Haven Nursing Home

Haven Nursing Home is a residential care home providing personal and nursing care for up to 70 older people. At the time of our inspection visit there were 68 people at the home.

Haven Nursing Home House accommodates people in one building over a single floor. Around half of the people at the home had en-suite facilities in their bedrooms. Other people shared bathroom and shower facilities. At the time of our inspection visit there was an outbreak of COVID-19. Those people who had tested positive for COVID-19 were isolated to their bedrooms and were being nursed in their room, until their isolation period ended.

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

Procedures to maintain a high standard of cleanliness, and to ensure infection control risks were managed, were not always effective. On the first day of our inspection the home required some improvements in infection control procedures and cleaning regimes. The provider had been put under pressure by the COVID-19 outbreak and the halting of re-furbishment plans and building work, which had created challenges for staff in keeping areas clean and dust free. Some areas of the home were difficult to clean due to peeling paint and woodwork. By the second day of our inspection visit the provider had made some improvements to the home to remedy peeling paint, and also to replace some woodwork. Plans were in place to continue to improve the home environment.

Procedures to maintain a safe environment were in place on the second day of our inspection visit. On the first day of our inspection visit we found some carpets were being replaced, and a trip hazard had been created, where work had ceased due to the outbreak of COVID-19. Procedures to maintain a safe environment were in place on the second day of our inspection visit.

Staff understood their responsibility to protect people from abuse and avoidable harm. People, staff and relatives told us there were enough staff to meet the needs of people using the service. Medicines were managed safely. The home was being improved and adapted to meet people’s needs.

The provider's systems and processes were not always used effectively to review and maintain oversight of the quality of the environment. This was specifically around maintaining a clean and risk-free environment during improvement and building work at the home.

Staff and the management team were committed to the people living at the home and feedback from our inspection was welcomed. The provider took action immediately when we identified improvements at our inspection.

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

Why we inspected

This was a targeted responsive inspection. The provider had reported an outbreak of COVID-19 at the home which involved more than twenty per cent of the people who lived there. 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.

We reviewed the information we held about the service. During the first day of our inspection visit we identified concerns in another key questions. We therefore opened our inspection to look at Safe and Well Led.

Rating at last inspection

This service was rated good in all areas at our previous inspection. The overall rating for the service has remained as good.

Follow up

We will return to visit as per our re-inspection programme.

Haven Nursing Home is a large nursing home, which is registered to provide care for 70 people, of which 10 beds are part of the ‘Discharge to assess’ (D2A) scheme (funded by Clinical Commissioning Groups and North Warwickshire Foundation Trust). The D2A scheme aims to ensure people are moved out of hospital (when medically stable) to receive a period of rehabilitation/re-ablement in a community setting, prior to assessment of their long-term care needs. At the time of our inspection visit there were 64 people living at the home, 8 of whom were on the D2A scheme.

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

At our last inspection in May 2018 we rated the service as ‘Requires Improvement’ as the registered manager and provider needed to embed and sustain safe procedures, and demonstrate they were consistently mitigating risks to people’s safety. Systems designed to check on and improve the quality of the service provided were not always effective and had not picked up on some of the issues we identified.

At this inspection we found people benefited from a well led service. The service was led by a new provider, a registered manager and management team who were committed to improving people’s lives. People and their relatives were placed at the heart of the service and were involved in choosing their care and support, from pre-admission to living in the home.

People received kind, responsive person-centred care from staff who were well trained, motivated and supported by a registered manager who led the staff team to provide the best care they could. The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated within the care home.

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 were involved in making decisions about the service, and their day to day lives.

Staff understood how to keep people safe and embraced team working to reduce potential risks to people. Partnership working enabled people to maintain their wellbeing and improved outcomes for people.

