This inspection was carried out on 4 June 2018. The inspection was unannounced.

We undertook an unannounced focused inspection of Harpwood Care Home on 4 June 2018. The team inspected the service against three of the five questions we ask about services: is the service well led, is the service effective and is the service safe. This was due to the concerns that had been raised, and the potential risk to others living at Harpwood Care Home. At this inspection the service was rated as requires improvement in safe, effective and well-led, therefore the overall rating for the service is now requires improvement.

Harpwood Care Home is a ‘care home’. 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.

Harpwood Care Home is a privately owned care home providing accommodation for up to 50 older people some of whom live with dementia. The service had three double bedrooms; the remainder of the rooms were single, some with ensuite facilities. There was a large garden for people to use with seating and pathways. There were 43 people living in the service when we inspected.

The service had a manager in post who had started after the full comprehensive inspection in July 2016. The manager had applied to become registered with the Care Quality Commission to manage the service. The manager had attended their registration interview in the week prior to our inspection. 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.

Some people’s care plans were detailed and gave staff guidance regarding how to meet people’s needs. However, some care plans were not always complete and, some contained conflicting information. One persons’ care plan recorded that they did want to receive medical attention in the event of an emergency; however, another page within their plan stated they did not want medical attention. Another persons’ care plan stated there was concern regarding the person’s weight loss, and that meals should be offered frequently. However, in practice staff were supporting this person to manage their weight and offering a low fat diet.

Risks posed to people had not been consistently assessed, recorded and monitored. Some people were at risk of skin damage and used specialist equipment to reduce this risk. However, the equipment had been incorrectly set, leaving these people at risk of skin damage. Another persons’ care plan stated they were at risk of falls; guidance was available for staff to follow to reduce this risk. However, the guidance was not consistently followed by the staff team, leaving the person at risk of falling. Other risks to people had been properly assessed and action was taken to mitigate the risk.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were encouraged to make their own choices and staff gained people’s consent prior to any care or support tasks. However, people’s capacity to consent to specific decisions had not always been sought in line with the principles of the Mental Capacity Act 2005 (MCA).

People felt safe with the staff at Harpwood Care Home. Staff understood their responsibilities to safeguard people from potential abuse. There were enough staff deployed to meet people’s assessed needs. Recruitment procedures had not consistently been followed; gaps in employment had not been explored or recorded. We have made a recommendation about this.

People received their medicines from trained staff as prescribed by their doctor. People were supported to maintain their health and attend appointments wit

This inspection was carried out on 1 and 6 July 2016. Harpwood is a care home situated in Wrotham heath, near Sevenoaks, providing accommodation for up to 50 older people some of whom live with dementia. There were 39 people living at Harpwood at the time of our inspection. The service had recently been registered under a new provider and as such this was the first inspection of the service under the new ownership. The service had three double bedrooms, but these were being used as single bedrooms at the time of the inspection. The remainder of the rooms were single, some with ensuite facilities. There were bathrooms in each wing of the service and planned improvements were underway to add a shower room and to refurbish areas of the premises. There was a large garden for people to use with seating and pathways.

There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 previous registered manager had left the service in May 2016. The registered provider was recruiting a new manager for the service. The deputy manager for the service was overseeing the running of the home, with support from an internal quality manager and the registered provider, until a new manager was appointed.

Accurate and complete records were not always maintained to allow the registered provider to monitor the delivery of care. We have made a recommendation about this.

Staff had not been trained in using fire evacuation equipment that people’s fire evacuation assessments said they needed to use. We have made a recommendation about this.

Staff knew how to recognise signs of abuse and how to report any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references. Staff were responsive to people’s needs and requests. People’s needs were assessed and personalised plans written to meet them. Staff knew each person well and understood how to meet their needs.

Staff had completed training to enable them to carry out their roles. There was an ongoing programme of training and development for staff. Staff were supported and supervised by the deputy manager. Staff communicated effectively with people and treated them with kindness and respect. People’s right to privacy was maintained. They promoted people’s independence and encouraged people to do as much as possible for themselves.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. People were promptly referred to health care professionals when needed.

The premises were well maintained, safe and comfortable for people to use. The home was kept clean and the risk of the spread of infection in the home had been assessed and managed.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When necessary, meetings were held to make decisions in people’s be