Havenfield Lodge

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and/or physical disabilities and/or mental health needs. There is a separate flat within the home shared by 3 people with its own staff team. At the time of this inspection 43 people were using the service.

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

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.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. As the setting could accommodate up to 46 people and there was a large communal area, this would not fit with the principles of right support, right care, right culture. However, the provider had mitigated this by ensuring people using the service had access to their own private areas within the home along with a number of smaller lounges that people could enjoy with their relatives or peers. Careful consideration was given to people coming into the service to ensure the environment was suitable and would be conducive to meeting the person’s needs.

Right Care:

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to people's individual needs. Staff understood how to protect people from poor care and abuse. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People could take part in activities and pursue interests that interested to them.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support, and treatment because trained staff could meet their needs and wishes. People were supported by a regular staff team who knew them well.

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

Rating at last inspection

The last rating for this service was requires improvement (published 27 January 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

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

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and/or physical disabilities. There is a separate flat within the home shared by three people with its own staff team. At the time of this inspection 42 people were using the service.

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

There were systems in place to recognise and respond to any allegations of abuse. Staff had received training in safeguarding vulnerable adults. Safe recruitment procedures made sure staff were of suitable character and background. There were enough staff deployed to meet people’s care and support needs in a timely way. Medicines were stored safely and securely. There were effective systems in place to ensure people received their medicines as prescribed. We were assured there were effective systems in place to help prevent and reduce the spread of infections.

Staff were provided with an induction and relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs through team meetings, regular supervisions and an annual appraisal. 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.

People enjoyed the food served at Havenfield Lodge. They were supported to eat and drink to maintain a balanced diet. People were encouraged to maintain good health and have access to health and social care services as required.

The service was well-led. Comments about the registered manager and deputy manager were positive. There were effective systems in place to monitor and improve the quality of the service provided. The provider had a comprehensive set of policies and procedures covering all aspects of service delivery. Significant improvements had been made by the provider and registered manager since the last inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. Overall people's individual needs were met by the size, setting and design of the service. However, the service can accommodate up to 46 people and as result there were large communal areas that were not conducive to meeting the varied and complex needs of some of the people who used the service. The type and layout of the building therefore did not meet all the components of right support, right care, right culture.

Best practice guidance for people with a learning disability recommends living alone or with a small number of other people in shared housing that has a small-scale domestic feel. The provider had tried to make the service homely, with people involved in choosing decorations and soft furnishings. There were also smaller, cosy areas available for people to use. People who preferred quiet had a bedroom away from the main hub of the home, wherever possible.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 inadequate (published 11 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 11 March 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 and 16 January 2020. Five breaches of legal requirements were found regarding: Safeguarding service users from abuse and improper treatment; Safe care and treatment; Staffing; Good governance; and Notifications of other incidents. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

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.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and or mental health and or physical disabilities. There is a separate flat within the home shared by three people with its own staff team. At the time of this inspection 40 people were using the service.

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

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. This guidance helps ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. The service promoted independence and provided person-centred support. However, this was within the constraints of an environment where a large number of people shared communal facilities. This had a negative impact on people and did not always meet their needs.

The provider had an audit system in place. However, these were not effective and had not been completed at the providers required frequency. Issues raised during our inspection had not been noted as part of this system putting people at risk. During our inspection we noted incidents and safeguarding issues had not been reported to CQC. Effective staff recruitment and selection processes were in place and although staff told us they felt they were supported they did not have regular supervision and appraisal.

People told us they felt safe at Havenfield Lodge, although this is not what we found during inspection. People’s needs were not always properly managed, putting them and others at risk of harm. Medicines were mostly managed in a safe way and there was adequate staffing to meet peoples assessed needs. Risks assessments were individual to people’s needs to minimise risk whilst promoting people’s independence. However, these were not always followed and had not been reviewed to reflect peoples changing needs.

We observed staff interacting with people and found they were kind, caring and patient. Staff respected people’s privacy and ensured their dignity was upheld and people were supported to be as independent as possible. Care plans contained enough information for staff to deliver person-centred care, although some information had not been updated. The provider had a complaints procedure and when people raised concerns they were appropriately dealt with. End of life care was discussed with people and recorded in their care planning documentation.

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 12 January 2019). At this inspection improvement had not been sustained and they have deteriorated to inadequate. The provider is in breach of regulations.

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 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.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability, and/or autistic spectrum disorder and/or physical disability. There is a separate flat within the home shared by three people with its own staff team. At the time of this inspection, 34 people were using the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection 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.

The provider is aware of the changes in legalisation relating to the right size of the service and is working towards ensuring the service operates in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are helped to live as ordinary a life as any citizen.

People were involved in their day to day lives through being empowered to make their own choices about where, who with and how they spent their time. Their independence was promoted and staff actively ensured people maintained links with their friends and family.

Staff were recruited safely and there were enough staff to take care of people and to keep the home clean. Staff received appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and received regular formal supervision where they could discuss their ongoing development needs.

People who used the service and relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

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 were supported to maintain good health. This included access to healthcare professionals, and support with medicines. Medicines were stored and managed safely.

There was enough staff on duty at the right time to enable people to receive care in a timely way. In addition, people had opportunities to access a wide range of activities. The service had made extensive efforts to integrate the service within the local community. Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome.

Staff showed a genuine motivation to deliver care in a person-centred way based on people's preferences and likes. People were observed to have good relationships with the staff team.

