About the service:

• The Harefield Care Home offers accommodation and personal or nursing care for up to 40 older people, some of whom are living with the experience of dementia. The accommodation is provided in two ground floor units in a purpose-built building. There were 37 people using the service at the time of our inspection.

• The Harefield Care Home is part of HC-One Oval Limited, a large organisation who owns over 300 care homes across the United Kingdom.

People’s experience of using the service:

• People were supported by staff who did not always receive training the provider identified as mandatory. The training records confirmed that some training was out of date.

• Staff stated they did not always feel supported by the management. We saw that, although they received supervision, this was not always regular.

• People’s records showed that staff did not always use respectful language and did not always demonstrate an understanding about the person’s needs. Some staff did not know about a person’s individual communication needs although these were recorded in the person’s care plan.

• People’s records about personal safety checks were not always completed appropriately and as stated in the care plans. These included repositioning charts and pressure mattress checks.

•The provider had systems in place to help ensure people who used the service received quality care and were safe from avoidable harm. However, these were not always effective because they had failed to identify the above shortfalls we found during our inspection.

• There was evidence that people were offered a range of activities and an activity plan was displayed. However, we saw that most people stayed in their room and were not aware of activities on offer because they were not informed.

• Care and support plans were comprehensive and detailed. They contained all the necessary information about the person and how they wanted their care provided. However, they did not always evidence people’s involvement in their care.

• Risk assessments were in place. These identified all risks that people faced and included guidelines for staff to follow to help ensure people were safe from harm.

• People’s healthcare needs were met because staff took appropriate action when concerns were identified.

• Medicines were safely managed. There were systems for ordering, administering and monitoring medicines. Staff received training in the administration of medicines and had their competencies checked.

• People’s end of life wishes were recorded in their care plan. This included their religious and cultural needs and where they wanted to be when they reached the end of their life.

• Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

• People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean and staff were provided with protective equipment.

• The environment was homely and bright and was suited to the individual needs of people, such as people living with the experience of dementia.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA). Where people lacked the capacity to make particular decisions about their care, their mental capacity was assessed. Where necessary, people were being deprived of their liberty lawfully.

• The provider had processes for the recording and investigation of incidents and accidents. We saw that these included actions taken and lessons learned.

• Rating at last inspection: The service was registered in 2017 and had only been inspected once before. At the last inspection the service was rated requires improvement in the key questions of ‘safe’ and ‘well led’ and overall (19 and 20 March 2018). During this inspection we found the service had not made the required improvements and remained requires improvement

This unannounced inspection took place on 19 and 20 March 2018.

The Harefield 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.

The Harefield Care Home is registered to accommodate 40 people, however they currently accommodate a maximum of 33 people in single rooms. The service was purpose built and there are two units. Each unit has communal lounge and dining facilities and all the accommodation is on the ground floor. There were 32 people using the service at the time of our inspection. This was the first inspection of the service since it was registered under this provider in February 2017. At this inspection we have rated the service Requires Improvement in the key questions of Safe and Well-Led and overall.

The service is required to have 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. The manager has been working at the service since November 2017 and had applied to CQC to become the registered manager for the service.

We found a few issues with the quality of the premises that although they had been identified, some since August 2017, had not been addressed to be made good. There were processes for auditing and monitoring the quality and safety of services people received, but in a few cases they had not always been effective in identifying shortfalls so action could be taken to make the necessary improvements.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe living at the service. Risk assessments were carried out for individuals and safe working practices were being followed. People were safeguarded from the risk of abuse and staff were confident to report concerns. Recruitment procedures were followed to ensure only suitable staff were employed at the service, There were enough staff available to meet people’s needs and where agency staff were used efforts were made to have consistent staff. Medicines were being safely managed at the service. We have made a recommendation around the disposal of medicines.

With the exception of the emergency lighting and ill-fitting doors and windows, systems and equipment were serviced at the required intervals and being maintained in working order. Processes were followed to learn from incidents and accidents and to improve practice where necessary.

People had been assessed and their needs and wishes identified prior to coming to the service. Training provided staff with the skills and knowledge to care for people effectively and further training was being planned. People’s dietary needs and preferences were identified and being met. People’s health was monitored and any concerns were reported to the GP and other relevant healthcare professionals for input.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The accommodation was appropriate to meet the needs of the people who lived there and bedrooms were personalised and homely.

People and their relatives were happy with the care people received. Staff were caring and kind and showed people respect, maintaining their privacy and dignity. Staff understood the care and support each person required and provided this in a gentle and friendly way. People’s religious needs were identified and respected.

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