Sitara Haven

Sitara Haven is a care home for up to three adults with mental health needs. The service is run by an individual who also lives at the care home. At the time of our inspection there were three people living at the service.

People’s experience of using this service and what we found

The provider did not always identify and assess possible risks in relation to a person’s health and wellbeing. People received their medicines safely, but the staff were not always provided with adequate information which increased the risk to people. When an incident and accident occurred, it was not always recorded and investigated to identify any actions to reduce further risks.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The provider did not have a robust quality assurance system to enable them to identify if action was required to make improvements.

People told us they felt safe and were happy at the home. Staff completed the training identified by the provider as mandatory and were supported in their role. People were supported to eat food they liked and encouraged to maintain a healthy diet. People were also supported to access healthcare and other service when required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 March 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. We issued a Warning Notice to the provider in relation to safe care and treatment requiring them to comply with the regulation by 30 April 2021. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 28 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sitara Haven on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, need for consent and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sitara Haven is a care home for up to three adults with mental health needs. The service is run by an individual who also lives at the care home. At the time of our inspection there were three people living at the service.

People’s experience of using this service and what we found

People received their medicines safely. However, records about medicines did not always give enough information and this meant there was an increased risk to people using the service.

The provider's systems for monitoring and improving the quality of the service had not always been operated effectively, and not enough improvements had been made to the way medicines were managed.

Some external professionals felt the service would benefit from more networking with others, for example, joining care provider forums.

People's social activities and access to the community had reduced during the COVID-19 pandemic, and particularly during periods of 'lockdown.' There had been limited therapeutic input to support people with improving their mental health, smoking cessation and healthier eating. However, people continued to have regular healthcare appointments remotely and the provider had alerted other professionals to changes in their health and well-being.

People were happy living at the service. They had lived there for many years and knew the staff well. They felt relaxed, comfortable and at home. There was a family atmosphere, as the provider (also the manager) and their family lived at the service. They shared meals and activities with the people they cared for.

People had regular contact with families and/or advocates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published 10 July 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This inspection was planned to follow up breaches we identified during our last inspection. We were also alerted to additional concerns about infection prevention and control raised by visiting healthcare professionals. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions of effective and caring. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found improvements had been made to infection prevention and control. However, improvements were still needed in other areas. Please see the safe and well-led sections of this full report.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sitara Haven on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Sitara Haven is a care home. The service is registered to provide accommodation for people who require personal care. At the time of our inspection, there were three people living at Sitara Haven. The provider is registered as an individual and manages the home. This is a family run business and the family live on the premises with people who are receiving care and support. In addition, there are two support workers employed.

People’s experience of using this service:

Relatives told us they were happy with the care that Sitara Haven provided. One relative told us “Carers are good.”

Following the last inspection, the provider had made some improvements to address the areas of concerns we identified. However, the provider’s quality assurance processes have remained ineffective and have failed to identify the issues we found during our inspection.

We found concerns relating to medicines management, risk assessments and infection control. The policy for the storage of insulin was confusing for staff and the provider was not following their own policy on infection control. People had risk assessments in place, but it was unclear how risk was assessed and managed. There were systems and processes in place to protect people from harm and abuse. There were appropriate levels of staffing for the service. The provider and staff understood their responsibilities to raise concerns both internally and externally. This helped to ensure that people were kept safe.

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.

People were supported to eat and drink healthily. Staff communicated effectively with each other about people’s care and support. This helped to ensure that people received coordinated person centred care.

Since the last inspection the provider had reviewed people’s care plans and had updated support plans. People and relatives told us staff were kind. Staff told us they protected people’s privacy and dignity and we saw evidence of this in peoples’ files.

Peoples needs and preferences were in care plans and they received care from staff who knew them well. Relatives told us they knew how to make complaints. People had end of life plans in place.

The provider failed to submit an action plan after the last inspection. The provider has developed some audits and checks to monitor the quality of care provided. However, many systems were ineffective in improving the quality of the care for people, as we found during the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The service was rated requires improvement when we inspected on 7 March 2018 (published 12 May 2018). At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected: This was a planned inspection as part of our inspection schedule.

Enforcement

We have identified breaches of regulations in relation to safe care and treatment and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Sitara Haven is a ‘care home’ for up to three people with learning disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection, three people were using the service.

The person who owns the home is registered as an individual and manages the home. Therefore the home does not require a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found people had risk assessments and management plans in place to minimise risks and incidents. These were reviewed annually but the risk management plans were not updated to show there was an evaluation of the risks people faced and the effectiveness of the management plans to mitigate the risks

Care workers followed procedures for the management of people’s medicines and underwent medicines training. Medicines audits were in place. Care workers had completed medicines competency testing but it was not clear what this involved and it did not include administering insulin injections. Therefore we could not be sure people were receiving their medicines safely as prescribed.

The provider did not always comply with Mental Capacity Act (2005) principles as an application for a Deprivation of Liberty Safeguards authorisation was not applied for. However we saw care workers were responsive to people’s individual needs and preferences. Additionally there was no indication that people’s end of life wishes had been considered as part of the care planning and consent forms were not fully completed.

Care plans were reviewed annually and involved people using the service but the paperwork was not up to date, so we could not be sure peoples’ current situation and preferences were recorded. In addition, the language used in the care plans was not always person centred.

The provider did not have effective quality assurance procedures as checks and audits did not identify concerns highlighted in the inspection.

We found four breaches of Regulations during the inspection. These were in respect of safe care and treatment, consent to care, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People’s rights to make decisions were not always respected and their independence was not always promoted.

The provider had procedures in place to protect people from abuse. Care workers we spoke with knew how to respond to safeguarding concerns.

Care workers had completed training in health and safety and used protective equipment as required.

Care workers had up to date relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service.

