Haven Court

¿ The registered manager had an effective monitoring system in place to check that the service was following government guidance and the provider's own policies.

¿ Staff were confident and knowledgeable about government guidance and what visitors were required to do prior to entering the service. Professional visitors and relatives were tested for COVID-19 at the service. Visiting professionals and staff provided evidence of their vaccination status to the registered manager

before entering the service.

¿ Staff and people received regular testing for COVID-19 and emergency care givers were included in this testing programme.

¿ The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors.

¿ People were encouraged and supported to leave the service to visit relatives or access the local community. Relatives were able to visit their family members either in their rooms, communal lounge areas or in the communal garden area.

¿ Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control from the provider.

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

People's needs were assessed to ensure they received care which was effective and appropriate to their needs. One person told us staff were very kind and patient and were quick to support them when they asked for help. Staff made sure people had access to a range of other healthcare professionals for example their GP, optician and dentist. People received a balanced and healthy diet and where necessary, people's food and fluids were monitored to support their well-being. Staff had the correct level of skills and experience to care for people safely and to support their well-being. Feedback from one relative was very positive regarding the staff team in place, they told us “We can’t praise them enough. They go above and beyond." The home had made some environmental improvements since the last inspection and further improvements were planned once the impact of the pandemic improved.

People's care plans were reviewed and updated on a regular basis to ensure their level of care was current to their needs. For those people who had been admitted to the reablement unit, analysis seen, indicated the successful and positive transition from hospital, to Haven Court and then back to their family home. The home employed a number of activities co-ordinators and people were supported to engage in either group or one to one activities. Further plans were in place to engage with local museums to provide a greater range of dementia themed activities.

The registered manager and their staff team had worked hard to improve the overall performance of the service. Feedback from one visiting professional was very complimentary about all of the staff working at Haven Court. The registered manager and provider had a range of quality assurance processes in place which allowed them to monitor the overall level of care and service provided.

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

The last rating for this service was requires improvement (published 20 December 2019).

Why we inspected

This was a planned inspection based on the previous rating to determine if the provider had made the required improvements.

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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. Please see the effective, responsive and well-led sections 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.

Haven Court is a service providing personal and nursing care to up to 80 people, including people who may live with dementia in one purpose-built building. On the day of inspection there were 56 people using the service. The resource provides long term care and also a short-stay service to maximise people’s independence following illness or injury and to facilitate an early discharge from acute hospital. A multi-disciplinary team of health and social care professionals provide care and treatment to people.

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

Improvements had been made since the last inspection and these included improvements to the premises, people’s safety, displaying the rating from CQC and governance. People, relatives and staff were positive about the changes.

There was a stronger governance system in place, but some improvements were still required to ensure person-centred care. Two managers had been appointed since the last inspection who were responsible for the daily running of the service.

People told us they felt safe with staff support and staff were approachable.

Due to our observations we have made a recommendation to keep staffing levels and staff deployment under review to ensure timely and person-centred care to people at all times.

Records reflected the care provided by staff and they were regularly evaluated but improvements were required to ensure people received person-centred care.

The service was well-maintained with a good standard of hygiene.

We have made a recommendation about following best practice guidance for the design of the environment to ensure people who live with dementia are kept orientated and engaged.

Improvements were required in relation to activities to keep people engaged and motivated.

People received their prescribed medicines. People were supported to access health care professionals when required. People had food and drink to meet their needs.

We have made a recommendation with regard to catering arrangements so people receive their meals in a timely way and at regular intervals.

Appropriate checks were carried out before staff began work with people. Communication was effective, staff and people were listened to. Staff said they felt well-supported and were aware of their responsibility to share any concerns about safeguarding and the care provided.

People were provided with care by staff who were trained and supported in their roles. One person told us, “The staff are really good and pleasant. A relative said, “Staff create a home from home and a lovely ambience, but more importantly treat [Name] as one of their own family.”

Risk assessments were in place which identified current risks to people as well as ways to reduce those risks. Staff worked well with other agencies to ensure people received appropriate care.

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

People and relatives told us the service was well-led and said they would recommend it to others.

The management team carried out a regular programme of audits to assess the safety and quality of the service. Processes were in place to manage and respond to complaints and concerns.

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 September 2018) 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.

Since the last inspection we recognised that the provider had failed to display their rating. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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.

At the last comprehensive inspection of the service on 14, 16 and 22 March 2017 and the home was rated as ‘Requires Improvement’ overall. We identified breaches of regulation 12, safe care and treatment, and regulation 17, good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the key questions of safe, effective, responsive and well led as ‘requires improvement’. The provider did not have safe and effective systems in place in relation to people’s medicines. The provider also failed to ensure that there was an effective system in place to monitor the quality and safety of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. At this inspection we found sufficient improvements had been made to address the key question of effective and responsive but the home continued not to meet all the fundamental standards we inspected against for the key questions of safe and well-led. This is the second time the service has been rated requires improvement.

Haven Court is a 'care home' located in South Shields. People in care homes receive accommodation and nursing or personal care as 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. The home can accommodate 80 people in one adapted building and on the date of this inspection there were 54 people living at the home.

During this inspection we found a breach of regulation 12 (Safe care and treatment), 15 (Premises and equipment), 17 (Good governance) and 20A (Requirement as to display of performance assessments) of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents. This was because the provider had not adequately assessed the risks to the health and safety of people using the service, the premises were not safe, there was no robust overarching governance framework in place, renewal applications for the Deprivation of Liberty Safeguards (DoLS), safeguarding incidents and serious injuries were not notified to the Commission,

You can see the action that we have asked the provider to take at the back of the full version of this report.

