• Care Home
  • Care home

Archived: Haversham House Limited

Overall: Inadequate read more about inspection ratings

Longton Road, Trentham, Stoke-on-Trent, ST4 8JD (01782) 643676

Provided and run by:
Haversham House Limited

All Inspections

2 March 2021

During an inspection looking at part of the service

About the service

Haversham House Limited is a residential care home providing personal and nursing care to 32 people aged 55 and over at the time of the inspection, some of which were living with dementia. The service can support up to 49 people.

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

People did not always have care plans and risk assessments in place or reflective of their needs, to enable staff to meet these. People were not consistently supported by staff trained in all of their healthcare needs to enable them to meet these effectively. People were not supported in a clean and well maintained environment and there were not sufficient staff to maintain a clean environment. There were areas of the home that were unsafe with exposed hot water pipes and uncovered radiators.

People's medicines records were not always complete and did not consistently contain guidance where they were prescribed medicine on an 'as required' basis. People's medicines were not always disposed of in a timely way where these were no longer prescribed.

People were not always supported by staff to isolate in line with government COVID-19 guidance on admission to the service. The provider had failed to act on concerns raised by external professionals around infection prevention and control practices.

Quality assurance tools were not effective at identifying areas of concern in relation to people's care files, infection control, the environment, medicines and staffing and ensure action was taken to implement improvements in a timely way. The provider had failed to ensure lessons were learnt when things went wrong and improvements were made at the home where these were required.

People were supported to access medical professionals as they required these. People were supported by staff that understood safeguarding and had raised concerns appropriately as required.

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 27 January 2021). The provider completed an action plan after the last inspection 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 regulations. The service is now rated inadequate. This service has been rated less than good for the last four consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had also received concerns from external professionals about people’s safe care and treatment, infection control practices and the governance and oversight of the home. We reviewed the information we held about the service and as our concerns were within the domains of Safe and Well led we inspected these domains only.

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

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safe care and treatment, the cleanliness and maintenance of the home, staffing and oversight.

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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

24 November 2020

During an inspection looking at part of the service

About the service

Haversham House is a residential care home providing personal care to 30 people aged 60 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 49 people.

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

Quality assurance tools had failed to identify, implement and sustain improvements at the service in relation to people's care records, medicines and falls monitoring equipment.

People's care plans and risk assessments did not consistently contain clear guidance around their changing needs. Despite this, staff knew people well and were meeting their needs.

People received their medicines as prescribed by trained staff. However, staff were not always recording where they had administered people's medicines that were prescribed in patch form.

People were supported by staff in a timely way with their needs.

People were protected from potential abuse and neglect.

People and their relatives felt able to share their feedback about the service.

People had access to external healthcare professionals as they required these.

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 10 April 2020) and there was a breach of regulation in relation to the governance at the service. 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 not been embedded or sustained and the service remained in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns about safety and oversight at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the governance and oversight of people’s care documentation, risk and medicines at the service.

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.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

19 February 2020

During a routine inspection

About the service

Haversham House Limited is a residential care home providing personal care and accommodation to 31 people at the time of the inspection, some of whom were living with dementia, a physical disability or needing support with their mental health, both younger and older adults. The service is registered to support up to 55 people in a single adapted building, however this had now reduced to 49 people and the provider informed us of this following discussion during the inspection.

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

Systems were not being utilised to ensure people always had a good experience of care. Staff were not always effectively deployed to ensure people had support at the time they needed it. Some improvements had been made to medicines management, but further improvements were needed to ensure they were always safe. People had enough to eat and drink, although the meal time experience was not always positive. The building was not fully fit for purpose and improvements were needed to the environment, although some plans were in place.

Risks to people were now being assessed and planned for. People were protected from the risk of cross infection, although improvements were needed to label foods and stock control in the kitchen fridge. People were protected from intentional abuse by staff who understood their responsibilities. Lessons were being learned and improvements were gradually being introduced.

People had their capacity assessed, although for one person this had not been reviewed regularly enough. Despite this, 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. Staff received training and support to be effective in their role. People were assessed prior to moving into the home to ensure their needs could be met. People had access to other health professionals.