Staff knew about people’s dietary needs and preferences. We saw when people indicated they wanted drinks or food, staff made this available. People and relatives told us there was a choice of meals and said the food was very good. They told us an ample supply of drinks and snacks were made available for people.

The service met the requirements of the Deprivation of Liberty Safeguards (DoLS) and was acting within the legal framework of the Mental Capacity Act (MCA).

There was a comprehensive complaints policy and this was available to everyone who received a service including relatives and visitors. The procedure was on display in the service where everyone was able to access it.

People who used the service, relatives and staff spoke highly of the registered manager who they said was approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, action had been taken to make improvements.

The environment was safe and people had access to appropriate equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely

There were appropriate governance systems in place to ensure quality of care was monitored and improved. The service engaged positively with people using the service and people and relatives spoken with felt they were listened to and their contributions were valued.

Whilst there were no breaches at the current inspection, we made recommendations to the provider in the body of the report under safe and well-led.

The administration of topical medicines such as prescribed creams was not recorded in a consistent way. Secondly, following risk assessments, specific care plans were not always in place for people. Thirdly, in addition some care plans for specific care regimes was limited and did not provide adequate information for staff to provide appropriate care. Lastly, while fire drills were regularly held, these practices did not include staff working during the night.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and/or autistic spectrum disorder and/or physical disability. There is a separate flat within the home shared by three people with its own staff. At the time of this inspection 36 people were using the service.

The service had 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.

People told us they felt safe at Havenfield Lodge.

Medicines were not always managed in a safe way for people because topical creams were not recorded as being administered, or checked to ensure they remained within their expiry date and were therefore effective. Some people did not have ‘when required’ protocols in place and medicine was not always administered in line with National Institute for Clinical excellence (NICE) guidelines.

There were adequate staff on duty to meet people’s assessed needs, although staffing was not always based on assessing each person’s levels of individual need or dependency. We have made a recommendation about considering the use of a dependency tool to allocate staff according to people’s individual assessed need for support.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence, although we saw one person had no risk assessment in place for bed rails.

Effective recruitment and selection processes were in place.

Staff had received an induction and received occasional supervision. We found staff training was not always up to date and so we could not be assured staff had the knowledge and skills to support people who used the service. We found similar concerns at the last inspection in November 2015.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, people’s mental capacity was not always considered when decisions needed to be made and evidence of best interest processes was not always available.

People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being, although one person was not supported to have their health needs met in a timely manner.

Staff interactions were caring and there were good relationships between staff and people using the service. Staff knew how to support people in a way that maintained their dignity and privacy, although we saw two examples where people’s privacy and dignity were not supported.

Staff promoted people’s independence, however, there was limited opportunity for people to sustain or develop independent living skills.

People and their representatives told us they were not always involved in planning and reviewing their care. Care plans contained enough information for staff to deliver person-centred care, although some information had not been updated. People’s needs were usually reviewed as soon as their situation changed.

Whilst most people engaged in social and leisure activities which were person-centred this was not at a level which would meet the needs of all the people using the service. We found there was a lack of interaction for one person with complex needs.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were approachable.

The system of audit and oversight used by the registered manager was not effective in identifying and addressing the issues we found. Robust action had not been sustained regarding staff training to ensure staff had the skills and knowledge to deliver effective care.

Records were not always up to date and there were gaps in daily recording for some people.

The registered provider had an overview of the service. They audited and monitored the quality and safety of the service but this system had not identified and addressed the issues we found.

People were positive about the registered manager and the culture of the organisation was open and transparent. The management team were visible in the service and knew the needs of people who used the service.

The registered provider used surveys to gain feedback about the service provided and the results of these were acted on.

We found breaches of the Health and Social Care Act (HSCA) 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.

We checked the medicines records and stocks of twelve people who were living in the home. We spoke with two people living in the home and whilst nobody was able to discuss their medicines in detail with us; no-one expressed any concerns about how their medicines were handled.

During this inspection we found that the home had completed the majority of actions as stated in their action plan. However, a pharmacist inspector from the Care Quality Commission who was part of the inspection found that people were still not protected against the risks associated with the unsafe use and management of medicines.

Following some concerns we had received, we looked into the staffing levels at the home. We found that here were enough qualified, skilled and experienced staff to meet people's needs.

We visited the service on 22 May 2013 as part of our scheduled inspection programme and also to check that improvements had been made to requirements relating to workers. We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw that relevant documentation relating to staff was now recorded.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. One person told us that staff provided them with 'enough information' to make their own decisions.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person told us 'I like living here. I like the staff.' There were various activities on offer for people living at the home.

Appropriate arrangements were not in place for the recording, handling, safekeeping, dispensing and safe administration of medicines

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We saw that people's privacy, dignity and independence was respected and staff used a positive, friendly and kind approach with people. People told us they were treated with respect and staff listened to what they had to say. They said they were able to make their own choices about what to do during the day. One person said, 'There's no pressure to do things, if you don't want to.'

People described the care they received and we found that the care, treatment and support provided met their needs. People said they felt well cared for.

People were cared for in a clean and hygienic environment. People told us cleaners, cleaned the home daily and staff wore personal protective equipment when carrying out personal care.

Documents were not available to demonstrate an effective recruitment procedure had taken place. One person using the service told us the provider had started to involve people using the service when staff were recruited. This person had been involved in the recruitment of one member of staff.

People told us about the complaints process. People were confident that they were listened to, including when they needed to make a complaint. They knew how to make a complaint, had done so and received a response to their complaint.