The Haven

The Haven is a residential care home providing accommodation with personal care to up to 32 people in one adapted building. The service provides support to people with care and support needs, including those living with dementia. At the time of our inspection there were 30 people using the service.

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

Care plans and risk assessments were in the process of being reviewed and updated, with the input of people and their relatives. There were some areas of the service where infection prevention and control measures could not be fully maintained, due to the need for renovations. The provider was aware of this and had invested in a substantial refurbishment, which was in progress at the time of inspection. Environmental checks took place to ensure the safety of the building and equipment. Medicines were given safely and as prescribed, although some ‘as required’ (PRN) medicine protocols needed further detail. Staff recruitment was safe. Systems and processes were in place to ensure any safeguarding matters were investigated fully.

There was a new management team in place since the last inspection, and they were working with a clear commitment and ambition to drive continuous improvement at The Haven. The new team were in a transitional period, due to being so new in post, and had not yet had the opportunity to demonstrate how changes would be made and monitored for success. We have made a recommendation about a service development plan. Systems and processes were in place to support good governance. Feedback from people and their relatives indicated an improving service with a caring staff team. Legal and regulatory responsibilities were well understood at leadership level. The service worked in partnership with other stakeholders.

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.

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 5 March 2020).

At our last inspection we recommended that the provider ensure care plans and risk assessments are updated, DoLs reflected all restrictions in place and quality assurance processes are robust. At this inspection we found the provider had made some improvements, but this still needed to be fully embedded whilst a new management team settled into their roles.

Why we inspected

We received concerns in relation to alleged organisational safeguarding matters. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Recommendations

We have made a recommendation on implementing a service development plan, to show how the management team are meeting their aims and ambitions for The Haven.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Haven provides accommodation and care for up to 29 older people, some of whom who are living with

dementia.

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

Environmental risks were not always managed or mitigated to ensure people were safe. Staffing levels were adequate to meet people’s needs. However, a tool used to identify what staffing levels were required, based on people’s dependencies, had not always been updated in line with people’s needs. Care plans and risk assessments were not always up to date in line with people’s current needs.

We have made recommendations about the updating of care plans and risk assessments

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. Policies and systems in the service supported this practice. However, DoLS had not always been updated with the local authority when additional deprivations of liberties had taken place

We have made recommendations about the application of DoLS

The home had strong management in place, however the manager did not always delegate to others meaning that they had not always picked up on errors or issues as highlighted in the report.

We have made recommendations about the quality assurance processes.

Staff were supported to develop within the service and had been supported with additional training and qualifications. People were supported to maintain a balanced diet and received information about healthy eating choices. People were supported to maintain their health and wellbeing in line with recommended guidance.

Staff responded to people in a kind and caring manner and people were comfortable with staff. Staff knew people well and were able to communicate with people individually based on their abilities. People and those in their life, were involved in making decisions about their care.

People enjoyed a range of social activities which were meaningful and gave them purpose. The home continued to use the Sparkle initiative. The Sparkle initiative gave people the opportunity to express a dream they had of taking part in an event or visit a place which was important to them.

The home was extremely thoughtful and compassionate about how they supported people receiving end of life care. This support was extended to staff and family members of people who had passed away in the service.

The management continued to look at new ways of working to improve care delivery for people. The home worked closely with partner organisations such as the local authorities training programmes and had been recognised nationally for their work.

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 outstanding (published 17 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a 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 2008 and associated Regulations about how the service is run.

At our last inspection in December 2015 we found that people received personalised care which was responsive to their needs and their views were listened to and acted on. At this inspection we found that the service had further developed the way that they responded to people’s needs and were exceptional in the way they tailored every element of peoples care and support to enhance their quality of life. The result of this was that people received an outstanding level of care and support.

People were at the heart of the service. They told us how staff went the extra mile to make sure that they were happy.

The atmosphere in the service was warm and welcoming and there was a strong person centred culture which promoted the importance of supporting people to express their views and understand their wishes. People felt staff listened to what they said and their views were of the utmost import when their care was planned and reviewed. This empowered people to lead their lives as they chose.

Staff were exceptionally compassionate, attentive and caring in their interactions with people. They showed empathy and understanding, were interested in people’s lives and knew them very well. People told us that they felt that their choices, independence, privacy and dignity was promoted and respected.

The management team were dynamic and innovative in their approach. They had a clear vision and set of values which they worked towards, and which were reflected throughout the staff team. Staff, people and relatives spoke highly of the management, and were confident in their ability.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff knew how to minimise risks and provide people with safe care. Procedures and processes provided guidance to staff on how to ensure the safety of the people who used the service.

There were sufficient numbers of staff to meet people’s needs. Staff were well trained and supported to meet the needs of the people who used the service. Recruitment processes checked the suitability of staff to work in the service.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 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.

There were systems in place to support people safely with their medicines. People’s nutritional needs were assessed and met. Professional advice and support was obtained for people when needed. People were offered meals that were suitable for their individual dietary needs and met their preferences.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. The service proactively engaged with these professionals and acted on their recommendations and guidance in people’s best interests.

There was an open and transparent culture in the service. A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner. People, relatives, visitors and staff were confident that any concerns raised would be taken seriously and dealt with appropriately by the management team.

The management team had a holistic approach and a robust quality assurance system meant they had highly effective oversight of how the service was meeting people’s physical, emotional and social needs. They set a high standard for their staff and led by example. There was a strong emphasis on continually striving to improve.

At this inspection we identified some clear improvements to the service. The previous manager, deputy manager and area manager had all left and there was a new manager in situ. They were not yet registered with the Care Quality Commission in respect of this service but was registered for another home owned by the same provider. The manager was confident they could successfully manage both services and said there were effective deputy managers and heavily supported by different members of the management team.