People indicated they were happy at the service and care workers knew peoples’ likes and dislikes and what their routines were. Families were welcome to visit.

People's dietary and health needs had been assessed and recorded and were monitored to make sure their nutritional needs were met.

The staff worked with other agencies, such as healthcare teams, to make sure people's needs were being met and people had access to medical services when needed.

There was a complaints procedure in place, however the service had not had any complaints since the last inspection. People using the service and care workers felt the manager listened to their concerns.

The last inspection took place on 15 March 2016 at which time we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to employing fit and proper persons and staff appraisals. At the inspection of 21 March 2017, we found improvements had been made to meet the regulations.

Sitara Haven is a care home registered to provide accommodation and personal care for up to three adults. The service supports people with learning disabilities and / or mental health needs. At the time of the inspection there were three people using the service.

The person who owns the home is registered as an individual and therefore the home does not require a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found people’s files did not record if they had the capacity to make specific decisions or if they had consented to their care.

Training was up to date, however not all staff understood the principles of the Mental Capacity Act (2005). Additionally one member of staff spoke very little English and we could not be sure they understood the training they had received.

There was a sufficient number of staff, but the provider and their partner worked long hours and we were concerned how this may affect their level of alertness.

Medicines were administered in a safe way but not all medicines were audited weekly and the medicines policy did not include guidelines for PRN (as required) medicines. We recommended the provider develop systems in line with the Royal Pharmaceutical Society guidance on the management of medicines in care homes to ensure the proper and safe management of medicines at all times.

Risk assessments minimised harm to people using the service. However, the service did not have Personal Emergency Evacuation Plans (PEEPs) for each person. The provider said they would action this.

The last Care Quality Commission (CQC) rating displayed, was out of date and the provider agreed they would display the latest rating.

There were procedures in place to safeguard people, staff knew how to respond if they suspected abuse, risk assessments minimised harm to people using the service and the service followed safe recruitment procedures.

Supervisions and appraisals were up to date to develop staff members’ skills to enable them to carry out their duties effectively.

People were satisfied with the menus and were able to have food and drinks when they wanted to.

People had access to health care services and the service worked with other community-based agencies.

We observed staff were kind and respected people’s dignity and privacy.

People received care that was person centred, which meant they were at the centre of decisions that related to their life, and they were involved in reviewing their care. Individual needs and preferences were met and we saw evidence that people accessed activities in the home and the local community.

An appropriate complaints procedure was available. Relatives and staff indicated they could speak to the provider about concerns.

There were a number of service checks carried out to ensure the environment was safe.

The last inspection of the service took place on 18 December 2014 and we made two recommendations. We recommended the provider make resources available to enable and empower the staff team to develop and to drive improvement. We also recommended that the provider ensure they understand and fulfil all the legal obligations of their registration with CQC.

Sitara Haven is a care home registered to provide accommodation and personal care for up to three adults. The service supports people with learning disabilities and / or mental health care needs. At the time of the inspection there were three people using the service.

The provider is registered as an individual and therefore does not require a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have an up to date Disclosure and Barring Services (DBS) check for one member of staff and they had not carried out any staff appraisals in 2015.

There were yearly reviews that people who used the service were involved in. However, families said they had not been to a review for their relatives in over a year.

People living in the service felt safe. There were procedures in place for safeguarding and staff had attended relevant training.

There were various risk assessments including assessments for finance and smoking. People had individual risk assessments attached to their care plans, which identified risks and the action to be taken.

Supervisions and team meetings were held every three months to discuss and review staff practice and development.

The service was working within the principles of the Mental Capacity Act 2005.

Food and menus was an agenda item for both team and residents’ meetings. People who used the service went with staff to do food shopping and food was cooked freshly in the evenings. Food reflected cultural preferences.

Files had a record of healthcare appointments. Sitara Haven had good communication with the local GP practice and all of the people using the service had been seen in the last six months, accompanied by staff. Medicines were being managed safely.

People who used the service indicated positive relationships with staff. They told us they could talk to staff about any concerns and staff listened. People were involved in their care plans and decision-making.

Each person who used the service had an individual day programme. There were a number of activities on offer in the service and the community.

There were processes in place for the maintenance and monitoring of the service.

The provider had relevant policies and procedures in place that were reviewed yearly.

Staff communicated well with each other and people using the service. Staff knew the needs of the people and there was a family atmosphere in the service.

We found two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke to a relative of a person using the service who told us, 'I don't think I could find a better place, no complaints.'

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw evidence that where people using the service were not able to consent, as they had been assessed as lacking capacity, that family members were consulted about care and treatment.

There were arrangements in place to deal with foreseeable emergencies. We saw that there had been a detailed fire risk assessment with clear and comprehensive guidance covering risk of fire. This was evidence that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Care staff had received training in food hygiene, health and safety and infection control. We saw that the bedrooms and communal areas at Sitara Haven were clean and people were cared for in a clean, hygienic environment

There were enough qualified, skilled and experienced staff to meet people's needs. People

received effective and safe care from suitably skilled staff who understood their individual

needs. We saw records of a very extensive programme of training that all care staff had

taken part in.

We saw care plans, assessments and training records demonstrating that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We saw that staff supported people using the service in a professional and friendly way. People were offered choices with regard to what time they got up in the morning, the food provided at mealtimes and activities in the local community. One person using the service also told us that they were involved in making decisions. They told us "I can get up when I like and go to bed when I like."

We spoke with two people working at Sitara Haven, including the home's owner. They were able to tell us how they maintained people's dignity, respected their privacy and gave them choices throughout the day. One member of staff commented "this is a good home, we are well trained to do our jobs.' The staff members we spoke with were aware of the risk of abuse and gave appropriate answers when asked about how they would respond if they had concerns about a person using the service.