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 comprehensive inspection report for Haven was published in July 2018 and we gave an overall rating of Requires Improvement. At this inspection we found the service had improved and have rated the service as Good in all areas.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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 had a ‘registered manager’ in post appointed by the provider. 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 our last inspection in June 2017, there was one breach of the legal requirements and Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to the management of medicines. At this inspection we found there were no breaches in the Regulations, however, we have rated the service as ‘Requires Improvement’ as the registered manager and provider needed to embed and sustain safe procedures, and demonstrate they were consistently mitigating risks to people’s safety.

Improvements were still required to medicines management procedures to ensure people always received their medicines, and the administration of medicines was always recorded. Medical equipment was not always stored in line with safety guidelines.

People felt safe, and personal risks to people had been assessed to inform staff how people should be supported safely. However, risks were not always mitigated, for example where people had specialised equipment to protect their skin, we found this was not always used properly.

The environment at the home required improvement, to ensure it was always safe for people. Equipment needed to be more closely monitored to ensure it was always safe to use.

At this inspection, we found action had been taken to ensure care plans were reviewed and updated regularly so people’s needs had been properly assessed and could be met.

There were enough staff to meet people’s needs safely, however, there were not always enough staff to meet people’s preferences in a timely way. Staff did not always take opportunities to engage with people due to time constraints. Further improvements in the way staff were deployed was being implemented. Staff were recruited safely and were aware of their responsibilities to protect people from harm or abuse.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships. Food and fluid intake was monitored where people were at risk, and action was taken where required.

Staff were clear about their responsibilities under the MCA (Mental Capacity Act 2005) and DoLS (Deprivation of Liberty Safeguards) legislation. People’s capacity to make decisions had been assessed, and DoLS applications made as required. However, it was not always clear which decisions people needed support to make and who was involved in making the decisions.

People told us they were supported with kindness and respect, and staff respected people’s privacy when supporting them with personal care tasks. A range of activities were on offer, and people could maintain hobbies and interests they had.

The provider ensured they received, handled and learnt from complaints and concerns raised by people. People, relatives and staff were positive about the registered manager and the senior team, and felt they were effective and approachable.

Systems designed to check on and improve the quality of the service provided were not always effective, and had not picked up on some of the issues we identified. However, the registered manager and provider were working to improve audits and checks at the home, and were empowering some senior staff to be involved in these procedures. An improvement programme was in place at the home, which included the updating of the environment, décor and an improvement in the quality of care people received.

community setting prior to assessment of their long term care needs. Some people on D2A may have complex health care needs and may not be able to return to their own home. At the time of our inspection visit there were 65 people living at the home, 11 of whom were on the D2A scheme.

The home 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.

At our last inspection in September 2016, there was one breach of the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. This breach was in relation to the level of staffing at the home which impacted on the support people received. The care and treatment was not focused on, and did not meet the needs of, each person. Service user’s individual needs had not been assessed to ensure they were appropriate, or that their preferences had been taken into account.

At this inspection, we found action had been taken to ensure care plans were reviewed and updated so people’s needs had been properly assessed and could be met. However, people’s care records were not always detailed enough to ensure people received consistent support from staff.

People did no always have their medicines administered as prescribed, and medicines were not always stored safely. Medical equipment was not always stored in line with safety guidelines.

We found this was a breach 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.

People felt safe, and risks had been assessed so people were supported safely. However, risk assessments were not always followed by staff, for example where people had specialised equipment to protect their skin, we found this was not always used properly.

There were enough staff to meet people’s needs safely, and the provider had reduced the use of agency staff so people had consistent staff supporting them. Staff were recruited safely and were aware of their responsibilities to protect people from harm or abuse.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships. Food and fluid intake was monitored where people were at risk, and action was taken where required.

Staff were clear about their responsibilities under the MCA (Mental Capacity Act 2005) and DoLS (Deprivation of Liberty Safeguards) legislation. People’s capacity to make decisions had been assessed, and DoLS applications made as required. However, it was not always clear which decisions people needed support to make and who was involved in making the decisions.

People told us they were supported with kindness and respect, and staff ensured people’s privacy and dignity was preserved.

