This inspection took place on 17 and 20 September 2018 and was unannounced. The inspectors returned to conclude the inspection announced on 21 September 2018. The Haven Rest Home is registered to provide accommodation and personal care for up to 17 older people including people who may be living with dementia. The Haven Rest Home is a 'care home'. 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 our inspection there were 15 people living at the home, who were accommodated in one adapted residential building.
The provider had appointed an acting manager who was present at the time of the inspection as the registered manager had been absent on leave since November 2017. 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.
At the last inspection of the service on 17 and 18 December 2015 the service was rated as 'Good' overall with Requires Improvement in the key question of Effective. On this inspection we found the provider had not maintained their rating of Good overall and we have changed the rating to Requires Improvement overall.
The provider did not have effective systems to ensure all statutory notifications were sent to the Care Quality Commission. The provider had failed to notify us of incidents and Deprivation of Liberty Safeguard authorisations as they are required to do by law.
The management of a medicine which required special storage because of the potential to misuse was not accounted for in the providers recording procedures. This had not been identified by the provider because the checks that had been undertaken were ineffective.
The provider had not ensured the home environment was visibly clean in all areas with suitable hand washing facilities made available, especially communal toilets. Staff were seen to wear protective clothing when undertaking their caring roles which required them to do so to reduce the risk of the spread of infections, except for when entering the kitchen area.
The needs of people who lived with dementia were not reflected in the home environment to ensure it had been adapted and designed to meet these. Amongst other things there was lack of directional signage to assist people and there were various cleaning products in an unlocked room which did not mitigate the risks to people’s health and safety.
Staff did not show through their caring practices that people’s privacy, dignity and right to confidentiality was consistently promoted.
There was not a robust quality assurance process in place. Audits to assess the quality of service provision were ineffective in identifying some of the improvements needed.
Systems for the safe recruitment of staff were not robust, and recruitment files showed there had been gaps in the recruitment process that had potentially put people at risk. Staff received an induction which was based on the providers expectations of their staff team and ongoing management support to assist staff to continually improve in their roles. Some staff practices did not consistently reflect the knowledge they had obtained to ensure they undertook their roles effectively.
Staff received training in, and understood, their responsibility to protect people from abuse and neglect. The risks associated with people’s care and support needs had been assessed and staff were knowledgeable about the equipment people required to meet their individual needs. The provider kept staffing numbers under review and had increased these to meet people’s needs safely.
People's individual needs and requirements were assessed prior to them moving into the home. People had support to eat and drink safely and comfortably, and contact had been made with doctors where required to obtain advice about meeting people’s nutritional needs. Staff supported people to maintain their health alongside relative’s involvement.
The provider had made improvements following our previous inspection to ensure people’s rights under the Mental Capacity Act were understood and promoted by staff and management.
Staff approached their work with kindness and compassion. People had support to express their views and opinions, and participate in decision-making that affected them.
People’s needs were written into care plans as guidance for staff to follow but these could be enhanced further to ensure staff had all the information they required to provide responsive care. Some activities were provided for people; however, the provision of activities did not always meet people's emotional, social and psychological needs. The provider had acted to recruit a staff member dedicated to supporting people with the planning and arranging of activities however this was in its infancy at the time of the inspection and needed more time to embed.
People who lived at the home, their relatives and staff felt able to approach the management team at any time. The acting manager was responsive during our inspection and gave us assurances by the actions they were taking to remedy the shortfalls we identified. They had an ambition to achieve an outstanding rating for the benefit of people who lived at the home.
As part of this inspection we reviewed information we held which included some concerns around a specific incident, following which a person using the service died. This incident was subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.
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.
We found breaches of 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.
Further information is in the detailed findings below.