People were supported by a caring staff team and felt they were treated with dignity and respect. People were able to make decisions about their care and were encouraged to be independent where possible. People had their religious needs considered.

People were able to partake in activities. People and relatives were involved in developing their care plan, with further work planned by the provider to ensure all care plans were updated. People felt they were supported in line with their preferences. People were supported at the end of their life. People could access written information in alternative format when necessary. People and relatives felt able to complain and these were investigated and responded to.

Notifications were now being submitted. The provider was aware of their responsibilities to be open and honest. An action plan was in place and action being taken to improve and learn. The staff morale and culture had improved at the service. People and staff felt positively about the deputy manager and management team. People and relatives were engaged in the service and were kept informed about changes. The service worked in partnership with other organisations.

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 (published 2 October 2019) and it was inadequate in well-led. There were multiple breaches of regulation. At this inspection it is still rated as requires improvement overall, although there were a ratings improvement in caring, responsive and well-led. Many issues were no longer breaches, although we identified one continued breach in relation to oversight of the service.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in relation to governance systems which were not effective at identifying areas that needed improvement.

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

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.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

13 August 2019

During a routine inspection

About the service

Haversham House Limited is a residential care home providing personal care and accommodation to 34 people aged 65 and over at the time of the inspection, some of which were living with dementia, a physical disability or needing support with their mental health. The service can support up to 55 people in a single adapted building.

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

People were exposed to some poor care as systems were not effective at identifying areas that needed improving in a timely manner. People did not always receive personalised care. Risks were not always assessed, planned for and mitigated to keep people safe. Medicines were not always managed safely. There were not always enough staff to respond to people needs and keep them safe. Lessons had not always been learned when things had gone wrong. The premises were not always appropriately maintained, and notifications were not always submitted to us.

Staff were not always effectively trained to support people appropriately; work was ongoing to refresh all staff training. People had their needs assessed but this did not always lead to a personalised plan, but work was being undertaken to remedy this. People were supported to have adequate amounts of food and drink, although the lunch time experience could be more made more positive for people. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice as concerns had not been identified. People had their capacity assessed as required. People had access to other health professionals, but this was not always consistent. The environment needed improving to ensure it was dementia friendly.

People did not always have access to meaningful activity, despite the activity coordinator making effort to attempt this. People felt able to complain and these were responded to, although there was mixed feedback about how effective this was.

People were protected from the risk of cross infection. People were protected from the risk of abuse. People were supported at the end of their life.

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 good (published 7 March 2017). It is now rated as requires improvement overall and inadequate in well-led, so care and support had deteriorated since our last inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines, risk management, staffing levels and staff training, person-centred care, the premises, governance systems which were not effective at identifying areas that needed improvement and not submitting notifications.

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

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.

Follow up

We have met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

9 February 2017

During a routine inspection

This inspection took place on 9 February 2017 and was unannounced. At our previous inspections in June and October 2016, we judged that the provider was not meeting the required fundamental standards of care. We identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was placed into ‘special measures’ following the June 2016 inspection because it was rated as ‘Inadequate’ overall. The service remained in ‘special measures’ following our October 2016 inspection because one of the key areas we looked at; ‘is the service safe?’ was rated as ‘inadequate’.

Services that are in ‘special measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that significant improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 31 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 and associated Regulations about how the service is run.

Risks to people’s health, safety and wellbeing were assessed and planned for. Staff knew how to keep people safe and risks were managed effectively to promote people’s safety.

Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

Medicines were managed safely and people received their medicines as prescribed.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when needed.

Staff knew people well which meant they could interact with them positively and effectively. People were treated with kindness and respect and staff promoted people’s independence, dignity and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to participate in leisure and social based activities that met their personal preferences.

People knew how to complain about their care and an effective system was in place to manage complaints.

Effective systems were in place to assess, monitor and improve the quality of care. Feedback from people was sought to enable the provider to identify if improvements to care were needed.

