Archived: The Haven Care Home

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.

People’s experience of using this service:

¿ Some records were not detailed to determine how the service was meeting the person’s nutrition and hydration needs. Each person had been individually assessed and advice was sought when concerns were identified.

¿ People had not consistently consented to having a sensor mat to alert staff when the person got out of bed. We have made a recommendation about this. People were asked for their consent prior to any care or support tasks.

¿ People’s needs were assessed prior to staying at the service for a period of respite or a permanent admission. Care plans were then developed with people and their relatives; this were regularly reviewed to ensure they met people’s needs.

¿ People felt safe and were protected from the risk of harm and abuse. Staff understood their responsibilities and knew the action to take if they had any suspicions about abuse.

¿ Staff followed guidance to mitigate potential risks that had been identified.

¿ People lived in a building adapted to meet their needs and was maintained to make sure people were safe.

¿ People received their medicines safely from staff that had been trained and had their competency assessed.

¿ People were supported to remain healthy with support from health care professionals.

¿ Staff knew people well, understanding their needs and personal histories. People were treated with kindness by staff that understood the importance of maintaining people’s privacy and dignity.

¿ People were offered the opportunity to participate in a range of activities which met their needs and interests.

¿ People’s feedback was sought and acted on.

¿ Systems were in place to monitor the quality of the service people received.

¿ The provider was in the process of redecorating and upgrading items of furniture within the service.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (report published 20 July 2018). At this inspection we found the service had improved to Good.

Why we inspected: This was a comprehensive planned inspection. We brought this inspection forward due to information of concern regarding people being at risk of harm and abuse. We did not find anything during our inspection which raised any concerns.

Follow up: We will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

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

The Haven Care 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.

The Haven Care Home provides accommodation and personal care for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 27 people living in the service when we inspected.

At our previous inspection on 18 April 2017 we found a breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions effective and well-led to at least good. Improvements were required in relation to ensuring staff had the skills, knowledge and competence to meet people’s needs, and to implement effective governance systems to monitor the quality of the service. The registered manager submitted an action plan stating they would meet the regulation by 31 July 2017. At this inspection we found that some improvements had been made to meet the relevant requirements relating to regulation 12. However, we found a continuing breach of Regulation 17, a new breach of Regulation 12, Regulation 13 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

There was a registered manager in post who managed the service who had worked at the service for a number of years. 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 this inspection, the registered manager was not aware of all of their responsibilities to ensure compliance with fundamental standards and regulations. They had failed to notify CQC of a notifiable event in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People were not always protected from the potential risk of harm and abuse. Potential safeguarding concerns where unexplained bruising had been found on a person had not been reported to the local authority safeguarding team. Staff had been trained in safeguarding adults and were aware of the signs of potential abuse.

Medicines were not always managed safely. Guidance was not consistently in place for people that had been prescribed ‘as and when required’ medicines. Procedures relating to ‘controlled drugs’ had not been consistently followed. Systems were in place for the ordering, obtaining, storage and disposal of people’s medicines. Staff were trained in the administration of people’s prescribed medicines.

Governance systems that were in place to monitor the quality of the service were not always effective. The audit that had been completed by the registered manager and the senior manager had failed to identify the concerns that were found during this inspection.

Potential risks to people, staff and visitors had been assessed with procedures put into place to reduce these risks. The environment and equipment had been maintained and serviced to reduce the risk to people. Accidents and incidents involving people had been monitored and recorded.

Staff had been recruited safely. Staffing levels were monitored to ensure there were enough staff to meet people’s assessed needs.

Staff received support and guidance from the management team. Staff had completed the provider’s mandatory training. However, staff had not always been trained to meet people’s specialist needs. We have made a recommendation about this. Staff completed the provider’s induction prior to working as part of the care team.

People’s nutrition and hydration needs had been assessed and recorded. People were offered a choice of meals, which they enjoyed. Staff supported people to remain as healthy as possible working in partnership with external health care professionals.

People’s needs were assessed prior to them receiving a service. People’s care plans were personalised, and informed staff how the person wanted their needs met. People were supported and encouraged to maintain their independence. Staff supported people to maintain relationships with people that mattered to them. Care records were reviewed on a regular basis by the management team.

Staff were kind and caring towards people. People were treated with dignity and respect, by staff who understood its importance. People did not always have freedom of movement; some people were not able to access their bedroom without the support from staff. We have made a recommendation about this.

People were given the opportunity to participate in a range of activities to meet their needs and interests. People were given to opportunity to raise concerns or make suggestions about the service they received. Suggestions were used to improve the service that was provided to people.

