The Haven Rest Home

The Haven Rest Home is a residential care home providing personal care to up to 17 people. The service provides support to older people who may live with dementia. At the time of our inspection there were 16 people using the service. The Haven Rest Home accommodates people in one adapted building.

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

Improvements had been made to the way people’s safety risks were managed and the checks senior staff undertook so they could be assured people received good care. Suggestions made by people and relatives were acted on. Staff said the senior staff were approachable and listened to their views for improving people’s care further.

Senior staff understood what key events needed to be reported to CQC. The provider had not completed a Provider Information Return but gave us assurances subsequent requests would be completed without delay. Staff worked with other organisations to ensure people’s health and well-being needs would be met.

People were protected from abuse. There were enough staff to meet people’s safety needs and staff were safely recruited. Relatives highlighted their family members were supported by staff who knew their safety needs well. People were assisted to have the medicines they needed to remain well by staff who had been trained to do this. Systems had been put in place to reduce the likelihood of the spread of infection.

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.

Rating at last inspection

The last rating for this service was requires improvement (published 05 November 2019).

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.

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.

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

Follow up

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

The Haven Rest Home is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 17 people.

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

Staff practices to manage the risks associated with infection prevention and control needed to be improved further in some areas. Staff told us they had access to enough equipment to support their practices in reducing the risks of cross infections.

The provider’s arrangements to undertake regular checks on all safety aspects of the home environment required to be further strengthened to consistently identify and mitigate all risks. Where risk assessments were required to promote people’s safety, these had not been consistently completed, particularly in relation to the home environment and one aspect of the garden area.

People’s care and support had been enhanced by the provider and management team working together to make improvements since our last inspection. Work was continuing to drive through further improvements required as identified at this inspection. The managers understood time was needed to embed improvements and sustain these.

People’s safety was protected from abuse by knowledgeable staff. Staffing arrangements were continually reviewed to promote people’s safety and individual needs. People were provided with assistance to take their medicines and their health was promoted by staff who worked alongside the relevant professionals.

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’s consent was sought by staff who knew people’s preferred communication styles to aid their understanding in making everyday choices and decisions.

People’s needs were assessed so the provider could assure themselves care was provided taking into account people’s own culture and preferences. People enjoyed their meals and drinks were plentiful. Staff supported people to be as independent as possible and where assistance was needed this was achieved in a discreet manner, to take into account people’s feelings.

The management and staff team had made significant improvements since the last inspection to the home environment and garden area. This enhanced people’s wellbeing and adaptations met people’s needs.

People and relatives felt they were supported by staff who were caring and thoughtful. Staff respected people’s privacy and had improved their practices in promoting people’s right to confidentiality.

Staff knew people well and were provided guidance in care records to promote personalised support. Staff supported people with fun and interesting activities. People’s end of life wishes were recorded and staff felt the care they provided aided people’s comfort at this important time in their lives. Improvements had been made to how complaints were responded with outcomes actioned.

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 24 October 2018) 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.

Why we inspected

This was a planned inspection based on the previous rating.

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

The Haven Rest Home is registered to provide accommodation and personal care for up to 17 older people including people who may be living with dementia. The Haven Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 15 people living at the home, who were accommodated in one adapted residential building.

The provider had appointed an acting manager who was present at the time of the inspection as the registered manager had been absent on leave since November 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of the service on 17 and 18 December 2015 the service was rated as 'Good' overall with Requires Improvement in the key question of Effective. On this inspection we found the provider had not maintained their rating of Good overall and we have changed the rating to Requires Improvement overall.

The provider did not have effective systems to ensure all statutory notifications were sent to the Care Quality Commission. The provider had failed to notify us of incidents and Deprivation of Liberty Safeguard authorisations as they are required to do by law.

The management of a medicine which required special storage because of the potential to misuse was not accounted for in the providers recording procedures. This had not been identified by the provider because the checks that had been undertaken were ineffective.

The provider had not ensured the home environment was visibly clean in all areas with suitable hand washing facilities made available, especially communal toilets. Staff were seen to wear protective clothing when undertaking their caring roles which required them to do so to reduce the risk of the spread of infections, except for when entering the kitchen area.

The needs of people who lived with dementia were not reflected in the home environment to ensure it had been adapted and designed to meet these. Amongst other things there was lack of directional signage to assist people and there were various cleaning products in an unlocked room which did not mitigate the risks to people’s health and safety.

Staff did not show through their caring practices that people’s privacy, dignity and right to confidentiality was consistently promoted.

There was not a robust quality assurance process in place. Audits to assess the quality of service provision were ineffective in identifying some of the improvements needed.

Systems for the safe recruitment of staff were not robust, and recruitment files showed there had been gaps in the recruitment process that had potentially put people at risk. Staff received an induction which was based on the providers expectations of their staff team and ongoing management support to assist staff to continually improve in their roles. Some staff practices did not consistently reflect the knowledge they had obtained to ensure they undertook their roles effectively.

Staff received training in, and understood, their responsibility to protect people from abuse and neglect. The risks associated with people’s care and support needs had been assessed and staff were knowledgeable about the equipment people required to meet their individual needs. The provider kept staffing numbers under review and had increased these to meet people’s needs safely.

People's individual needs and requirements were assessed prior to them moving into the home. People had support to eat and drink safely and comfortably, and contact had been made with doctors where required to obtain advice about meeting people’s nutritional needs. Staff supported people to maintain their health alongside relative’s involvement.

The provider had made improvements following our previous inspection to ensure people’s rights under the Mental Capacity Act were understood and promoted by staff and management.

Staff approached their work with kindness and compassion. People had support to express their views and opinions, and participate in decision-making that affected them.

People’s needs were written into care plans as guidance for staff to follow but these could be enhanced further to ensure staff had all the information they required to provide responsive care. Some activities were provided for people; however, the provision of activities did not always meet people's emotional, social and psychological needs. The provider had acted to recruit a staff member dedicated to supporting people with the planning and arranging of activities however this was in its infancy at the time of the inspection and needed more time to embed.

People who lived at the home, their relatives and staff felt able to approach the management team at any time. The acting manager was responsive during our inspection and gave us assurances by the actions they were taking to remedy the shortfalls we identified. They had an ambition to achieve an outstanding rating for the benefit of people who lived at the home.

As part of this inspection we reviewed information we held which included some concerns around a specific incident, following which a person using the service died. This incident was subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full 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.

We found 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.

Further information is in the detailed findings below.

We overheard staff ask for consent before they attemped to provide care for people. We saw that people had opportunities to make choices about their personal references and that staff respected the decisions they made. One person told us: "I like to have a bath. Staff ask me if I'm ready to have it".

People's needs had been assessed and care and treatment was planned and delivered in line with their individual wishes. One person said: "I am looked after pretty well". We found that there were systems in place for the safe administration of medicines that promoted people's health and well-being.

People were cared for, or supported by suitably qualified, skilled and experienced care workers. The provider had robust recruitment processes in place and had made appropriate checks before they offered employment. This protected people from risks of harm.

People were encouraged to exercise their rights in making a complaint if they were not happy with the services provided to them. The people we spoke with told us they were satisfied with the care they received and had never made a complaint.