We spoke with twelve out of the twenty-four people who used the service, three staff, and one relative and observed the care being provided at different times of the day in the home. We observed lunch and social activities being provided. We looked at three care plans and other care records. We looked at staff training, recruitment and induction records, the homes annual quality audit and other audits. We considered our inspection findings to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

There were sufficient staff on duty to meet people's need and we saw that people were regularly monitored for their own safety. We did not hear any call bells throughout the morning and judged that some people would not be able to use them. We saw the provider had not assessed people to see if they would be able to use the call bell, but we found people were checked at least hourly, more if required and there were records to show this.

We found no restrictions for people and they were free to move about the home. One person had sustained a number of injuries and these had been unwitnessed. We saw that some people had sensors in their bedrooms alerting staff to when they were moving around. We saw that one person had been assessed as requiring bedrails and other people had crash mats on the floor which had been assessed as appropriate for their needs and to help reduce the risk of injury. This meant staff would know to check them to ensure their safety.

Records showed that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded and protected from harm. Staff had received annual updated training in protecting people from abuse and had access to policies and procedures so that they knew what actions they should take to keep people safe. The manager had taken appropriate action in response to events affecting the well-being and, or safety of people using the service and had responded appropriately to complaints and concerns.

We saw records documenting people's care needs and their preferences of care. However we noted that some risk assessments were inaccurately completed which meant that staff had not been appropriately trained to carry out risk assessments and people might receive inappropriate care. We also observed some poor manual handling practices by staff. The provider assured us that all staff would have updated manual handling training and observations of practice before the end of the week to ensure people were safe.

The environment was well maintained and in good decorative order. There were sufficient staff employed for the purpose of maintaining and cleaning the home over seven days a week. Routine audits were completed to check that the building was safe and regular checks were completed on fire safety equipment and equipment used in the home such as hoists, and wheelchairs/ to make sure they were safe to use. We identified a number of minor concerns for the provider to address.

Is the service effective?

We observed the care provided and saw that there were sufficient staff to meet people's needs and help them join in social activities. We saw that the staff tried to encourage people's independence and offer people appropriate choices.

People's care was planned in a way which intended their safety and well-being. People's needs were assessed and evaluated regularly to ensure the care being provided was effective. Where risks had been identified steps had been taken to ensure the risk was controlled but initial risk assessments had not always correctly identified the level of risk.

Is the service caring?

We saw some very good staff interactions and we saw displays of genuine warmth and affection between staff and residents. Staff were tactile and knew residents well which enabled them to respond to their needs appropriately. During the day we saw staff responding appropriately and quickly to people and saw some good team work between the staff. The provider employed regular staff who were familiar with people's needs.

Is the service responsive?

We saw a range of things for people to do during the day to keep them engaged and active. Activities were provided to meet the needs of individuals and there was improving involvement with the local community and community groups. Life stories were not complete for each person and would have helped staff support the person more appropriately. We noted that 'All about me' documentation helped staff know how people liked to be cared for and staff showed a good understanding of this.

We saw from people's records that their health care needs were being met and they received the services they needed, like chiropody, district and community nursing and speech and language. We saw from people's daily records that changes to people's health needs were quickly identified and actions taken to prevent the persons health declining.

The manager was proactive in dealing with concerns and complaints and met with family members to try and resolve concerns.

Is the service well led?

There have been a number of changes to the management of the service although there has been good retention of care staff. During our inspection there was a new management team who were familiar with the home and had already started to establish improved links with health care professionals and community groups. We saw that the management team were trying to lead by example by working alongside care staff and observing their practices and identifying any training needs. We saw that staff were receiving regular supervision and observation of practice.

We saw that the provider was hands on and was regularly assessing the quality of the service provision and identifying necessary improvements whilst maintaining high staffing levels despite a number of vacant beds.

We spoke with seven people using the service and observed the care they received throughout the day, including breakfast and lunch time. We found that staff were kind and caring and treated people with dignity and respect.

We looked at four care plans and 'How to support me' documents. These provided a good overview of the support people required, however we found that people's care and treatment was not planned and delivered in a way that was intended to ensure their safety and welfare. We identified improvements were necessary in terms of monitoring risks to people's health and documenting their specific care needs.

We found that people were not cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were not adequately supported to deliver care and treatment safety and to an appropriate standard.

Systems in place to monitor the quality of service were not robustly carried out and did not identify, assess and manage risks to the health, safety and welfare of the people using the service.

People's care and welfare was protected through risk assessments and detailed plans of care. One person told us "The food is good, they look after us here." Another person told us 'I am very happy here, the staff are good, they help over and above what they are required to do, and the food is generally good.' We spoke with one person and their relative who told us that they were more than satisfied with the service, 'The staff were lovely and very caring, the food excellent and there are plenty of snacks between meals'. One person commented 'If I could improve anything, I would like to see more activities, my relative lacks stimulation.'

We found that people were cared for in a safe, clean and well maintained environment.

There were adequate numbers of staff on duty and people were attended to promptly. Staff had regular meetings and supervisions and had recently undertaken training. Staff were able to obtain further qualifications from time to time relevant to their job role.

Records for the service were up to date and stored securely. Where audits had been carried out and concerns noted, actions had been planned and carried out to address them.

During this inspection we noted that many improvements had taken place and that people's needs were being met in a more consistent way. There had been some improvements to the provision of support and training to the staff team which had enabled them to carry out their roles more effectively. However, the home did not have a manager as they had recently left the home. The provider had recently employed an area manager who was overseeing the management of the home.

We had also identified areas of the home in which improvements were still needed. For example, areas of risk associated with the accommodation for people still needed addressing. Improvements were also still needed with regard to record keeping and ensuring that people were treated with dignity and respect.