Harmony Care and Support was rated Good overall following an announced inspection in January 2016, with improvements confirmed in safe, effective, caring and responsive domains since the previous inspection. However, the service was rated Requires Improvement for well-led due to a continuing breach of Regulation 17, with ineffective auditing, unresolved action plans, poor office communication and unassessed care call durations.
Concerns (6)
critical
Governance
: “The provider did not have a comprehensive approach to auditing the quality of the care being provided. Where auditing was in place it had not been followed through to ensure improvement were made.”
moderateIncident learning: “Two consecutive audits identified the same concerns for one person. The action plan did not include dates for the work to be completed by and staff agreed these actions had not been followed up.”
moderateMedication management: “We checked medication audits and saw these were completed every month. Where concerns were identified we saw that actions had not been completed.”
moderateCommunication with families: “A relative told us of several occasions when a message had not be relayed to the staff relating to the person having an appointment. This meant the person did not receive the service they required.”
moderateMissed or late visits: “Staff had five minutes to travel to each support visit...on occasions this was not sufficient time...we saw records which confirmed people did not always receive the full time allocated.”
moderateConsent / capacity: “There was no information to show the provider completed assessments to confirm decisions were made in people's best interest when they lacked the capacity to do so.”
Strengths
· Staff were trained in safeguarding and knew how to raise concerns; risk assessments covered all aspects of care and environment.
· Medicines were managed safely using blister packs and medication administration records were consistently completed.
· Sufficient and regular staffing with an on-call system available out of hours.
· Staff had positive, caring relationships with people and respected privacy and dignity.
· People were involved in planning their care and could make choices; care plans were up to date and reflected individual needs.
Quality-Statement breakdown (13)
safe: Safeguarding and risk assessmentGood
safe: Medication managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training and competencyGood
effective: Consent and Mental Capacity Act complianceGood
effective: Nutrition and healthcare supportGood
caring: Relationships and person-centred supportGood
caring: Privacy, dignity and involvement in care decisionsGood
responsive: Care planning and responsiveness to needsGood
responsive: Complaints handlingGood
well-led: Quality auditing and governanceRequires improvement
well-led: Communication and operational managementRequires improvement
Harmony Care and Support received an overall rating of Requires Improvement following a December 2014 inspection, with significant concerns around medication management, inaccurate and outdated care records, poor complaints handling, and governance systems failing to identify shortfalls. The service demonstrated strengths in staff safeguarding knowledge, recruitment practices, and the caring attitude of support workers toward people using the service.
Concerns (8)
criticalMedication management: “'[person's name], prescribed paracetamol that is not on MAR chart, carers have been administering them without the correct MAR chart.'”
criticalRecord keeping: “It was evident that not every visit had been recorded. This meant that there was a risk that these visits had not taken place.”
moderateMedication management: “When we checked the medication administration records we found these had not always been completed.”
moderateCare planning: “Plans of care were in place but not always up to date or accurate... one person had been provided with an extra visit in the evening, though this had not been included in their plan of care.”
moderateComplaints handling: “The provider's complaints procedure had not been followed because the registered manager had not responded to a complainant appropriately or within the timescale stated.”
moderateGovernance: “It was evident that the monitoring of such records had failed to identify shortfalls within them. Care records were not up to date, medication records were not completed accurately.”
moderatePerson-centred care: “One person receiving nine different carers to provide 14 calls in one week... inconsistency of support workers was a concern to people.”
minorIncident learning: “There was no evidence to suggest that the complaints that had been received, had been used as an opportunity for learning or service improvement.”
Strengths
· Staff had received safeguarding training and knew procedures to follow when a concern was raised, including referring to relevant authorities and notifying the CQC.
· New staff were appropriately recruited with DBS checks and references obtained before working alone in the community.
· Support workers provided induction, ongoing supervisions, spot checks and team meetings.
· People told us support workers were kind, respectful and caring, observed treating people with dignity and compassion.
· People and relatives were involved in care planning and support workers obtained consent before providing care.
Quality-Statement breakdown (16)
safe: Safeguarding people from abuseGood
safe: Risk assessment and managementRequires improvement
Harmony Care and Support was rated Good across all five key questions at its February 2017 inspection, demonstrating sustained improvement since a March 2016 inspection that identified gaps in quality monitoring and communication. The service showed strong person-centred care, safe medicines management, robust governance systems, and a supported, well-trained workforce.
Strengths
· People felt safe and staff understood safeguarding responsibilities; concerns were investigated and learning shared with staff.
· Sufficient staffing levels maintained with an ongoing recruitment programme; people informed of their weekly care rota.
· Structured induction including care certificate, shadowing and competency observations for all new staff.
· Care plans completed with people to reflect preferences and choices; reviewed approximately every six months.
· Provider received a dignity award from the local authority in October 2016; privacy and dignity consistently respected.
Harmony Care & Support Ltd was rated Good overall at its September 2019 inspection, with staff widely praised for their caring, skilled and person-centred approach. The Well-Led domain deteriorated to Requires Improvement due to inconsistent communication with people and families, and inadequately recorded governance actions and service improvements.
Concerns (6)
moderateCommunication with families: “The management is very tacky, with no communication. I don't want to change care company because the carers are so brilliant, I just want them to be better organised.”
moderateGovernance: “improvements weren't always clearly recorded, and it wasn't always evident how the registered manager had improved care as a result of identified issues.”
moderatePerson-centred care: “Harmony, however, well, the organisation is abysmal, they don't let you know who's coming, and that leaves you feeling very vulnerable.”
minorMissed or late visits: “They don't always tell me who to expect, they aren't always on time.”
minorRecord keeping: “one person's wishes regarding DNAR were not clear in their plan. The registered manager told us this would be updated immediately.”
minorComplaints handling: “Some people told us they didn't receive responses to concerns raised.”
Strengths
· Staff were consistently praised as caring, well-trained and knowledgeable about people's individual needs and life histories.
· Safe recruitment processes and thorough medication audits were in place, with best-practice medication plans highlighted at local provider forums.
· Care plans were detailed, person-centred and regularly reviewed with involvement from people and their relatives.
· Staff received comprehensive induction, regular supervision, and training including MCA and safeguarding.
· Effective partnership working with external professionals including GPs, social workers, and speech and language therapists.
Quality-Statement breakdown (25)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Kindness, dignity and respect
Good
caring: Involvement in care decisionsGood
responsive: Care planning and accuracy of recordsRequires improvement
responsive: Continuity of care workersRequires improvement