The Haven Rest Home

The Haven Rest Home is a residential care home providing accommodation for up to 20 people in one adapted building. The service provides support to older people who may be living with dementia and/or a physical or sensory impairment. At the time of our inspection there were 18 people using the service.

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

People told us they were safely cared for. We found improvements were required to ensure risks to people had been assessed and plans were in place and followed to mitigate those risks. Not all safeguarding incidents had been referred to the local authority or notified to CQC. Not all recruitment checks were fully completed. Information to support the administration of ‘as required’ medicines’ was not always person centred with safe administration guidance for staff. The registered manager acted promptly on the concerns we raised during and following the inspection.

Consent for decisions about people’s care and treatment did not always follow guidance and the law. 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; however, the policies and systems in the service did not always support this practice.

A quality assurance system was in place; however, this had not been effective in identifying all the concerns we found. The registered person had failed to notify CQC without delay of all incidents as required in the regulations.

There were enough skilled and knowledgeable staff to support people safely. Procedures were in place to prevent and control the spread of infections.

People’s needs were assessed and reviewed, and they received the healthcare and nutritional support they required. The provider had made improvements to the environment which took account of the needs of people living with dementia.

People and relatives told us they would recommend the home to others. We saw the service had received compliments from people and relatives about the care they had received. The registered manager had made improvements at the service and this was acknowledged by staff, people and relatives.

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 15 May 2019). At our last inspection we recommended the provider sought advice and guidance on checking the environment supported people living with dementia. At this inspection we found the provider had made some improvements. The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which were rated requires improvement at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating

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.

Enforcement and Recommendations

We have identified breaches in relation to the need for consent in line with law and guidance and the notification of incidents to CQC.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

• At this inspection we found significant improvements had been made. The provider had recruited a new manager and engaged the support of an external consultant.

• Improvements had been made to keep people safe. Risks associated with people’s care were being assessed more effectively and plans developed to reduce these. Although some of these would benefit from more detail the manager was aware of this need and staff’s understanding of the risks to people was good.

• Risks we had previously found in relation to the environment were no longer present and the provider had plans to work of general redecoration and maintenance to ensure the home was dementia friendly. Appropriate checks and servicing of equipment were in place.

• Staffing levels had improved.

• The management of medicines had improved. Storage was safer and when errors occurred, these were investigated and acted upon to try and prevent reoccurrences.

• The service was more person centred with staff focusing on what people wanted, rather than tasks that needed to be completed. Activities had improved to be more meaningful and to involve people in the running of the home.

• People were supported by staff who were kind and caring in their approaches, who understood their right to make their own decisions and who supported them to make choices and be involved.

• Staff spoke positively about the changes that had been made. They felt training and supervision had improved. They said they now felt listened to and valued.

• People and their relatives expressed how the manager and provider had been open about the rating of the service and its position, expressing a desire to make improvements and told us they had no concerns.

• A representative for the provider was open with us about why they felt the service had failed and a number of governance system shad been implemented to drive continual improvement in the home. These needed more time to fully embed in order to be confident the improvements seen were sustained.

The service no longer met the characteristics of inadequate and the overall rating had improved to requires improvement. As such, the service has been removed from special measures.

Rating at last inspection: Inadequate (published 11 December 2018)

Why we inspected: This was a planned inspection to follow up on the previous rating of inadequate and check improvements had been made.

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

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

People did not receive a service that provided them with safe, effective, compassionate and high-quality care. The management of risk and medicines was ineffective and placed people at risk of harm. Staff were not recruited safely and people and staff had mixed views about staffing levels. People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to. People were not empowered to make choices and have control over their care and people were not provided with support that was personalised to them. The service was not well led and there was a lack of quality assurance processes in place. People told us staff were kind and treated them with respect and people lived in clean environment.

Rating at last inspection: The service was last rated as Inadequate and published on 22 September 2018. Following the last inspection in January and February 2018, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good’. We found the provider had failed to achieve this.

