CQC report explained · a residential care home
What the CQC found at Harlington House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People generally felt safe and there were enough staff, but health risks were not always monitored consistently. Recruitment checks, medicine timings and infection control also needed improvement.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- People received personalised care and had choice and control. They were supported with goals, relationships, activities, communication and complaints.
- Well-led?
- Requires improvement
- The manager was visible and had an improvement plan, but quality checks did not reliably identify risks. The provider remained in breach of Regulation 17.
What inspectors found, December 2022
Rated Requires Improvement; inspectors found personalised, responsive care, but safety and oversight were not reliable, although the home is no longer in Special Measures.
This was an unannounced focused inspection. Inspectors visited on three occasions, including one evening visit. They spoke with people, relatives and staff, and checked medicines, care plans, risk assessments, recruitment records, training and the home's quality checks.
The home had improved since its previous inadequate rating. People received personalised care, had choice and were supported with activities, relationships and independence. Staff knew people well and relatives spoke positively about the care.
There were still important problems. Health risks, such as weight monitoring, were not always checked as planned. Some medicines were not given at the recorded times, staff recruitment checks were not robust, and staff were not following the required infection control guidance on PPE. The home's quality systems had failed to identify some of these issues.
The overall rating changed from Inadequate to Requires Improvement. Safe and Well-led were rated Requires Improvement, while Responsive was rated Good. The home was removed from Special Measures, but the provider remained in breach of Regulation 17 on good governance.
Personalised support
People were involved in planning their care and were supported to pursue their goals and aspirations.
“Staff supported people to achieve their aspirations and goals.” from the report
Choice and independence
Staff supported people to make choices and develop their independence. Medicine support was adjusted for people who could manage some medicines themselves.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests” from the report
Activities and relationships
People were supported to take part in social and leisure activities, including outings and activities in the home.
“People were supported to participate in their chosen social and leisure interests on a regular basis.” from the report
Staffing levels
There were enough staff to provide planned one-to-one support and help people take part in activities and visits.
“The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.” from the report
Health monitoring
needs fixingTwo people's weights were not reviewed as set out in their care plans. This meant risks linked to their weight were not identified effectively.
“Risks to people's health had not always been consistently monitored.” from the report
Recruitment checks
needs fixingEmployment gaps were not always explained and reference information was not always considered when assessing possible risks or performance concerns.
“Staff recruitment was not robust. Gaps in staff's employment had not always been accounted for and feedback from references had not been considered in relation to potential risk or performance issues.” from the report
Infection control
seriousStaff were seen not wearing PPE in line with the guidance. Inspectors said this increased people's risk of infection.
“Staff were observed not wearing any Personal Protective Equipment (PPE) in line with government guidance. This put people at increased risk of infection.” from the report
Weak quality checks
seriousThe provider's monitoring systems did not identify several problems found during the inspection. Care plans were not always up to date and risk instructions were sometimes unclear.
“Governance systems were not effective to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Medicine timing
needs fixingSome time-sensitive medicines were not given at the times recorded on the medicine administration record. One person's barrier cream was also not applied as often as the guidance required.
“Time sensitive medicines were not always given at the time documented on the medicine administration record.” from the report
- 01How are you now recording and reviewing people's weights, and what happens if a weight changes?
- 02What checks are now made on staff employment gaps and references before staff are employed?
- 03How do you make sure time-sensitive medicines and topical medicines are given exactly as prescribed?
- 04What has changed to ensure staff follow current PPE and infection control guidance?
- 05How will you show that your quality checks identify risks and keep care plans up to date?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected, and their previous ratings were carried over when calculating the overall rating. This explanation was written from the published report of 2 December 2022 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, June 2022
Rated Inadequate and placed in special measures; inspectors found risks to safety, poor oversight and care that was not always personalised.
Inspectors visited on 7 and 15 February 2022. They reviewed care plans, risk assessments, building safety records, staff files and medication records. They spoke with people, relatives, staff, managers and local safeguarding and authority teams.
The home had deteriorated since its previous Requires Improvement rating in March 2021. Inspectors found that risks were not properly assessed or managed, staffing and training were not reliably sufficient, infection control was not consistent, and people were not always involved in their care or activities.
There were some improvements in medicine storage, and people and relatives said they felt safe. However, the overall rating was Inadequate. Safe and Well-led were rated Inadequate, while Responsive was rated Requires Improvement. Effective and Caring were not rated in this inspection.
People said they felt safe
People and their relatives consistently told inspectors that they felt safe at the home.
“People and their relatives consistently told us that they felt safe at the service.” from the report
Safe recruitment
Inspectors found that staff recruitment checks were carried out safely.
“Staff were safely recruited. Staff told us they found the acting manager approachable and fair.” from the report
Medicine storage improved
Medicine storage and temperature checks had improved since the previous inspection, although these improvements were not yet fully established.
“Medications were stored safely and effectively. Processes to ensure medicines were stored at the correct temperature were now being followed.” from the report
Safeguarding awareness
Staff understood how to recognise and report safeguarding concerns, and had completed safeguarding training.
“Staff had completed safeguarding training and understood the signs of abuse.” from the report
People were at risk of harm
seriousThe front door mechanism was broken, allowing access to bedrooms. Risks relating to self-harm were not always clearly recorded or understood by staff.
“Risks found in the home environment were not acted upon and placed people at risk of harm.” from the report
Unsafe staffing and training
seriousThere was no reliable method for deciding safe staffing levels, and the manager could not assure inspectors that commissioned one-to-one hours were being provided. Some important staff training had expired.
“The provider had failed to ensure there were sufficient numbers of suitably trained staff. This placed people at risk of harm” from the report
Care was not personalised
seriousPeople were not always involved in decisions about their care, and activities were sometimes chosen because they were easier to supervise rather than because people wanted them.
“People did not receive an individualised and person-centred approach to their care. This was a breach of regulation 9” from the report
Weak management oversight
seriousAudits did not identify or resolve problems with medicines, infection control and staffing. The home had no registered manager and no active improvement plan.
“The provider had not ensured systems and processes operated effectively to maintain governance of the service and compliance with their responsibilities.” from the report
Poor communication with relatives
needs fixingRelatives said communication was very poor. Some complaints were not recorded, and relatives did not always receive a response or update.
“Relatives consistently told us that communication from the home was very poor” from the report
- 01What has been done to repair the front door and manage risks for people who may leave the home alone?
- 02How do you now calculate safe staffing levels, and how do you make sure each person's commissioned one-to-one hours are provided?
- 03Which staff training has been renewed, including first aid, diabetes, challenging behaviour and medicines training?
- 04How are cleaning checks, COVID-19 visitor checks and infection-control records now monitored?
- 05How are people and relatives involved in care planning, activities, health appointments and responses to complaints?
This began as a targeted inspection of infection control, visiting arrangements and staffing pressures, then widened to a focused inspection including Safe and Well-led; Effective and Caring were not rated. This explanation was written from the published report of 8 June 2022 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 Harlington House
7 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- December 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2022Inadequatedown from Requires improvementSafe: InadequateResponsive: Requires improvementWell-led: Inadequate
- March 2021
Location report published without a new overall rating.
- March 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- June 2018Goodup from Requires improvementSafe: GoodResponsive: GoodWell-led: Requires improvement
- March 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2015Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- October 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 10 May 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.
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37 live-in carers within about an hour of York
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 £1,270 a week. 32 can care for a couple. 11 years' experience on average.
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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.