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Care Services

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Harlington House, Fullford, York.

Harlington House in Fullford, York is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, learning disabilities and mental health conditions. The last inspection date here was 16th June 2018

Harlington House is managed by Milewood Healthcare Ltd who are also responsible for 13 other locations

Contact Details:

    Address:
      Harlington House
      3 Main Street
      Fullford
      York
      YO10 4HJ
      United Kingdom
    Telephone:
      01904634079
    Website:

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Requires Improvement
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2018-06-16
    Last Published 2018-06-16

Local Authority:

    York

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

10th April 2018 - During a routine inspection pdf icon

Harlington House 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 accommodation and care for up to 17 people with a mental health need or learning disability. The home is divided into two areas; Harlington House, which is a three storey older detached building containing individual flats, and Harlington Lodge on the same site, which is a more modern building and has two floors. It is located in a residential area south of York, close to local community facilities and on a public bus route. There are parking facilities.

At the time of this inspection there were 13 people using the service.

The inspection was unannounced and took place over two days on 10 and 12 April 2018. At the previous inspection in November 2016 the service was rated Requires Improvement. There was a breach of legal requirements because records were not stored securely, some documentation could not be located and quality assurance audits were not always effective in ensuring improvements were made promptly. At this inspection we found the provider had made sufficient improvement to meet legal requirements and was now rated Good overall.

The provider is required to have a registered manager as a condition of their registration and there was a registered manager in post. They had been registered with CQC since September 2017. 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.

There were systems in place to assess and minimise risk to people, whilst respecting people’s individual choice and wishes. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of safeguarding procedures and how to raise concerns. There were systems to ensure people received their medicines safely, but there were anomalies in the recording of one person’s insulin injections.

Improvements had been made to the effectiveness of the cleaning systems in place to ensure appropriate standards of hygiene were maintained.

The provider followed robust systems for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient staff to keep people safe and meet their needs. Staff received an induction, training and regular supervision to give them the skills they needed to support people.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People told us they were happy with the meals available and had opportunity to be involved in preparing their own food where they were able to. Staff monitored people’s weight and nutritional needs. People were supported to maintain good health and access healthcare services, but we found some records in relation to people’s healthcare needs lacked clarity.

People’s privacy and dignity was respected, and we observed staff were attentive, caring and respectful in their interactions with people. It was evident staff knew people well. People were involved in decisions about their care.

Detailed care plans were in place to give staff the guidance they needed to support people. Care plans were regularly reviewed.

There was a complaints procedure in place and records showed us that any complaints and concerns were acted on. People told us they would feel able to raise any concerns.

The registered manager and provid

22nd November 2016 - During a routine inspection pdf icon

Harlington House is registered to provide accommodation and personal care for up to 17 people with a learning disability. People either live in Harlington House, which is a three storey older detached building or Harlington Lodge on the same site, which is a more modern building and has two floors. It is located in a residential area south of York, close to local community facilities and on a public bus route. There are parking facilities.

The inspection took place on 22 and 23 November 2016. The inspection was unannounced.

At an inspection in November 2014, we asked the registered provider to take action to make improvements with regard to quality assurance, consent to care, staffing, supporting staff and record keeping as they were not meeting legal requirements at that time. The registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation. At an inspection on 30 April 2015 we found that the registered provider had taken action to address the breaches and was meeting legal requirements. The service was rated ‘Requires Improvement’ overall.

At the time of our inspection on 22 and 23 November 2016 there were ten people who used service, who had a learning disability and/or mental health or physical health needs.

The registered provider is required to have a registered manager in post and there was no registered manager at this service. This meant that we could not rate the question: Is the service well-led? any higher than requires improvement. The previous registered manager had left in April 2016 and a new manager had started in post approximately two months prior to our inspection, but they had yet to submit an application to register with the Care Quality Commission (CQC). 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.

There were effective systems in place to help make sure people who used the service were protected from the risk of abuse. Staff demonstrated a good understanding of their responsibilities in relation to reporting safeguarding issues.

People’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. There were systems to ensure people received their medicines safely, but there was some inconsistency in the registered provider's records relating to prescribed creams.

There were cleaning schedules in place, but some areas of the home had not been cleaned effectively and we have made a recommendation that the registered provider takes action to ensure appropriate standards of hygiene are consistently maintained.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient numbers of trained, competent staff to keep people safe and meet their needs, although the registered provider had been relying on regular agency staff in order to maintain staffing levels.

Staff received an induction, training and supervision to enable them to provide effective care for people.