About the service: The Haven Rest Home is a residential care home that was providing personal care to 18 people at the time of the inspection. It is registered to provide a service to 20 older people who may be living with dementia or physical disability.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: At the last inspection the service was rated ‘Inadequate’. At this inspection the rating remained the same. Therefore, the service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

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.

The inspection was unannounced and took place on 9 January 2018. Following this, we received concerns about the care provided at The Haven so we carried out another unannounced inspection visit on 7 February 2018.

There was a registered manager in place. 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, on 06 January 2017, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines administration recording were not completed appropriately and in line with national guidance. The provider had taken action in relation to the concerns we raised during that inspection. However, we found other concerns which led to a continuing breach of this Regulation. There was also a breach of Regulation 17. The quality assurance system had not been robust and auditing had not always identified where improvements were required. At this inspection we found a continuing breach of Regulation 17.

We found at this inspection that there were new breaches of the Regulations.

Some risks associated with the management of medicines and people’s care and treatment had not been identified because effective checks were not undertaken.

There was not a robust quality assurance process in place. Audits to assess the quality of service provision were ineffective in identifying improvements needed. Action plans were not developed to ensure improvements were made.

Feedback from people was sought. There was a complaints procedure in place; these were investigated but not adequately resolved for people.

Allegations of abuse, incidents and accidents were not always investigated thoroughly by management.

The home was not always clean and in some areas of the home there was malodour.

Staff had completed training in line with the provider’s policy. However, some staff did not demonstrate an understanding of what they had received training in.

Staff sought verbal consent from people before providing support, but did not always follow legislation designed to protect people’s rights when making decisions on their behalf. Care plans had some mental capacity assessments in place but these were not reviewed when necessary.

Staff had not always notified CQC of significant events that occurred in the home.

People were supported to access other healthcare services when needed. They enjoyed the meals provided; however people did not have their food and fluid intake adequately monitored.

People were complimentary about the staff. Interactions we observed between staff and people were positive. Staff encouraged people to remain as independent as possible, however people’s privacy and dignity was sometimes compromised.

People told us they were satisfied with the activities in the home but people’s spiritual needs were not met.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Haven Rest Home provides accommodation, personal care and support for up to 20 people living with dementia. There were 17 people living at the home at the time of our inspection.. The accommodation is arranged over two floors of a large, converted building with stair and lift access to both floors. There is a large, well maintained garden to the rear of the property for people to enjoy.

There were 17 care workers, three domestic and kitchen staff, one team leader, one deputy manager, an activities co-ordinator and a registered manager.

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.

Following an inspection in January 2015 we asked the provider to take action and set recommendations for them to make improvements which related to Deprivation of Liberty Safeguards (DoLS) assessments, complaints, audits and seeking feedback from people and staff. At this inspection, we found the necessary improvements had been made.

Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed and where people were unable to consent to their care the provider had adhered to the Mental Capacity Act 2005. However, relevant paperwork for those deprived of their liberties was not always in place and had not been followed up in a timely manner.

Staff had a good understanding of how to keep people safe from abuse and avoidable harm, and how to report concerns appropriately. Robust processes were in place to recruit staff, which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. Staffing levels were sufficient to safely meet the needs of people living at the home.

Medicines administration recording was not completed appropriately and in line with national guidance. There were systems in place to ensure medication was stored securely.

Assessments to mitigate risks to people’s health and wellbeing had not been completed for the individual person. A template risk assessment was placed in files and used as a general guide for all people living at the home.

Staff were supported with regular supervision and appraisals. Staff received an induction in line with recommended guidance and had ongoing training to ensure they had the knowledge and skills to carry out their roles effectively.

People were encouraged to eat and drink enough to promote and maintain a balanced diet. People who had specific dietary requirements were supported to manage these. When required, people were supported to access healthcare professionals.

People's privacy and dignity was respected and people spoke positively about their care experiences. Staff were caring and considerate when they were supporting people. and knew people well. Staff involved people and their relatives in the planning of their care.