Staff did not always take opportunities to engage with people, or to ensure the environment was as responsive as possible.

A range of activities were on offer, and people could maintain any hobbies or interests they had.

The provider ensured they received, handled and learnt from complaints and concerns raised by people.

People, relatives and staff were positive about the registered manager and the senior team, and felt they were effective and approachable.

Systems designed to check on and improve the quality of the service provided were not always effective, and had not picked up on some of the issues we identified.

At our last inspection in March 2016, there were three breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to the support people received. Care was ‘task focused’, not focused on the needs of each person. Staff did not have the time to support people with interests or activities. People in the Birch unit experienced very little engagement to meet their social care needs. The provider did not ensure the proper and safe use of medicines. Risks were not always recorded and responded to appropriately; there was not an effective and accessible system for complaints; the provider did not have effective systems and processes to make sure they assessed and monitored their service.

Following the September inspection, we issued the provider with a Warning Notice in relation to the lack of effective oversight and the home was put into ‘special measures’. When we inspected in March 2016 we found the requirements of the warning notice had not been met and the home remained in special measures.

The provider sent us an action plan which detailed the actions they were taking to improve the service. At this inspection we found that there was enough improvement to take the provider out of special measures however further improvements were still required.

A new manager was appointed in May 2016. The manager has submitted an application to us so they can be ‘registered’. 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.

Since the March inspection, there had been some improvement in the management of medicines, and the provider had taken steps to ensure people received their medicines safely and as prescribed. However, guidelines which were now in place for staff to administer medicines to people on as ‘as required’ basis, continued to require improvement.

The provider now ensured they received, handled and learnt from complaints and concerns raised by people.

People continued to be supported in ways that were task focussed and were not person centred. Care plans did not support staff to provide personalised care consistently as they had not always been reviewed and information in them was not always accurate. This meant assessments intended to identify and address risks to people’s health and safety had not always been updated.

There were enough staff were on duty to meet people’s needs. However, people sometimes had to wait longer than they should for needs to be met, and staff said they sometimes struggled to meet people’s needs. The provider used agency staff, but recruitment for permanent staff was underway.

Staff were clear about their responsibilities under the MCA (Mental Capacity Act 2005) and DoLS (Deprivation of Liberty Safeguards) legislation. The manager understood their responsibilities and had ensured applications had been made to the appropriate body. However, these had not always been followed up with the local authority where delays in assessing restrictions were experienced.

People living with dementia were properly supported. People’s needs had been reassessed and those living with dementia had now begun to be integrated into the rest of the home, and the unit where people living with dementia had been supported no longer had a locked door. This gave people more freedom and provided them with more and varied interactions.

Staff were respectful and treated people with dignity and respect. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained.

More effective systems were now in place to check the quality and safety of service provided, although these had not picked up on some of the issues we identified. There was now better governance, so the service people received could improve.

We found one breach 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.

people with more complex nursing needs are mainly supported in Oak and Elm units. At the time of our visit there were 38 people living in the home.

At our last inspection on 8 and 10 September 2015, we found there were six breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to the support people received. Care was task focused, not focused on the needs of each person which meant individual needs had either not been identified or acted on. People’s social care needs were not met because staff did not have the time to provide interests or activities for all. People in the Birch unit (a specialist unit for people living with dementia) experienced very little engagement to meet their social care needs; staff did not act in accordance with the requirements of the Mental Capacity Act 2005 to ensure that decisions to restrain people were in their best interest; the provider did not ensure the proper and safe use of medicines, or ensure there was always sufficient stock, to meet people’s needs. The provider did not ensure risks were recorded and responded to appropriately; there was not an effective and accessible system for identifying, receiving, recording, handling and responding to complaints; the provider did not have effective systems and process to make sure they assessed and monitored their service to ensure compliance with the requirements of the Health and Social Care Act 2008. People were not receiving the personal care they required to be safe, because there were insufficient staff to meet their needs; staff had had not received training to enable them to support people living with dementia.

