Archived: The Haven Care Home

Updated 16 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by two inspectors on the first day of inspection and three inspectors on second day of inspection.

Service and service type

The Haven Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Haven Care Home is a care home without nursing care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 December 2022 and ended on 13 December 2022. We visited the service on both dates.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 21 November 2022 to help plan the inspection and inform our judgements. We sought feedback from the local authority and professionals who work with the service. We received feedback. We used all this information to plan our inspection.

During the inspection

We spoke with 7 members of staff including care workers, senior care workers and the registered manager. We spoke with 5 relatives and 2 people about service delivered. We reviewed a range of records. This included 19 people's care records, and 5 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We observed a medicines administration round and reviewed medicine records. We observed staff practices throughout our inspection and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We continued to seek clarification from the registered manager and staff to validate evidence found. We feedback our concerns to the provider, area manager and registered manager after our inspection.

Updated 16 March 2023

About the service

The Haven care home is a large detached residential care home providing care and support for up to 30 older people, most of who are living with dementia. At the time of our inspection there were 26 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care for or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

People were at risk of harm because of failures to adequately identify and address concerns about people’s safety. The leadership of the service was ineffective; management did not have effective systems in place to maintain oversight of the service and had not identified the issues we found during inspection. The registered manager was responsive to our feedback and had started to make improvements.

Right Support:

Systems for monitoring and learning from accidents and incidents were inadequate. Accidents and incidents were inconsistently and inappropriately recorded. There were no monitoring or analysis tools in place to manage, monitor or learn from them.

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; the policies and systems in the service supported this practice. However, the registered manager failed to notify CQC that authorisations of deprivations were in place as required by our regulations.

Staff enabled people to access specialist health and social care support in the community.

Right Care:

Staff did not understand how to protect people from poor care and abuse. The service did not work well with other agencies to protect people from abuse. Staff had training on how to recognise and report abuse. However, staff told us they were afraid of reporting potential abuse.

People could take part in activities and pursue interests that were tailored to them.

Staff did not always protect and respect people’s privacy and dignity. People were not always given emotional support when needed.

Right Culture:

People are at risk of harm because they experience or are at risk of abuse.

Management failed to effectively evaluate the quality of support provided to people and to fully involve people, their families and other professionals as appropriate. The registered manager failed to complete a comprehensive audit of the quality of support provided to people.

People’s quality of life had not been enhanced due to the lack of the service’s culture of improvement and inclusivity.

The registered manager had not ensured risks of a closed culture within the staff team were minimised so that people received support based on transparency, respect and inclusivity.

There was a lack of visible leadership, staff were reluctant to report incidents, and management fail to act on known issues.

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

Rating at last inspection

The last rating for this service was good (published 12 April 2019)

At our last inspection we recommended that the registered manager ensures documentation relating to people's food and fluid intake are completed in full and that the registered manager assess people on an individual basis and seeks the appropriate consent to the sensor mats. At this inspection we found the provider had acted on these recommendations and improvements had been made in these areas.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being provided to people such as alleged abuse, poor record keeping, poor staff practice, management concerns and a review of the information we held about this service.

The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

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

The provider acknowledged the significant shortfalls found during this inspection. They took some action following the first day of inspection to begin to address some of the shortfalls found. However, these needed to be fully embedded into the practice in the service.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to infection control, risk to people living in the service, safeguarding, records and audits.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.