The registered manager understood the requirements of their registration with us and they reported notifiable incidents to us.

18 October 2016

During a routine inspection

We carried out an unannounced inspection of this service on 1 June 2016. At that inspection, we identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as ‘inadequate’ and was placed into ‘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 undertook this unannounced comprehensive inspection on 18 October 2016 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Haversham House on our website at www.cqc.org.uk.

At this inspection, we found that some of the required improvements had not been made. Some breaches of Regulations were still present and although the service is now rated as ‘requires improvement’ overall, the safe domain has been rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 34 people were using the service.

The service did not have 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 and associated Regulations about how the service is run. A new home manager had been appointed and had applied to register with us.

At this inspection, we found that that new systems were in place to assess, monitor and improve the quality of care. However, these systems were not yet effective. This meant some areas of unsafe or inappropriate care were still not being identified and rectified by the manager and provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely. This meant that’s people’s safety, health and wellbeing was not consistently promoted.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe.

People’s care plans did not always contain the information needed to ensure they received safe, effective and consistent care. As a result, people didn’t always receive care that met their needs or preferences.

People’s dignity was not always promoted, but people were now supported to be as independent as they could be.

People were supported to eat and drink in accordance with their preferences. Prompt advice was sought from health and social care professionals when people’s needs changed.

Safe recruitment systems were in place to ensure staff were suitable to work at the home. People spoke fondly about the staff and at times we observed some positive interactions between staff and people.

People were protected from the risk of abuse because staff knew how to identify and report suspected abuse. Some people needed to have their freedom restricted at times to keep them safe. When people were restricted, these restrictions were appropriate and lawful.

People knew how to complain about their care and complaints were managed appropriately to make improvements to people’s care experiences.

The manager and provider notified us of reportable incidents, such as suspected abuse. The home’s rating was clearly displayed at the home and on the provider’s website as required.

1 June 2016

During a routine inspection

We inspected this service on 1 June 2016. This was an unannounced inspection. Our last inspection took place in March 2015 November 2015. At that time we found the provider was meeting the required Regulatory requirements.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 47 people were using the service. However, one of the people had been admitted to a local hospital after sustaining a serious injury at the home.

The service did not have 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 and associated Regulations about how the service is run. A new home manager had been working at the service for approximately two months. However the provider informed us this manager left the service in the 48 hours following our inspection.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘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.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely and people were not always protected from the risk of abuse. This meant that’s people’s safety, health and wellbeing was not consistently promoted.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. Some people who could make choices about their care were being restricted unnecessarily and were unable to move around the home freely. Some people were unable to make decisions about their care were being unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours. There were gaps in some people’s care plans which meant staff didn’t always have the information they needed to provide safe and consistent care.

People’s dignity and independence was not always promoted and staff didn’t always have the time to engage with people in a manner that was meaningful to each individual.

People and their representatives were not always involved in the planning and review of their care. As a result, people didn’t always receive care that me their needs or preferences. People were not supported to participate in leisure and social based activities that were meaningful to them.

People were reluctant to complain about their care and effective systems were not in place to manage complaints to improve people’s care.

The provider did not always notify us reportable incidents and events as required and the CQC rating from our last inspection was not being displayed in accordance with the law.

People were supported to eat and drink in accordance with their preferences. However, mealtimes were chaotic and disorganised which impacted on people’s dining experiences.

Safe recruitments systems were in place to ensure staff were suitable to work at the home. People spoke fondly about the staff and at times, we observed some positive interactions between staff and people.

19 March 2015

During a routine inspection

The inspection took place on 19 March 2015 and was unannounced.

Haversham House provides accommodation with personal care for a maximum of 59 people. The service specialises in providing care for people with dementia over 65 years of age.

A registered manager was 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.

People’s risks were assessed in a way that kept them safe from the risk of harm. Where possible people’s right to be as independent as possible was respected.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s care needs. Staff were trained to carry out their role and the provider had plans in place for updates and refresher training. The provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Staff knew how to support people in a way that was in their best interests and advice had been sought from other agencies to ensure formal authorisations were in place where people may be restricted.