Care plans were in place, reviewed regularly and met the individuals’ needs. People’s care was delivered according to their preferences and wishes. People knew how to complain about their care, and complaints were logged and dealt with in a timely manner and according to policy.

Staff told us that they felt able to go to the registered manager with any concerns or worries and they would be listened to. There were auditing and management systems in place to monitor and improve the quality of care provision within the home. However, auditing had not always identified where improvements were required, for example with medicines administration.

People and staff spoke highly of the registered manager. There was an open and supportive culture promoted by the registered manager and the deputy manager.

We found three 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 end of the full version of this report.

We set out to answer our five questions; Is the service caring? Is the service Responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

People were treated kindly by staff. People and/or their representatives told us about their satisfaction with the home and told us they felt safe.

We looked at the staffing levels and skill mix within the home. Suitable numbers of staff were on shift throughout the day and night. Staff received a variety of training including; dementia awareness, first aid, food hygiene and the provider encouraged staff to complete the Health and social care qualification.

CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) which applies to care homes. Management we spoke with had a good understanding of Deprivation of Liberty Safeguards (DoLS) and their responsibility in this.

We found the provider had not followed the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and as such people were not always protected against the risks associated with the spread of infection.

Is the service effective?

People's health and care needs were not always fully assessed. Some support needs were not included in care plans or risk assessments. We found the risks associated with people's care and treatment had not always been assessed, and agreed actions to reduce these risks had not always been made. This meant people were at risk of receiving care which was not planned and delivered in a way that was intended to ensure people's safety and welfare. We have asked the provider to tell us what they were going to do to meet the requirements of the law in relation to assessing people's needs and planning the delivery of care.

Is the service caring?

People were supported by staff that were kind and patient in their approach. We saw care workers showed patience and gave encouragement when supporting people. People and/or their representatives described their satisfaction with the home. They told us 'I have no complaints'. One relative told us about a recent situation and said 'They responded very quickly' They have a good understanding of [their] support needs'.[They] are very happy and content'. Another relative told us 'All the staff are really helpful and supportive'.They are very attentive and have made the effort to get to know [them]'.

People using the service were involved in regular meetings to discuss the home.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We saw the home held records of all complaints and how these had been managed.

Is the service well-led?

All of the staff said if they witnessed poor practice they would report their concerns to the manager or provider. They told us they were confident these would be acted upon.

We saw the service had some systems in place to monitor and assess the quality of the service including incident/accident records, 'resident meetings' and staff meetings. However, we found that the home had no risk assessment to assess and manage any risk associated with the carrying out of the regulated activity. We found no evidence the health and safety of the home was monitored. The emergency contingency plan lacked detailed information to confirm all events that may constitute an emergency had been assessed and measures identified to manage these situations effectively should they arise. We were not confident the system for reviewing policies was effective in identifying any necessary changes and up to date external guidance.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

We spoke with four people. They told us they were happy with the care they were receiving. One relative visiting the home told us that their relative seemed happy living at The Haven.

During this inspection we looked at the progress the service had made on meeting the two compliance actions made at our last inspection on 12 March 2013. We found that there had been improvements in both areas of staffing recruitment and care and welfare of people living in the home. There was still room for improvement in the record keeping. People we spoke with at The Haven Rest Home were happy with the service they received. They told us staff treated them with respect and were kind and caring. They told us they felt their privacy was maintained.

People told us they were happy with the care they received. People said the staff were attentive and kind. Care plans detailing the care people received were not reflective of the care given and had not always been fully completed.

The home had suitable information available to staff on abuse to ensure staff were aware of how to identity and protect people from abuse. People told us they felt safe living at The Haven.

People told us they were happy with the staff. We found that recruitment records were not adequate to ensure the safety of people.

People told us if there were unhappy with any aspect of their care or environment they would complain to the manager. People told us they had confidence the manager would be able to resolve their complaint.