We issued the provider with a Warning Notice in relation to the lack of effective oversight.

As a result of the September 2015 comprehensive inspection, the provider was put into special measures. We asked the provider to take action to improve the areas we had identified as being of concern. The provider sent us an action plan which detailed the actions they were taking to improve the service. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Following our September 2015 inspection, a new manager was appointed but had since left so that at this inspection visit, the home 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 2008 and associated Regulations about how the service is run.

Since the September inspection, whilst there had been some improvement in the management of medicines, the provider had not done enough to ensure people received their medicines safely and as prescribed.

The provider had taken action to ensure enough staff were on duty to meet people’s needs. They were no longer in breach of the Regulations of the Health and Social Care Act 2008. However, staff said they felt under pressure at times and struggled to meet people’s needs. The provider also continued to use agency staff to provide care to people, but recruitment for more permanent staff was underway.

Staff were clearer about their responsibilities under the MCA and DoLS legislation and were no longer in breach of the Regulations of the Health and Social Care Act 2008. Plans were in place for people who lacked capacity to ensure they were not restrained unlawfully, for example by the use of bed rails. However, the provider acknowledged applications might need to be made to deprive people of their liberty, and plans were in place to do this.

The provider had taken some action to ensure people living with dementia were properly supported, and was no longer in breach of the Regulations of the Health and Social Care Act 2008. Staff had received some training, and people living with dementia had been reassessed to ensure their needs could be met.

Staff were respectful and treated people with dignity and respect. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained.

People continued to be supported in ways that were task focussed and were not person centred. Care plans did not support staff to provide personalised care consistently as they had not been reviewed and information in them was not always accurate.

The provider had not taken steps to ensure effective systems were in place to check the quality and safety of service provided, and there was a lack of governance which made it difficult for the service to improve.

We found a number of 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.

At this inspection, we saw significant improvements had been made.

We found that people's needs were assessed and regularly reviewed and that their care records were sufficiently detailed to reflect the care and support they required from staff.

We saw that there were sufficient qualified and experienced staff on duty to meet people's needs in a timely manner.

We found that people were asked for their views about the home and people were listened to. The provider had an effective system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made.

We saw that not all people's care plans were regularly reviewed. Staff knew and understood the changes in people's needs, but changes were not clearly recorded in their care plans.

The manager and staff understood their responsibilities for reporting any concerns regarding potential abuse of people who used the service.

We found that staffing levels were inadequate to meet the care needs of people in a timely and effective way. As a result, some people did not have their preferences and choices respected and were at risk of not having their health and wellbeing met.

Quality monitoring systems were in place but were not fully effective in ensuring people received the care and services they should expect.

We found that suitable and sufficient improvements had been made in the areas where we had identified concerns. We saw the provider had put right what was required.

During our inspection we spoke with two people who used the service and with one relative who was visiting the home. People told us that they were well cared for. One person said, "It's very nice indeed, it couldn't be better."

A visiting relative told us, 'My relative is well looked after, I couldn't ask for better care for them.'

We looked at the care records for three people to check how well their needs were assessed and planned for. We saw that care was based on the individual needs of people and, where appropriate, specialist advice was sought.

We observed the lunch time meal in the dining room and saw there was a pleasant eating environment without interruptions.

We looked at medication processes to assess compliance with this outcome. We found that the home had carried out improvements to provide safer storage and administration of medicines.

We saw that changes and improvements were being made to the management structure of the home. An acting manager and a deputy manager had been recruited and the service was overseen by a consultant manager. .

We had limited conversations with some of the people who lived in the home. They responded positively when asked about their care. We spoke with visiting family members of three people. One family member said, 'My relative is well cared for; I have no concerns.'

Care records seen were not always up-to-date to make sure staff managed risks and delivered care that met people's needs. Gaps in recording meant the service could not always be confident care had been delivered in a consistent manner.

We looked at how the home ensured people received their prescribed medication in a safe manner. Records we reviewed did not demonstrate that medicines were given safely and as prescribed.