CQC report explained · a nursing home
What the CQC found at Harmony House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- The inspection looked at infection control, people's finances and welfare, but not the whole Safe question. Infection control had improved and the provider was no longer in breach of Regulation 12 in that area, although further sustained improvement was needed.
- Effective?
- Requires improvement
- The provider was reviewing staff training. Some staff said induction did not always give them the knowledge and confidence needed for their roles. People said they enjoyed the food and were supported to choose what they ate and drank.
- Caring?
- Good
- Caring was not assessed as a separate question in this targeted inspection.
- Responsive?
- Good
- Responsive was not assessed as a separate question in this targeted inspection.
- Well-led?
- Requires improvement
- People spoke positively about management and most staff described a positive culture. Some staff did not feel able to raise concerns openly, so the provider was asked to review its feedback systems.
What inspectors found, April 2023
Inspected but not rated; the home had improved infection control, but the previous Requires Improvement rating remained and some staff concerns were not fully resolved.
This was an unannounced, targeted inspection on 17 and 23 March 2023. Two inspectors spoke with six people and gathered feedback from 14 staff. They reviewed records and information about leadership, privacy, finances, welfare and staff training.
People said they were happy and treated well. The home had improved its infection control, including clearing clutter and repairing some damaged areas. Systems were in place to manage people's money and protect them from abuse.
The provider was reviewing staff training, but some staff said induction did not always give them enough knowledge and confidence. Most staff described a positive culture, although some did not feel able to raise concerns openly. The home was inspected but not rated, so its previous overall Requires Improvement rating remained.
People felt happy and well treated
People told inspectors they were happy at the home and treated well by staff.
“People told us they were happy and treated well at the service.” from the report
Infection control had improved
The home had started repairs and renovations and cleared clutter from communal corridors, making cleaning more effective.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12 in relation to infection prevention and control, though further and sustained improvement was needed.” from the report
Money was managed safely
Records and systems were in place to monitor people's finances and reduce the risk of abuse.
“Systems were in place to ensure people's finances were managed safely.” from the report
People's food choices were supported
People were offered food and drink that reflected their preferences, and they said they enjoyed the food.
“People were supported to eat and drink from a menu that reflected their choices and preferences.” from the report
Staff induction was not always effective
needs fixingSome staff said induction did not always provide the knowledge and confidence needed to do their jobs. The provider said it would review the process.
“Some staff we spoke with said this process was not always effective at ensuring staff had the knowledge and confidence needed to do their jobs.” from the report
Staff feedback was not fully open
needs fixingSome staff did not feel able to approach the manager or provider with concerns, or felt that concerns were not acted on. The provider was asked to review its feedback systems.
“However, some staff felt they were not always able to approach the registered manager or provider to discuss their concerns, or that if they did these were not acted on.” from the report
Further improvement was needed
needs fixingAlthough infection control had improved, inspectors said the improvement needed to be maintained. The full Safe, Effective and Well-led questions were not reviewed.
“The provider was no longer in breach of regulation 12 in relation to infection prevention and control, though further and sustained improvement was needed.” from the report
- 01What has changed in staff induction since inspectors found that some staff did not have enough knowledge and confidence?
- 02How can staff now raise concerns, and how do you show that concerns are acted on?
- 03What further work is planned to make infection control improvements sustained?
- 04Which previous breaches were not reviewed during this inspection, and what action has been taken about them?
- 05When is the next comprehensive inspection expected to assess all five questions?
This was a targeted inspection of specific concerns about leadership and culture, privacy and finances, welfare, staff training and infection control; it did not assess the full key questions, and Caring and Responsive were not reviewed. This explanation was written from the published report of 1 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, January 2023
Requires Improvement; inspectors found serious shortfalls in safe care, consent, medicines and oversight, although people generally felt cared for.
This was an unannounced focused inspection. Inspectors visited on 14 and 20 December 2022, spoke with people, relatives, staff and professionals, and checked care records, medicines records, recruitment files and management records.
The home was not always safe. Risks, staffing, medicines and infection control were not managed reliably. Some people were left without the support they needed, including a person at risk of choking who was left unattended while eating. Restrictions were also used without the required capacity assessments and best-interest decisions.
The overall rating is Requires Improvement. Safe, Effective and Well-led were also rated Requires Improvement. Caring and Responsive were not inspected in this visit, so their previous ratings carried over. The overall rating fell from Good at the last inspection in 2018. The provider had started an action plan, but CQC said it would continue monitoring progress.
People felt safe
People spoken with generally said they felt safe and were happy with their care.
“I feel very safe, always have.” from the report
Supportive culture
Staff described management as supportive and approachable. Relatives also gave positive feedback about the care and communication.
“They really have looked after my [relative], they treat them like one of the family.” from the report
Food and drink choices
People had enough to eat and drink, with alternatives available when they did not want the set menu. People could also make their own drinks and snacks.
“There is a set menu for dinner, but if you don't like it they make you something else.” from the report
Safeguarding response
The manager handled safeguarding concerns appropriately, and staff understood how to report concerns.
“If I had any concerns I would inform the manager, inform all staff what to look out for, inform the community mental health team and inform safeguarding.” from the report
Partnership working
The home had working relationships with the local authority and health professionals. People received regular medicine and mental health reviews.
“I am confident in sharing any concerns or updates with [the registered manager] and these are followed up appropriately.” from the report
Risk and staffing
seriousRisk assessments and care plans did not always explain how to keep people safe. Staffing was not always sufficient, including for people needing one-to-one support or help while eating.
“On both days we visited the home we found a person who was a recognised choking risk was left unattended in the dining area whilst eating as staff were needed elsewhere in the home.” from the report
Medicines
seriousMedicines were not managed safely. Records had gaps, storage temperatures were not consistently checked or acted upon, and controlled drug stock records were sometimes inaccurate.
“There were gaps in administration records which meant it was not possible to tell whether people had received their medicines as prescribed.” from the report
Consent and restrictions
seriousRestrictions, including limits on access to lighters, alcohol and parts of the home, were not always supported by capacity assessments or best-interest decisions.
“Restrictions were being imposed on people without evidence of capacity assessments or best interest decisions.” from the report
Incomplete care records
needs fixingCare plans did not always explain people's individual needs, what helped during distress or how staff should respond if coping strategies failed.
“Care plans did not contain information on exactly how to support people at times of distress, what worked in terms of de-escalating situations, what coping strategies people had developed or what to do if these failed.” from the report
Cleanliness and condition
needs fixingSome areas were not clean, and damaged paintwork and furniture made effective cleaning difficult. The environment also needed refurbishment.
“We found some areas of the home were not clean and other areas could not be adequately cleaned due to damage.” from the report
Weak quality checks
seriousAudits and monitoring did not identify the issues found during inspection. The provider also failed to notify CQC about all notifiable incidents.
“Audits and quality monitoring had not identified the issues we found during the inspection.” from the report
- 01What has been done to make sure medicines are stored correctly, temperatures are checked daily and administration records have no gaps?
- 02How will staffing ensure that people at risk of choking and people needing one-to-one support are supervised at all times?
- 03How are capacity assessments and best-interest decisions now recorded before restrictions are imposed?
- 04What changes have been made to care plans so they explain each person's distress triggers, coping strategies and de-escalation support?
- 05What evidence can you show that cleaning, damaged furniture and damaged paintwork have been put right?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 25 January 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.
Every inspection of Harmony House Nursing Home
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- April 2023Inspected but not ratedcurrent ratingSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- January 2023Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2021Inspected but not ratedSafe: Inspected but not rated
- September 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 27 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.
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