People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice. Staff offered people choices and gained people’s consent prior to any care or support tasks.

We found four 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 this report.

This is the third time the service has been rated requires improvement.

The Haven provides accommodation and personal care for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 28 people living in the service when we inspected

At our previous inspection on 15 January 2016 we found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We required the provider to make improvements in relation to assessing people’s capacity to consent. The registered manager submitted an action plan stating they would meet the regulation by 01 June 2016. At this inspection we found that improvements had been made to meet the relevant requirements. However, we found additional breaches of regulations.

There was a registered manager in place who had worked at the service for a number of years. 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. The registered manager was supported by a number of senior care staff who managed the care staff.

Staff had not always received the training they required to meet people’s specialist needs. Staff were supported in their role by the registered manager. New staff completed an induction prior to working within the service. There was an open culture where staff were kept informed about any changes within the service or people’s care needs.

People were not always protected from potential abuse or harm by staff who understood the signs and the action to take if they suspected abuse. Potential risks to people had not always been recorded within the care file, to ensure staff were following the most up to date guidance. We have made a recommendation about these areas.

Systems in place to monitor the quality of the service were not effective. The overall governance by the registered provider had failed to identify the shortfalls that were found during this inspection. People were encouraged to raise any concerns or complaints they had. People’s feedback about the service they received was sought and acted upon.

There were enough staff on duty to meet people’s assessed needs. People were treated with kindness by staff who respected their privacy and dignity. People’s likes, dislikes and personal interests had been recorded within their care files. Safe recruitment practices were not always followed to ensure staff were safe to work with people who needed care and support. We have made a recommendation about this in our report.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, applications had been made to deprive people of their liberty. The registered manager understood their responsibilities under the Mental Capacity Act 2005 (MCA). Mental capacity assessments and decisions made in people’s best interest were recorded. People were actively encouraged and supported to make decisions relating to their lives. Staff’s knowledge varied in their understanding of the MCA. We have made a recommendation about this in our report.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and their relatives and reviewed to ensure people continued to have the support they needed. Records showed that some people’s needs had not changed over a period of 18 months. We have made a recommendation about this in our report.

People were encouraged and supported to maintain as much independence as possible. People were supported to participate in a range of activities within the service and in the local community.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded. Staff met people’s specific dietary needs and received guidance from health care professionals where required.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and senior staff had been trained to administer medicines safely. People were supported to remain as healthy as possible with the support of healthcare professionals.

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.

The service provides accommodation and support for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 29 people living in the service when we inspected.

A registered manager was in post and was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the registered manager had applied for DoLS authorisations for some people living at the service, with the support and advice of the local authority DoLS team. The registered manager understood their responsibilities under the Mental Capacity Act 2005. However, people’s capacity to consent had not always been assessed prior to applications being made to deprive people of their liberty.

Not all activities were specific to meet people’s needs interests or preferences.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure people’s safety. People’s safety in the event of an emergency such as a fire had not been assessed or recorded. We have made a recommendation about this.

Recruitment checks had taken place prior to staff starting work at the service, however gaps in people’s employment history had not always been explored. We have made a recommendation about this. Staff felt supported in their role and received regular supervision. Staff told us the registered manager was approachable and there was an open culture within the service. The registered manager provided leadership and guidance to the staff team with the support from senior staff.

There were enough trained staff on duty to meet people’s needs. Staff told us they had received the training and support required to fulfil their role. However, staff had not always received the refresher training they required in a timely manner. We have made a recommendation about this.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded. People were asked for feedback on their food and action was taken if required.

People were supported to maintain good health. Staff had up to date information to support people to remain as healthy as possible. People were supported to stay in touch with people that mattered to them.

Processes were in place to monitor the quality of the service being provided to people. Records were up to date and stored appropriately. A complaints policy and procedure was in place and people knew how to report any concerns they had.

We found a breach 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 this report.

People told us that the food was very good and that there was always a choice at every meal time. We saw that people needing help with eating and drinking were encouraged and assisted discreetly.

It could not be assured that people received their medication at the times they needed them, as there were some areas in administration records, this was because some staff had not signed the medication administration records to confirm that medicines had been given. A photograph of each person who lived in the home was not available for staff. Therefore, staff could not complete all the identity checks as detailed in the homes policy for the safe administration of medicines, to ensure that they were giving the right medicines to the right person.

People's safety was protected because effective recruitment procedures were in place.

There was a complaints policy in place and staff were aware of their responsibilities in relation to reporting and recording complaints. People living at the service had confidence in the manager and said they felt sure if they made a complaint it would be dealt with.

People told us that they were offered choices in their daily lives and that they felt listened too.