Staff were able to demonstrate an understanding of the importance of gaining consent before providing care to someone and we found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People told us staff were caring and we observed many examples of positive, warm and friendly interactions between people and staff. People were involved in decisions about their care and we observed people being offered choices about their daily routines, what they wanted to eat and what they wanted to do with their day. People’s privacy was respected.

Care plans were developed in order to give staff the guidance they n

30th April 2015 - During a routine inspection pdf icon

Harlington House is registered to provide accommodation and personal care for up to 17 people with a learning disability. People either live in Harlington House, which is a three storey older detached building or Harlington Lodge on the same site, which is a more modern building and has two floors. It is located in a residential area south of York, close to local community facilities and on a public bus route. There are parking facilities.

The inspection took place on 30 April 2015. The inspection was unannounced.

At the last inspection on 6 and 11 November 2014, we asked the provider to take action to make improvements with regard to quality assurance, consent to care, staffing, supporting staff and record keeping, and this action has been completed.

After the comprehensive inspection on 6 and 11 November 2014 the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation. Their action plan stated that the service would be compliant by 27 February 2015.

We have made two recommendations within this report with regard to the monitoring of people's weight and improving the quality assurance processes.

The registered provider is required to have a registered manager in post and there has not been a registered manager at this service since July 2014. We followed this up with the registered provider and a new manager was appointed in February 2015, but they have yet to submit an application to register with the Care Quality Commission. 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.

At the time of the inspection on 30 April 2015 we were told by the manager and senior staff that there were eleven people living in the service, all of whom had been diagnosed with a learning disability. In addition to this, some of the people living in the home had either mental health or physical health needs.

We found that people were protected from the risks of harm or abuse because the provider had effective systems in place to manage issues of a safeguarding nature. Staff were trained in safeguarding adults from abuse and the staff understood their responsibilities.

We found the premises to be safe and well maintained; people had their own bedrooms and access to a garden area.

There were sufficient numbers of trained, skilled and competent staff on duty although the manager was relying on bank staff and staff from other homes to fill staff vacancies until new care staff were recruited. The registered provider did have robust staff recruitment procedures in place.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include people’s preferences, likes and dislikes. People who used the service received additional care and treatment from health care professionals based in the community.

People spoken with said the staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided within the service.

The staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. Improvements were needed to ensure the progress being made by the service was documented appropriately.

12th August 2014 - During a routine inspection pdf icon

Is the service safe?

The safety of people living at Harlington House was promoted as the service took prompt action to manage and report any allegations of abuse. However, the service did not operate in a way that respected people’s human rights and dignity. Several people told us they did not like living there.

The service was not safe, clean and hygienic. Furniture was not well maintained and the overall environment was not monitored. This put people at unnecessary risk.

When people displayed behaviours that distressed other people living there the staff did not always manage the situation in an effective way. This meant that the atmosphere was not calm and relaxed and people were at greater risk of becoming frustrated and upset.

Systems and procedures related to medicines management were not robust. This meant there was a risk that people may not get their medication in a safe way, and as prescribed. This placed people at risk of harm.

Procedures were not in place to help people when they did not want the care and support offered to them. There were no systems to ensure that action was taken and guidance sought, when people regularly declined the support offered to them.

There was a lack of direction and leadership at the service. Staffing rotas were not completed to reflect essential regular tasks like shopping, and other needs, like healthcare appointments. Insufficient staffing levels places people at increased risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to respecting and involving people, the environment and infection control practices, care and risk management, staffing and medicines.

Is the service effective?

Whilst the service displayed information about independent advocacy services, this was not always in a format that people could understand. Therefore some people living at Harlington House may not know this service was available.

We saw some evidence that people had been included and consulted about their care and support needs, in that they had added their signature to the records. However, those we looked at were not in a format that could easily be understood by someone with a learning disability. This made it more difficult for people to feel involved and included in the writing of their care plan.

We saw that whilst healthcare professionals were consulted, when people were feeling unwell, the guidance provided was not always followed in a timely way. This could affect people’s well-being, general health and ability to be independent.

People’s plans of care were not always being followed. People’s needs, choices and wishes were not being respected. Procedures were not in place to ensure that guidance was sought when people did not want their agreed support.

People’s needs had not been considered in the way the service was operating. There were no effective measures in place to ensure the environment was calm and relaxing. There was no pride in living there because the environment was dirty and uncared for.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to respecting and involving people, the environment and infection control practices, and care and risk management.

Is the service caring?

People said they liked practically all the staff who worked there. They said they were kind and friendly. One person said “The staff are nice. I’m very happy here.” However, another told us “The staff don’t talk to me that much. They’re all too busy. I get frustrated when they don’t talk to me.”