People were supported to maintain good health and were referred to relevant health care professionals as and when required. People had enough to eat and drink and were supported with their nutritional needs.

People told us that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld.

People had opportunities to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure available for people who used the service and complaints were appropriately managed.

There was a positive atmosphere within the home and staff told us that the registered manager was approachable and led the team well. Staff received supervision of their practice and had opportunities to meet regularly as a team.

The registered manager had systems in place to monitor the service and we saw that improvements had been made when identified as necessary.

13 December 2013

During a routine inspection

Haversham House consists of two units the main home which provided care and support for elderly people some of whom have dementia. Many of the people have mobility problems. The Rainbow unit provided care and support for older people who had more advanced dementia or more challenging needs.

People who used the service at Haversham House were treated with respect and their dignity was protected, but there were not always sufficient activities available for people. A person who used the service said, 'There's not much to do most of the time'.

People's care and treatment was planned and delivered in a way which met their needs. A relative of a person who used the service said, 'The staff seem very friendly and look after my relative very well. My concern was safety, before they came here, but now I feel better knowing they are safe'.

We found that Haversham House was clean and tidy. Staff had been trained in infection control procedures and had a good understanding of their role.

There were sufficient suitably qualified, skilled and experienced staff on duty at all times to meet the needs of people who used the service. A person who used the service said, 'You take it from me, it's marvellous here'.

The provider had a complaints policy. Complaints were recorded and responded to in a timely manner and complainants were updated throughout the process.

4 March 2013

During a routine inspection

During the inspection we spoke with people who used the service and their relatives. We spoke with staff and the registered manager and we viewed records. We did this to help us understand the outcomes and experiences of selected people who used the service.

We observed staff treating people who used the service with dignity and respect. Staff listened to people's wishes and acted upon them. People we spoke with told us that they were happy with the support provided. One person told us, "All the staff are very good and they always listen to what I have to say".

We saw that people appeared comfortable when staff were providing support and staff we spoke with understood the procedures to follow if they felt that someone was at risk of harm.

Staff had received an induction at the start of their employment and staff we spoke with told us that they felt supported in their role. Staff had opportunities to undertake training and to develop their skills.

The provider had systems in place to monitor the service provided and where improvements had been identified an action plan had been put in place.

During an inspection looking at part of the service

When we visited in January 2012 we found that the home was not gaining people's consent to decisions about their care. They were also not completing assessments for people that could not make decisions about their care. The provider sent us an action plan telling us how they would address the issues we had raised.

The provider sent us information to show us that it had addressed the issues. We saw evidence that people were involved in planning and making decisions about their care.

We also saw that where people did not have the capacity to consent to care a mental capacity assessment was completed. The provider was also recording information to show how decisions for people that lacked capacity were made and the reasons for them. This meant there was evidence to show that decisions were made in people's best interest and that their rights were upheld.

10 January 2012

During an inspection looking at part of the service

We carried out this review to check on the care and welfare of people using this service. We visited Haversham House in order to up date the information we hold and to establish that people's needs were being safely met.

There were 58 people living at Haversham House when we visited on 10 January 2012. The visit was unannounced which meant the provider and the staff did not know we were coming.

When we arrived some people were sitting in the lounge areas, whilst others were in the dining room having breakfast. One person having breakfast told us, 'The food is very good here; you can see our plates are clean.' Another told us, 'They know I like a newspaper in the morning and there is one waiting for me after breakfast.'

There was a separate unit within the home, Rainbow House. We were told this unit, which had ten people living there, was for people who required extra support. The unit had a separate lounge, dining area and garden.

During the visit we spoke with people living at the home, family and friends who were visiting and staff members. One person living at the home told us 'Staff are very nice, polite and very helpful.' A staff member told us, 'I enjoy working here, I feel supported to do my job.'

We looked at the plans of care for four people living at Haversham House and found little evidence that people had been involved in the development of the plans and little documentation in relation to people providing consent to care. We were told that care planning was being reviewed and a new process was due to be implemented.