Haven Care Home

Haven Care home provides personal and nursing care for up to 36 older people living with a range of health care needs. Haven Care home is registered to support up to 40 people however, four bedrooms were no longer being used as double rooms. At the time of our inspection, 34 people were living at the home.

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

People were protected from the risk of abuse and avoidable harm by the systems and processes in place. Risks to people were identified and managed by staff. People were supported by staff that knew them well and how to keep them safe. Staff were recruited safely and there were enough staff appropriately deployed to support people. The home was clean and hygienic and staff practices reduced the risk of infection. Medicines were stored, managed and administered safely. There were effective processes to check that medicines were safe.

People's needs and choices were assessed in line with standards, guidance and the law. People's needs were assessed before they moved into the home and assessments formed the basis for people's care plans. Care plans provided sufficient detail for staff on how people chose to be supported. Staff received a thorough induction, training and supervision to carry out their role effectively.

People were supported to eat and drink enough to maintain a balanced diet and people were positive about the food. Staff worked in partnership with health and social care professionals to provide joined up care for people.

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.

Leaders and managers promoted an open and honest culture focused on empowering people. People and relatives told us the atmosphere of the home was calm and friendly. The registered manager had worked hard to make improvements to the home since the last inspection. Relatives and staff told us that things had improved and they were happy with the changes. Quality assurance and feedback systems were robust and enabled continuous learning and improvements to be made to the service.

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 8 September 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 changed from requires improvement to good based on the findings of 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 COVID-19 and other infection outbreaks effectively.

Follow up

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

Haven Care home provides personal and nursing care for up to 36 older people living with a range of health care needs. Haven Care home is registered to support up to 40 people however, four bedrooms were no longer being used as double rooms. At the time of inspection, there were 28 people living at the home.

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

The registered manager and staff team had worked hard to address the areas for improvement following the last inspection. Although improvements had been made, further time was needed to fully embed these changes into day to day practice.

Improvements had been made to staffing and there was now a permanent team of staff that knew people and their needs well. However, we found that areas of the home were not always staffed effectively. People and relatives were positive about the staff but felt there were not enough staff to provide regular meaningful engagement to people.

Safeguarding processes had improved at the service. Staff were able to identify different types of abuse and knew how to report any concerns appropriately. The registered manager appropriately reported safeguarding concerns and feedback from the safeguarding team was positive.

Improvements had been made to the management of people's topical medications, however more oversight was needed to ensure that topical medication administration records were completed accurately.

People who were cared for in bed or spent the majority of time in their bedrooms and were unable to use their call bell, were not regularly monitored. We observed some people received interactions from staff only when staff needed to support the person to reposition. This was an area that needed improvement.

Improvements had been made to quality assurance processes, however these needed more time to be fully embedded in the service.

People's care plans contained up to date information and people's individual risks and support needs. People's care plans were person centred and contained information about people's likes, hobbies and histories. Activities provided by the home were based on people's interests.

People and their relatives were positive about the registered manager and the positive impact staff had made to people living at the home. People told us they were happy and would "recommend the home to anyone." The home was clean and hygienic.

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 requires improvement (8 October 2019) and there were four 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. However, the service remains rated requires improvement. Further time is needed to allow these improvements to be fully implemented and embedded into everyday practice.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haven Care Home 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.

We found the following examples of good practice.

Due to a recent outbreak of COVID-19, the home was currently closed to visitors. People were being supported to isolate in their bedrooms. Staff provided people with one to one activities in their rooms. People had mental capacity assessments and best interest decisions which assessed their understanding of the pandemic and the need to isolate in their bedroom during an outbreak. These had been completed with the person and their family. People had care and support plans in place to manage the risks of COVID-19.

Staff had been supporting people to keep in touch with their relatives through phone calls. Residents that were able to, were supported to use video calling software. Some people also received letters from their loved ones, letters were kept in isolation for 72 hours and laminated before being given to people in order for letters to be easily cleaned.

Visits for people at end of life were supported by the service. Relatives completed a lateral flow test before entering the service, had their temperatures taken and were provided with personal protective equipment (PPE). Visitors entered the home through the closest entrance to the person’s room in order to minimise the risk of cross contamination with other people living at the home.

Staff were wearing PPE in line with government guidance. Staff had received training in putting on and taking off PPE safely as well as infection prevention and control training. The registered manager undertook regular spot checks to ensure staff were using PPE appropriately and following infection control procedures.

The registered manager had ensured that the environment was clean and free from clutter. Aesthetic items, such as soft furnishings, that could not be easily cleaned had been removed from use to promote infection control. Communal areas of the home had undergone a refurbishment during the pandemic, which included new flooring, wall decoration and furniture. This had improved infection control at the home and made it easier to keep communal areas clean. The area and quality manager were able to monitor infection prevention and control practices throughout the outbreak of COVID-19 using video calls to talk to staff and inspect the environment.