We saw people were shown kindness however, whilst staff tried to help people, this was not always in the most appropriate manner. Staff did not encourage people by working alongside them, or by asking the individual to do small tasks for themselves. This meant people were not challenged to learn new skills or to have more interesting lives.

People in some cases looked uncared for. Their clothes were stained. Some men were unshaven. Whilst staff were promoting people’s independence the care records did not indicate that they were helping people who either did not want or could not manage aspects of their care themselves.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning and managing their care.

Is the service responsive?

The provider is part way through consulting with people, their families and with visiting professionals about the service they provide. Their feedback will help to indicate whether people living there and stakeholders want to see changes in the way the service was operating.

There were not robust records to demonstrate that people were leading interested and varied lives. One person was looking forward to a holiday in Cornwall. One person said “I like to go out, but sometimes the staff are sick, so I can’t go.”

The processes to show that people’s views were actively sought about their care, their meals, weekly activities and general day to day life needed improving. People’s rooms looked at were not individualised in that they did not reflect their preferences and interests.

Although the service had a complaints policy this was not always in a format that people could understand. The service had a complaints policy though complaints were not always taken seriously and looked into properly.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in decisions about their care, in staffing and in managing complaints.

Is the service well-led?

Whilst the provider had a senior management team and systems to monitor the quality of the service, we saw little evidence that these were being completed. This meant the quality of the service was not being kept under review.

There was a lack of leadership, organisation and work allocation. The staff lacked direction and they were unaware of their roles and responsibilities. This meant no-one took responsibility for failures and failings. There were no processes in place to develop best practise that could be used to enable the service to be continually improving.

The service did not have a system to learn from accidents, incidents, safeguarding concerns and medication errors. There was no effective system to continually review these incidents. There was no evidence of analysis of these events, or action plans to show what the service was doing to minimise the risk of a similar event happening again. This meant there was no evidence that the service learned from these events.

Whilst the provider had identified that more staff were needed there was no system in place to monitor the staff competencies and ensure staff were receiving training in a timely way. Staff were not supervised to check that their skills and behaviours were in line with the ethos of the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to the management of the service.

23rd August 2013 - During a routine inspection pdf icon

We met most of the people who used the service and with one visitor whose relative lived at Harlington House. People spoke positively about the care they received. One person who used the service told us “I have been here a long time, staff are good to me. I like it here.”

People were asked for their consent and everybody worked together to assist people to learn how to manage risks associated with everyday living. We saw that there were opportunities for people who used the service to make choices and they had a say in how their treatment or care was delivered. We found that care and treatment was personalised and people took part in a range of activities in the community.

Throughout our inspection we observed there were sufficient numbers of staff available to support people in their chosen activities. There were good interactions between the members of staff and people who used the service. We saw that people who used the service were relaxed in the care of the staff. A healthcare professional told us staff listened to advice and that they were adaptable. The manager was singled out for mention by most of the people we spoke with. One person said “I would go to (the manager); she sorts everything out for me.” Another person said “I have no concerns when (the manager) is here. She is really great.”

Effective systems were in place to monitor the quality of the service and promote people’s safety and wellbeing in a well maintained home.

20th February 2013 - During a routine inspection pdf icon

People were supported in promoting their independence and community involvement. People contributed their views as far as they were able to do so and everybody worked together to assist people to learn how to manage risks associated with everyday living.

People who used the service told us “It's okay living here my key worker talks to me about what is happening in my life”. Another person said “I moved upstairs to be with the other guys. Staff asked me if I wanted to move”

During our inspection we spoke with relatives and they told us that staff had worked with them to ensure that the person who used the service was properly supported. They appreciated the effort staff made to ensure their relative had the best support possible.

Staff were aware of the different types of abuse and said they were confident they would be able to identify any signs of abuse in people who used the service.

People told us that if they had a complaint they would tell a member of staff or the manager. They also told us that there were regular house meetings where they could all discuss any concerns they had. One person said "The staff take time to talk to you" and another said "I talk to my key worker if I am unhappy." Relatives spoken with told us that when they had made a complaint it had been dealt with appropriately and the manager always took time to let them know what was happening in relation to their relative.

14th September 2011 - During a routine inspection pdf icon

People who use the service told us that the staff are very supportive and encouraged them to be as independent as possible. They also said that staff help them to access employment courses, drama courses and the local community. They said that if they were unhappy then they could speak to the staff.

Staff told us they can access regular training to ensure their skills remain relevent. They also said that the management structure is supportive and helps them in their role.

1st January 1970 - During an inspection to make sure that the improvements required had been made pdf icon

This inspection took place on 6 and 11 November 2014 and was unannounced.

