a separate dining room and activities area, a main kitchen, laundry room, and a small courtyard and garden at the rear of the premises. There are offices which people can use for private meetings. The building comprises four storeys and does not have a passenger lift.

The service had a registered manager in post, who had worked for the provider for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered manager was based at another local registered service run by the provider and was not actively involved in the daily management of Harwood Road. The provider confirmed that they were in the process of applying for the service manager to be registered by the Care Quality Commission to manage the service.

At the previous inspection in September 2015 we found three breaches of regulation and made one recommendation. The provider had not informed the Care Quality Commission of significant events in the service that impacted on the safety and wellbeing of people who used the service. People’s safety had not been properly ensured due to the non-completion of some fire prevention measures and inconsistent practice with the management of medicines. The provider had not documented how they addressed people’s healthcare needs and preferences in a person centred way within their care plans. We made a recommendation for the provider to seek guidance about how to support people to use their food budget to purchase and prepare balanced meals.

Following the inspection the provider sent us an action plan which highlighted the action they would take in order to improve. At this inspection we found the provider had met the three breaches of regulation and achieved sustained improvements in regards to the recommendation.

Staff were properly recruited and although there were sufficient staff to support people to meet their needs, we noted that a significant proportion of the staff team comprised regular bank staff and agency workers. The provider demonstrated that this issue was being addressed through recruitment initiatives, so that people could benefit from building longer-term relationships with a stable staff team.

Staff understood how to protect people from abuse and the provider notified relevant authorities. Risks to people’s safety and wellbeing and actions to mitigate these risks were not clearly identified at all times.

Appropriate arrangements were in place to support people to safely take their medicines and access healthcare services. Records showed that people were consulted about food choices, supported to get involved with food preparation and cooking, and encouraged to eat a healthy diet.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. The service manager and the staff team understood and adhered to the principles of upholding people’s human rights in line with legislation.

People were supported by staff who had suitable training to meet their identified needs. Staff were obs

People expressed their views and were involved in making decisions about their care and treatment. We spoke with four people who use the service. All spoke positively about the service. One person told us that staff treated them with "respect" and worked with them in a way that maintained their "dignity."

Staff we spoke with demonstrated a good knowledge of the needs of the people they worked with. They described how they drew up support plans involving the person and if appropriate their family members or other professionals.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There was a safeguarding policy in place and knew what protocols to follow if they suspected abuse.

We looked at staff training records. We saw that staff had the opportunity to develop professionally and had received training in areas relevant to their role. This included equality and diversity, manual handling, lone working and medication administration.

Records were kept securely and could be located promptly when needed. Records were kept both electronically and in paper format. Paper records were kept in a lockable filing cabinet in the staff office. All computers were password protected. All staff at the service had access to the database and had passwords to access it.

Overall, people who use the service were happy living at Harwood Road. They told us that they had consented to how their support needs were met. We saw that people who use the service had signed their support plans and other documentation to show they agreed with it. People who use the service told us that they knew who their key worker was and met with them regularly. We saw that these meetings were documented. There were systems in place to ensure that people's medicine were stored securely and safely administered. Medication stock was checked regularly and any discrepancies were reported to the manager.

People who use the service felt able to raise any concerns with staff. One person described staff as "very responsive". We saw information on how to make a complaint on display and heard of examples of how complaints had been investigated and resolved satisfactorily.

People told us that they were happy living in the home and felt cared for. They said that staff were nice and treated them with respect and they felt safe.

They told us that they felt listened to and were involved in their own care. They also enjoyed the activities provided by the home and told us they had been involved in deciding what they should do.

The majority of people had a bed sit in the home with a small kitchen area. They told us that they liked their rooms and had made them their own with their own belongings.

The inspection took place on 16, 17 and 24 September 2015. At our previous inspection on 2 October 2013 we found the provider was meeting the regulations we inspected. Harwood Road is registered with the Care Quality Commission to provide care and accommodation for up to 15 men and women with mental health needs. At the time of our inspection one person had been admitted to hospital and there was also one vacancy.

There are 13 bedsits, which provide kitchen facilities and en-suite bathrooms. Additionally, there are two single occupancy bedrooms with a shared kitchen and bathroom. Communal areas include a lounge, a separate dining room and activities area, a main kitchen, laundry room, and a small courtyard and garden at the rear of the premises. There are offices which people can use for private meetings. The building comprises four storeys and does not have a passenger lift.

The service had a registered manager in post, who had worked for the provider for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered manager was primarily based at another local registered service run by the provider and was not actively involved in the daily management of Harwood Road. The provider advised us of their plans to de-register the current registered manager and for the service manager to apply for registered manager status.

People had not been protected through the provider informing the Care Quality Commission (CQC) of events that affected the safety and wellbeing of people who used the service, as required by legislation. However, events had been reported to the local authority. This meant we did not have evidence to reassure us that the provider took appropriate actions.

Although the provider carried out a range of health and safety checks within the premises, there was insufficient evidence to demonstrate the completion of all actions identified on the service’s fire safety risk management plan.

There were inconsistencies with the overall management of medicines, which placed people at risk of not safely receiving their prescribed medicines.

Sufficient staff deployed to meet people’s needs. Recruitment records demonstrated that efficient checks were taken in order to ensure that staff were suitable to work with people using the service.

Risks to people’s safety were identified and risk management plans were developed. However, the risk assessments we saw were not always person-centred and needed more information about how to mitigate the identified risks.

Although people were supported to attend healthcare appointments and access healthcare services, people’s care plans did not always comprehensively identify their healthcare needs and describe how staff met those needs on a daily basis.

Staff received training and support to carry out their roles and responsibilities; however we found that there were gaps in training and supervision sessions had not been consistently provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. We saw that staff understood the provider’s policy and could explain how they protected people’s rights.

People told us they had opportunities to cook their own meals but some people felt they needed more guidance about how to cook healthily with their food budget.

We saw positive interaction between people and staff, although some of our observations demonstrated a more task orientated approach. People were supported to access community resources and leisure facilities, and provided with information about advocacy and mental health groups.

The provider sought people’s views through residents’ meetings and people said they felt listened to. Complaints were properly investigated and actions were taken to make improvements, where necessary.

People and staff thought the service had improved following a period without stable management. The provider had responded to safety concerns about unauthorised people entering the premises and impacting on the safety of people using the service, their authorised visitors and staff. There were systems in place to monitor the quality of the service. However, improvements were needed to ensure that record-keeping practices were properly organised so that there was a clear audit trail of how people were kept safe and supported to meet their needs.

We found one breach of the Care Quality Commission (Registration) Regulations 2009 and two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider had not informed the CQC of significant events in the service that impacted on the safety and wellbeing of people who used the service. People’s safety was not properly ensured due to the non-completion of some fire prevention measures and inconsistent practice with the management of medicines. The provider had not documented how they addressed people’s healthcare needs and preferences in a person centred way within their care plans. We have made a recommendation for the provider to seek guidance about how to support people to use their food budget to purchase and prepare balanced diets. You can see what actions we told the provider to take at the back of the full version of this report.