Archived: Havelock House Nursing Home

The pandemic had put pressure on staff levels as some staff had to self-isolate. The registered manager took advice and managed the situation until staff returned to work. At the time of the inspection only one person remained in isolation in their room. Although people were now able to access communal areas, most people chose to remain in their rooms throughout the day. The dining room was no longer being used at meal times. People were having their meals in their rooms to aid social distancing. People were able to access the large communal lounge and were supported to remain socially distanced as required.

The home had designated cleaning staff to ensure levels of cleanliness were maintained, this included regular cleaning of communal areas, shared bathrooms and toilets. All staff ensured regular disinfection of frequently touched surfaces of the home for example handrails and bannisters. We suggested that staff recorded the times when high touch areas were cleaned to ensure this was documented.

The registered manager had followed current guidance in relation to infection prevention and control. This included enhanced cleaning schedules and personal protective equipment (PPE) stations located around the home. The home was currently closed to non-essential visitors. Measures had been implemented to ensure people and staff entering the home did so following current guidance regarding PPE and social distancing.

Havelock House is a residential care home providing personal and nursing care for up to 27 people aged 65 and over. There were 21 people living at the home during the inspection. Most people needed support with personal care and moving around the home safely and were living with different healthcare needs. This included living with dementia, physical disability, Parkinson’s Disease and frailty linked to age.

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

A quality assurance system had been developed and introduced following the last inspection and audits were used to monitor the services provided. However, it had not been consistently effective and concerns found at the last inspection had not been addressed. This included the management of medicines, learning lessons when accidents or incidents occurred, to prevent a reoccurrence, and record keeping.

We observed 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. Although the information in the care plans did not reflect this. Staff had completed a mental capacity assessment for a person who had capacity and a relative had signed the consent form in the care plan for a person who had capacity. The registered manager agreed additional training was needed.

A robust recruitment procedure made sure only suitable people were employed at the home and there were enough staff to provide the care and support people needed. There was an ongoing programme of training, which was continually reviewed, and staff were supported to develop new skills. Additional training was being arranged following this inspection to support staff to develop their practice.

Staff had completed safeguarding training and were confident if they had any concerns they could raise them with the registered manager and action would be taken.

People received care and support that was delivered by staff who understood their needs and how they should be met. Staff knew about people’s dietary needs and preferences and nutritious meals and drinks were provided based on these. People had access to health professionals to promote their health and social well-being.

The home was clean and well maintained and staff followed infection control procedures to protect people, relatives and staff.

A range of activities were provided for people to participate in if they wished. These included one to one time with people who chose to remain in the rooms, so that people were not isolated. Complaints were listened to and resolved in line with the providers policy.

The registered manager knew people, relatives and staff well and promoted an open culture where they could share their views and suggestions. They understood their responsibilities and were committed to delivering a high standard of care to each person living in the home.

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 requires improvement. (Published 28 February 2019)

This was a planned inspection based on the previous rating.

This is the second inspection that the service has been rated as requires improvement.

We identified a repeated breach of regulation, in relation to record keeping and the quality assurance system and additional breaches of regulation, in relation to safe care and treatment.

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

Havelock House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 27 older people who require personal support and nursing care. At the time of the inspection there were 24 people living at the home. Some people required nursing care as they had complex health care needs, such as a stroke or Parkinson’s disease, or end of life care. Other people needed support with personal care and assistance to move around the home safely and some people were living with dementia.

The registered manager was present during the inspection. 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 our last inspection in July 2016 we rated the service as Good overall but Requires Improvement in the Responsive key question. Although we had asked the provider to make improvements in relation to record keeping; including care plans, so that they reflected people’s individual care needs. Also, there was no system in place to assess and meet people’s social needs, such as activities or support to continue with their hobbies.

At this inspection we found these improvements had not been made; there was a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and additional areas for improvement were identified. The rating for Havelock House Nursing Home has changed from Good to Requires Improvement.

There was no evidence of provider oversight of the service and there was no quality assurance system to effectively monitor the services provided. The registered manager had developed and introduced audits, as part of a new quality assurance system. These reviewed some aspects of the services and facilities but, had not identified the areas we found where improvements were needed. Satisfaction questionnaires and been given out to obtain feedback and comments suggested there should be more activities, which was an area that needed additional work from the last inspection.

Care plans and supporting documentation was not up to date. For example, although risk had been identified it was not clear how people’s needs were met and there was not enough guidance for staff to follow to provide the care and support people needed. Staff said they had attended relevant training and explained how they supported people to be independent. However, not all staff followed current guidance when they assisted people to move around the home using walking aids.

Staff had attended safeguarding training and understood how to protect people from abuse. They explained what action they would take if they had any concerns and followed current guidelines.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were not fully aware of what these changes meant.

We recommend that the provider seek advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People said the food was very good; they were offered choices for each meal and staff provided assistance when required. Relatives and visitors said they were made to feel very welcome, they said the staff were good and the registered manager was available if they needed to talk to him.

You can see what action we told the provider to take at the back of the full version of the report.

Havelock House is a detached older style building with accessible gardens to the rear, suitable for wheel chair users. Accommodation is provided over two floors with communal areas on the ground floor.

Havelock House is owned by Havelock House Nursing Home. We last inspected the home in November 2014 and no concerns were identified.

There was no registered manager in post. 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 and associated Regulations about how the service is run. There is an acting manager who is due to submit an application to be registered with the CQC.