At our last inspection of Harlington House in August 2014, we found that people were not always treated in a respectful manner and were not always receiving safe, consistent care and support. Furthermore the home was dirty and uncared for and people were not protected from the risks associated with medicines. We found there were not always enough staff working, and those staff were inadequately trained and supported. We also found that records were poorly maintained. The provider did not have robust monitoring checks in place, so had not identified that the service delivery had slipped and was inadequate. We issued eight compliance actions to the provider and told them that they must make improvements.

We also required the provider to submit regular updates to us to demonstrate the improvements being made. Furthermore the provider agreed to not admit any more people to the home, until the improvements had been made.

This inspection was to check that the improvements recorded in the provider’s action plan had been made. However, as we identified a range of areas where improvements were required at our last inspection, we carried out a comprehensive inspection at this visit, looking at all aspects of the service delivery.

Harlington House has been registered by Milewood Health Care Limited to provide accommodation and personal care for up to 17 people with a learning disability and /or mental health needs. People live in either Harlington House, which is a three storey older detached building, or Harlington Lodge, on the same site, which is a more modern building with communal areas and two floors. The Lodge accommodates six people, with the remainder being supported in small flats in the main house. It is located in a residential area south of York, close to local shops, community facilities and on a public bus route. There are parking facilities on the site.

The manager of Harlington House has been in post for less than three months. They have submitted their application to the Care Quality Commission (CQC) to be registered and on the day of our visit this application was being considered. 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.’ The service has been without a registered manager for four months.

We found the service had made improvements to some, but not all areas where improvements were needed. The provider told us in their action plan that their recruitment and training programme would not be complete until December 2014. So we have not been able to report on this in detail, and will re-look at this next time we inspect the service.

We found other areas where improvements were still required. Records kept at the service were still not well maintained. Care records were not written in a way that was easily understood by people living there and did not identify important information, like the person’s likes and dislikes, choices and interests. Important information was either missing or could not be easily located because of the way the records were managed and stored. This increased the risk of people receiving unsafe or inappropriate care.

We also found that whilst there had been some improvements in the way the service was monitored, further improvements were still required. This indicated the service was still not compliant, however, we noted the manager had not been in post very long. As a result we have decided to give both her and the provider more time to demonstrate that the new arrangements were making a difference to the way the service was being run.

We identified concerns at this inspection about the way the service recognised and acknowledged people’s rights, when decisions were made about their care. Whilst the manager knew about the Mental Capacity Act and Deprivation of Liberty safeguards (DOLS) the staff we spoke with had no knowledge about this subject.

However, we observed staff were kind, friendly and helpful. The atmosphere at the home was more relaxed. Staff worked alongside people, helping them with tasks, rather than doing things for people. Staff asked people what they wanted to do and where they wanted to go. They listened to what people said to them.

The service was better organised and staff had a clearer understanding of their roles and responsibilities. Staff were more focussed in their work. As a result they had more time to spend with individuals and support people to do the things they wanted to do.

Staff were also supporting people to maintain their own personal hygiene. Records indicated that this was completed discreetly, in order to promote people’s independence, whilst protecting their privacy and dignity.

People were supported to access and maintain healthcare support, though the records relating to meeting people’s healthcare needs could be improved.

We found overall that the home was clean and well maintained and people were getting help from staff to maintain the cleanliness of their own rooms. This meant people were now taking some pride in where they lived and worked.

People were receiving their medications appropriately and safely. The service had arrangements in place to protect people from the harm associated with the unsafe use of medication.

People were now receiving a more varied and balanced diet. The food cupboards and fridges were well stocked so people had choices if they wanted snacks or drinks during the day.

People overall told us they thought they and their belongings were safe. Staff were clear of their roles of identifying and reporting abuse. The provider took prompt action when abuse was reported. Having robust safeguarding processes helped to protect people from harm.

Whilst people were asked about the community activities they wanted to be involved with, these did not always happen as agreed. The records did not describe why the planned activity did not go ahead.

There was a new manager in post; however they needed more time to implement the changes they wanted. People and staff and visiting professionals told us the manager had made a difference to the way the home was being run. They said the manager was approachable and available and staff were better organised and better led.

Overall the record keeping at the service was not good enough. This meant the service could not evidence actions they had taken, or evidence changes they had made as a result of events happening there. Care records were not person-centred. Other records relating to risk management and staff records were incomplete or missing.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the day to day staffing levels and the training provided to the staff team. Continued breaches were also identified in relation to the quality monitoring arrangements and record-keeping at the service.

We found a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to assessing people’s consent and mental capacity, when decisions about their care were being considered. You can see what action we told the provider to take at the back of the full version of this report.

 

 

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