The provider had a designated coronavirus email address. This email account was staffed by a team who kept up to date with current government recommendations, regulations and provider policies and procedures. This email address was given to staff, relatives and people. There was also a designated phone line that people, staff and relatives could call with any queries or questions about the pandemic.

Haven Care Home provides nursing and personal care for up to 40 older people living with a range of health care needs. This included people who live with diabetes, a stroke and physical disability. Some people had memory loss or frailty associated with the age. Most people required support from two members of staff for personal care and mobility. There were 22 people living in the Haven Care Home at the time of the inspection.

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

The quality assurance and monitoring system was not effective. It had not identified the concerns we found at this inspection, and there was no evidence that management had responded to the improvements needed that had been found by HC-One, using their own internal inspection process.

There were not enough permanent staff, care staff and nurses, working in the home. This meant there was a reliance on agency staff, which had a negative effect on the support and care provided. The manager was from another of the provider’s homes and was managing on a temporary basis. Care plans had not been updated and reviewed when people’s needs changed; risk had not been identified and person-centred care was not consistently provided. Medicines were not well managed and safeguarding referrals had not been made in line with current guidance. Staff training was provided but had not included training to support people who had specific health care needs, such as mental health needs.

People were not consistently supported to have maximum choice and control of their lives. Where people had disabilities, such as poor eyesight, staff had not taken this into account when they developed their care plans. Staff had not consistently supported people in the least restrictive way possible and in their best interests; the policies and systems in the service had not ensured good practice.

Staff were kind and caring and enjoyed working at the home. A range of activities were provided, and people were positive about these and joined in if they wanted to. The home was clean and tidy, and people were protected from the risk of infection.

People, relatives and staff were positive about the current manager and felt they provided good support at a difficult time. This was due mainly to the changes in management at the home since the last inspection; which meant there was no consistent day to day management of the care and support provided.

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 7 August 2018) and there were two breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of two regulations and we identified two further breaches of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the legal requirements related to safe care and treatment; safeguarding people from inappropriate care and treatment; person-centred care and good governance at this inspection.

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

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.

This was the first inspection of Haven Care Home following the change of provider to HC – One on 15 December 2017.

Haven Care 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 40 older people and people with disabilities. At the time of the inspection there were 27 people living at Haven Care Home. People had different health care needs. Some required continual nursing care due to complex health care needs; including end of life care. Other people needed support with personal care and assistance to move around the home safely due to frailty or medical conditions 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.

There were not enough permanent staff working in the home, which meant there was a reliance on agency staff, particularly agency nurses. This had a negative impact on the support and care provided; medicines were not given out as prescribed, there had been errors and safeguarding referrals had not been made in line with current guidance. This meant people may have been at risk of harm or injury.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and safeguarding. They said they were aware of current guidance to ensure people were protected. However, not all staff had demonstrated a clear understanding of protecting people from harm and had restricted a person without following current guidelines. For example, a best interest meeting with appropriate health and social care professionals.

Care plans had been personalised, they identified people’s specific needs and included guidance for staff to follow and provide the care and support people needed. However, the information recorded was not consistent and had not been effectively reviewed by the nurses, due to the lack of permanent staff. Records showing the support and care staff offered daily had not been completed and did not accurately reflect the actual care provided.

HC - One quality assurance and monitoring system had not been set up at the time of the inspection and staff were unable to access policies and procedure at the home. Policies requested were available after the inspection and were sent to CQC. Following the inspection an improvement plan had been completed that identified areas where improvements were needed and what action would be taken to address them. These improvements would take time to implement and embed into practice.

Risk had been assessed and people were encouraged to be independent in a safe way, with the provision of walking aids and assistance from staff as required. Emergency procedures had been developed to support people if they had to leave the building; there were regular checks of the environment and staff followed the providers infection control policies with a cleaning schedule that ensured people were protected.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. 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 aware that people had different communication needs, such as sensory loss, and were able to explain how they supported people to communicate. However staff had not attended training in.

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

Staff had received relevant training and were supported to develop their knowledge and professional practice through regular supervision and yearly appraisals.

People said the food was good, choices were offered and staff assisted people with their meals. Any concerns with people’s diet were referred to the GP and people were weighed regularly to ensure they had sufficient to eat. Staff said people had access to health care professionals and there was evidence of the management of people's care between the staff and external professionals.

People were encouraged to keep in touch with people who were important to them and relatives and friends said they could visit at any time and were made to feel welcome. People, relatives and staff said they were aware of the issues in the home with staffing and the change of provider and were involved in discussions about improving the services.

We found one two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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