Harmony House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This assessment did not assess all quality statements within this key question and therefore, an overall rating has not been produced. We assessed 3 quality statements; assessing needs, delivering evidence-based care and treatment, how staff teams and services work together. Overall, people's care, support and treatment reflected their needs and any protected equality characteristics. There were inconsistencies in people’s care records which needed additional information to ensure they remained specific and person centred. Feedback from staff showed there were gaps in knowledge, for example around supporting people with risks of choking. Following our visit, the registered manager confirmed additional training was planned to ensure staff were up-to-date with national guidance, evidence-based good practice and required standards. People and relatives felt people's general health needs were met but did not always feel involved with the plan of care. Comments included, "They look after any medical conditions alright but they never discuss my care needs," "They’ve never discussed [person's] care with me. I don’t know about care plans" and, "They don’t discuss [person's] care with me. I've never been involved with a care plan. I don’t think they have time to listen’. This evidence suggests people and relatives do not know if their care needs are regularly reviewed and therefore people cannot be confident that their individual needs have been appropriately assessed and are fully understood.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt people's general health needs were met but did not always feel involved with the plan of care. Comments included, "They look after any medical conditions alright but they never discuss my care needs," "They’ve never discussed [person's] care with me. I don’t know about care plans" and, "They don’t discuss [person's] care with me. I've never been involved with a care plan. I don’t think they have time to listen."

Staff were positive about the way information was shared to ensure peoples assessed needs were identified and communicated across staff teams. One staff member said, “Nurses are good at letting us know things.” Staff gave examples that showed how they worked with other health professionals to promote good skin integrity. The registered manager told us they had identified improvements were needed to involve people and relatives more within people's care plans and reviews. Plans were in place to make these improvements following our visit.

Records showed systems were in place to assess people’s needs when they first moved to the home. Processes were in place to support staff to work with other health and social care professionals to assess people’s needs.

People did not always feel their care and treatment was delivered in partnership with them. People told us, "I only get a shower every 8 days, the strip wash isn’t adequate. They look after any medical condition alright but they never discuss my care needs" and, "I haven’t seen a care plan. There’s never been a review. I don’t think they have discussed my care needs." Relatives also commented, "I've never seen a care plan here and there’s never been a review meeting" and, "‘They don’t discuss [person's] care with me. I've never been involved with a care plan. I don’t think they have time to listen."

Staff told us they involved people in their day to day care needs. The registered manager had failed to effectively communicate best practice guidance around eating and drinking to staff who supported people who were at risk of choking. The registered manager confirmed they had booked further training for staff following our visit. Feedback from staff showed inconsistency in knowledge around specialised diets and how people needed their food to be prepared to mitigate the risk of choking. This demonstrated staff had a lack of understanding around risks related to eating and drinking.

The providers processes required further improvement to ensure they delivered people’s care and treatment with them, and in line with legislation and current evidence-based good practice and standards. For example, senior staff sought advice from speech and language therapists. However, care staff directly supporting people did not always have the level of guidance and training required to ensure risks to people’s safety and their health was consistently maintained.

People and relatives were positive about about how staff worked with other healthcare professionals to ensure people's general health needs were met. They talked about having regular access the GP, chiropodist and opticians. One relative commented, "They phone the GP when needed and they come in. The chiropodist looks after them and they have seen a dentist."

Most staff were positive about the way information was shared across teams. One staff member told us, “Staff do talk to each other about what works in handover. Staff work out strategies, and share how they do it.” This staff member shared how this had improved nutrition, hydration and personal care outcomes for a person. Overall, staff told us care staff and clinical staff worked well together. However, one staff member told us important information was not always shared with all staff about people's changing clinical needs.

Staff worked with a range of health and social care professionals to develop plans to meet people’s health and well-being needs. These included mental health teams, GPs, and emergency care providers. Stakeholders reported positive engagement and partnership working with the home. One stakeholder described communication with the home as 'excellent.'

Records did not consistently detail the care people required when they had moved from other settings. Although most care records contained a good level of detail, some care plans required further detail to effectively guide staff when people had moved from other services. For example, with the on-going management of good catheter care.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.