People commented they felt safe living at Havelock House. One person told us, “I feel comfortable and cared for.” Another person said, “I came here as I wasn’t safe at home, I’m very safe and happy here.”

Whilst care plans and risk assessments for people were in place, not all were fully reflective of peoples’ individual specific health needs. However when we spoke with the staff, they knew people very well and were knowledgeable about the people they cared for. The documentation had not impacted on safe outcomes for people at this time. A new clinical lead had been employed and they were currently reviewing the care plans and risk assessments. There was at present a lack of meaningful activities for people to engage with. There were people who told us, “Not a lot going on at present.” People who remained in their bedrooms and on continuous bed rest lacked a clear rationale for that specific decision and there was no guidance for how staff could meet their social needs on a day to day basis.

People and staff felt staffing levels were sufficient to meet the needs of the people they supported. One person told us, “Always lots of staff around.” A staff member said, “We are well staffed and a good team, I don’t feel pressured and I can do my job well.”

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them.

There was a focus on providing care and support that focused on the needs of the person whilst supporting their individuality and identity. However there was a lack of meaningful activities provided to ensure people’s social and mental well-being was being fully promoted. The acting manager The acting manager told us, “The staffing levels and the caring nature of our staff means we can give people the time they need, by staff that know them well.” We were also told, “We try to ensure that our residents are happy and comfortable.”

Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

People told us they were happy living at Havelock House. One person told us, “I’ve not been here long, and I’m glad I’m here – it’s really fantastic, I like the staff and I have made friends.” Staff spoke highly about the people they supported and spoke with pride and compassion when talking about people. People’s privacy and dignity was respected and staff recognised that dignity was individual and should be based on what each person wants.

The provider had processes to support staff to carry out their roles safely and effectively. Staff were encouraged to take further qualifications to develop their careers.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings (handovers) were held after each shift to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management team was very good; and were always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. Audits were undertaken regularly, including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

The service currently has an embargo on admissions implemented by the local authority.

The home did not have a registered manager. The appointee manager was responsible for the day to day running of the home. As part of our inspection we spoke with three staff, including the appointee manager. During the inspection we spoke with four people who lived in the home.

One inspector carried out this inspection.

People told us, "It is all nice here, my family visit and they are happy too." And, "I stay in my room, my choice I feel secure and the staff look after me, it's good I am quite happy here."

We saw staff speaking to people and providing care and support. Staff spoken with were able to tell us about people and their individual needs. There were systems in place to report and audit accidents, incidents and falls effectively.

The home asked people who used the service for their feedback, This was in the form of a satisfaction survey which had been completed by people living at Havelock House and a further survey by their relatives. We saw that comments had been followed up and actioned. Therefore evidence was seen to show the results of these surveys had been used to improve the service.

At the time of our inspection there were 24 people living at Havelock house. Not everyone who lived at the service could tell us about their experiences, those who could told us they were happy with the care provided. We were told, 'I have been here about a year, it's like a second home.' And, 'They look after you.' We also spoke with relatives and visitors to gain feedback from people who could not tell us about their experiences of living in the home.

We reviewed records about the assessment and monitoring of the quality of the service, policies, information around supporting and training staff, care plans and associated documentation.

Below is a summary of what we found.

Is the service safe?

We saw that care plans and risk assessments were in place. These had been written and reviewed regularly to ensure that information provided to staff was up to date and relevant.

The staff we spoke with demonstrated an appropriate level of understanding around how to recognise and report abuse. However not all staff had received all the mandatory training. No staff had received training in dementia care since commencing employment at the service.

Is the service effective?

Staff spoken with knew people and were able to tell us about their needs. People we spoke with who lived at Havelock House and relatives of people told us that the staff were supportive and provided good care. One relative told us, 'I visit almost every day, staff are on the ball.'

Is the service caring?

We observed staff talking to and supporting people in a kind caring manner. Relatives and visitors spoken with told us they found staff to be kind and caring at all times. We were told, 'Staff are lovely, they pick up on X's mood, they know them and tell me how they've been when I come in.'

Is the service responsive?

We saw that referrals had been made to outside agencies and other professionals including GP's and Tissue Viability Nurses (TVN). We saw that one person living in the home required increased levels of care and supervision. It was unclear what assessments had taken place to ensure that the service was able to meet this person's needs.

Is the service well-led?

The service had a registered manager. There was no deputy manager, however the manager told us that they were supported in their role by the activities co-ordinator who covered when the registered manager was unavailable. Staff and visitors told us if they had any concerns they raised these with the activities co-ordinator who we were told was very approachable and readily available around the home when they visited. If the co-ordinator was unavailable they would happily speak to the manager.

Staff meetings had only taken place once in the last year. A residents meeting had taken place in June 2013. Staff supervision and appraisals had not been completed in the last 12 months. The activities co-ordinator had started to gain feedback in resident satisfaction questionnaires. We saw that two of these had been completed, one in May and one in June 2014. Relative's feedback forms were last completed in 2011.

We observed that people and relatives had positive relationships with care staff, were being treated well, receiving good care and supported in a sensitive and professional manner. People told us that their nutritional needs were being fully met. Staff reported that they felt valued, trained and supported and demonstrated a good understanding of people's individual care needs. One member of staff told us 'We try hard to provide the best service to the people who live here; this is their home'.

The provider had a range of systems embedded into practice to address security and maintenance issues and to monitor the quality of service. People described the home as ''a happy home', told us that it was a ''good place to live'' and that they could speak with the manager at any time if they had any concerns.

We found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.