CQC report explained · a nursing home
What the CQC found at Harbledown Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unclear or inconsistent risk guidance, incomplete care records, unsafe medicines management and weaknesses in infection control and building safety. Staffing, recruitment, safeguarding and mental capacity arrangements were positive.
- Effective?
- Good
- This area was not inspected during this visit. The report says ratings for areas not inspected were carried forward from the previous inspection.
- Caring?
- Good
- This area was not inspected during this visit. The report says ratings for areas not inspected were carried forward from the previous inspection.
- Responsive?
- Good
- This area was not inspected during this visit. The report says ratings for areas not inspected were carried forward from the previous inspection.
- Well-led?
- Requires improvement
- Quality checks and audits had not found or corrected the problems identified by inspectors. Some complaint responses were not sufficiently transparent, although people and relatives said managers were approachable.
What inspectors found, April 2023
Requires Improvement; inspectors found risks in care records, medicines, infection control and quality checks, with breaches of Regulations 12 and 17.
This was an unannounced focused inspection on 28 February 2023. The inspector spoke with people, relatives and staff, observed care, and checked care plans, medicines, staff recruitment records and management checks.
People said they felt safe and there were enough staff. However, risks were not always assessed clearly, care records were not always accurate, medicines were not always managed safely, and some parts of the building were difficult to keep clean and safe.
The home was rated Requires Improvement overall. Safe and well-led were both rated Requires Improvement. The other three areas were not inspected, so their previous ratings were carried forward. The overall rating fell from Good at the previous inspection, published in 2019.
Enough staff
Inspectors found enough staff to support people safely. Recruitment checks, including references and DBS checks, had been completed.
“Staff had been recruited safely and there were enough staff to safely support people.” from the report
Safeguarding
People said they felt safe. Staff understood how to recognise and report abuse, and managers understood their safeguarding responsibilities.
“There were effective systems in place to keep people safe from abuse and discrimination.” from the report
Learning from falls
The home reviewed accidents and incidents. It introduced measures such as crash mats and floor sensors, and records showed that falls had reduced.
“Records showed these actions had reduced the number of falls.” from the report
Listening to people
People, relatives and staff were asked for their views through meetings and surveys. The home had acted on at least one concern by buying hot meal trolleys.
“People and staff were engaged by the registered managers and had been asked to complete quality assurance surveys about the service.” from the report
Incomplete risk and care records
seriousSome care plans did not clearly explain how staff should manage risks. Records showed that repositioning had not happened regularly, and a person developed a sore on their heel.
“Records showed people had not had their position changed regularly and a person had developed a sore on their heel.” from the report
Medicines
seriousMedicine trolley temperatures had not been recorded, tablet counts were not always accurate, and some instructions for medicines given when needed were not detailed enough.
“The records of the number of tablets available were not always accurate.” from the report
Infection control and repairs
seriousSome bedrail bumpers were dirty or damaged, and some en-suite facilities were in poor repair. These problems made cleaning and infection prevention more difficult.
“We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
Quality checks missed problems
seriousThe home's audits did not identify the shortfalls found during the inspection. Some earlier actions had also not been completed.
“The audits had not identified the inconsistent guidance in care plans, management of potential risks to people and shortfalls in medicine management.” from the report
Complaint responses
minorWritten responses to complaints were not always open and transparent. Inspectors said some wording could sound defensive.
“The wording of written responses from the registered managers to complainants did not always promote transparency and could be defensive.” from the report
- 01What has been changed to make risk assessments and care plans clear, consistent and up to date?
- 02How do you now record repositioning and check that people at risk of skin damage receive the care they need?
- 03How are medicine trolley temperatures, tablet counts and 'when required' medicine instructions checked now?
- 04What repairs and cleaning work has been completed in bedrooms, bathrooms and areas with damaged equipment?
- 05How do your audits now identify problems and make sure agreed actions are completed on time?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 28 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2019
Harbledown Lodge was rated Good overall; inspectors found safe, kind and well-managed care, with improvements since the previous inspection.
This was an unannounced, planned inspection on 29 and 30 August 2019. One inspector spoke with people living in the home, relatives, staff and a visiting healthcare professional. They also observed care and checked care records, medicines records, staff files and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found accurate care records, safe medicines practice, enough trained staff and good links with health professionals. People said they felt safe and happy, and inspectors saw staff treating people with kindness, dignity and respect.
The home had improved from Requires Improvement at the previous inspection. The earlier breach about governance and inaccurate records had been resolved, and the home was no longer in breach of regulations. Inspectors noted that some end of life wishes were not recorded when people or relatives did not want to discuss them, and the home was still moving from paper to electronic care records.
Accurate care records
Records about care and treatment were accurate, allowing staff to show that people received the care they needed. This addressed the main problem found at the previous inspection.
“At this inspection we found enough improvement had been made and the provider was no longer in breach of regulation 17.” from the report
Safe medicines
People received medicines as prescribed. Staff were trained and their competence was checked regularly.
“People received their medicines when they needed them and as prescribed by their doctors.” from the report
Kind and respectful care
Inspectors saw staff respond patiently and kindly. People were supported with dignity, choice and independence.
“Staff were kind, caring, friendly and attentive.” from the report
Strong management checks
Managers carried out regular audits and acted quickly when they found shortfalls. People and relatives were asked for their views.
“At this inspection there were effective systems in place to monitor the quality of the service.” from the report
Support with health and nutrition
Staff worked with healthcare professionals and followed specialist advice about conditions, swallowing, nutrition and other health needs.
“Where dieticians had recommended people received fortified food, this was understood and carried out by kitchen staff.” from the report
End of life wishes
minorWhen people or relatives did not want to discuss end of life wishes, this was not always recorded. The manager agreed to update several care plans, and this was completed during the inspection.
“However, when people or their relatives did not want to discuss their wishes, this was not always recorded.” from the report
Activities staffing
minorThe activity coordinator had recently left. An interim coordinator was arranging activities while the home advertised for a replacement.
“People took part in activities they enjoyed, although the activity co-ordinator had recently left the service.” from the report
Change to electronic records
minorThe home was still transferring paper care plans to electronic records at the time of inspection. An action plan set a target to finish this by the end of October 2019.
“An action plan was in place to complete this task by the end of October 2019.” from the report
- 01How do you record and review a person's choice if they do not want to discuss their end of life wishes?
- 02Has the move from paper care plans to electronic records been completed, and how do you check records remain accurate during changes?
- 03Who is currently responsible for activities, and what activities are available for people with different interests and abilities?
- 04How are staffing levels adjusted when people's needs change, and how often are these levels reviewed?
- 05How will you involve my relative and our family in regular care plan reviews?
This was an unannounced planned inspection covering all five CQC questions, with the previous Requires Improvement ratings and one breach reviewed. This explanation was written from the published report of 2 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Harbledown Lodge
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- April 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- August 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
39 live-in carers within about an hour of Kent
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 33 can care for a couple. 12 years' experience on average.
“Always on time and with a lovely smile for my mum. Theresa is kind and sensitive to my mum's needs.”
“Irene was a very kind and empathetic carer who knew just the right words to say to put a smile on my face.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.