At the time of the inspection was no registered manager in post and we were supported by the home’s quality and patient safety coach. A registered manager is a person who has registered with the CQC 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 that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The management team continued to provide on-going training for staff and monitored when refresher training was required. Staff had received training in end of life care and the service worked closely with partnership agencies to deliver this when required.

Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. We observed that there were enough staff on duty to support people appropriately in line with their assessed needs.

During our inspection we found that the premises were not safe for people living at the home. We found windows on the ground and first floor did not have restrictors in place or were locked closed. Fire doors stating “keep locked” were open, the laundry room was open for people to access, the clinical waste bin was open, kettles containing boiling water were left unattended in communal areas, pull cords were propped out of reach, sharp items in communal areas, substances that may have caused damage to people’s health were not securely stored.

Infection control measures were in place and the service was clean. We saw domestic staff cleaning the home regularly during inspection.

The home provided safe medicine management. Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. There were records regarding other professionals involved in people's care. People’s medicine care plans completely documented all the information needed to fully support people.

People were supported to maintain a balanced diet and we saw people had access to a range of foods and fluids throughout the day. Relatives and people told us that they were pleased with the range of food provided. We observed that at times people waited for long periods of time for their meals to be served. Food and fluids were easily accessible to people who were at risk of aspiration and choking or who had special dietary requirements.

The premises were not always 'dementia friendly '. There was some pictorial signage to help people orientate themselves. Bedrooms did not have personalisation.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. Staff demonstrated their understanding of the MCA.

We saw staff asking people for consent when supporting and asking for people's choices for meals and drinks. Staff treated people with dignity and respect. They showed kind and caring attitudes and people told us the staff spoke nicely to them. We observed people enjoyed positive relationships with staff and it was apparent they knew each other well. People and relatives knew how to raise a complaint or concern. There was information on how to make a complaint displayed within the service and this was accessible to everyone. Feedback was sought from people, relatives, staff and visitors to help continuously improve the service.

People had person-centred care plans and risk assessments in place to keep them safe. People, relatives and external health professionals were all involved in best interest decisions and mental capacity assessments. People's care records were accurate and up-to-date.

The management team had a clear vision to care for people living at the home. Staff told us that they could approach the quality and patient safety coach or deputy manager if they needed support or guidance. Relatives said that they were always welcome at the service. The quality and patient safety coach and deputy manager carried out checks and audits of the service but these were not always documented. The provider did not have a thorough governance framework in place to monitor the quality and assurance of the home.

People had access to a variety of meaningful activities and were able to enjoy social activities within the service. There was a large garden area and a coffee shop for people, relatives and visitors to access.

People’s privacy and dignity was respected by staff. During the inspection we observed staff asking people discretely if they could carry out personal care and if they required support. The service promoted advocacy and there was accessible information available detailing what support people could access to help make choices about their individual lives.

This was the first inspection of this service. It was registered with the Care Quality Commission on 4 August 2016.

Haven Court is a residential home which provides nursing care, personal care, short term care and reablement (short term support usually after people are discharged from hospital). There were 53 people living there at the time of our inspection, some of whom were living with dementia. 25 people were receiving short term care on the reablement unit which is located on the ground floor. All bedrooms have en-suite facilities.

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.

During this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed in the right way. There were gaps and inaccuracies on some medicine administration records and guidance relating to ‘when required’ medicines was not detailed. The provider's quality assurance processes needed to be sustained over time to address the areas for improvement we identified during this inspection in relation to care records being unclear on the observations people required, support plans not always being person centred and support plans not being reviewed often enough. We have made a recommendation about staff training.

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

People we spoke with told us they felt safe living at the home. Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people who lived there. Staff said they felt confident the registered manager would deal with safeguarding concerns appropriately. Staff also understood the provider's whistle blowing procedure.

Medicines that are liable to misuse, called controlled drugs, were stored appropriately. Records relating to controlled drugs had been completed accurately. People received their prescribed creams when they needed them in line with the instructions on their prescriptions.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Risks to people's health and safety were recorded in care files. These included risk assessments about people’s individual care needs such as nutrition, mobility and skin care.

Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

People, relatives and staff had mixed views about whether there were enough staff to attend to people's needs. During our inspection we saw people’s needs were met in a timely manner and call bells were responded to promptly.

Some people’s care plans were unclear in relation to the frequency of health related observations and checks they required. For example, in one person’s care plan it was unclear whether their weight should be checked weekly or monthly. People’s individual support plans were not always reviewed when required. Support plans were detailed and mostly personalised but some could be improved.

People told us the dining experience had improved in recent months but that the food could be improved. The provider’s representative told us they were raising this with the hospital’s catering department. There were enough staff to support people to eat. Food and fluid charts were completed accurately and were reviewed regularly.

There were visual and tactile items around the home to engage people living with dementia. Picture signs and colours had been used appropriately to support people to find their way around.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been authorised for relevant people.

People and relatives spoke positively about staff and the care provided.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

The service employed two activities co-ordinators and had a team of volunteers but people and relatives said there was a lack of activities.

People we spoke with knew how to make a complaint. They told us they would speak to a member of staff or the manager if they had any issues. Relatives had mixed views whether complaints they had raised had been dealt with appropriately.

Feedback from people and relatives was sought regularly and mostly acted upon in a timely manner. Staff had various ways in which they could provide feedback about the service.

The provider’s quality monitoring system was not always effective in identifying areas for improvement and generating improvements.

People, relatives and staff had mixed views whether the service was well led.

Most staff we spoke with said there had been “teething problems” since the service opened but this was improving.