Haven Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Most of the admissions to Haven Nursing Home were through a ‘trusted assessor’. This is an initiative to promote safe and timely discharges from NHS Trusts to adult social care services. The registered manager told us they reviewed assessments carefully to ensure they had the systems and processes in place to meet people’s needs safely and effectively before accepting an admission into the home.

Care plans were developed from the assessment of needs in collaboration with people and others involved in their care. Care plans were reviewed monthly or as people’s needs changed. For example, we saw 1 person’s care plan was continually being updated and adjusted as their needs were changing daily. One staff member told us, “We share our observations with the nurses, and they update the records. It’s important to share anything you see or any problems you are having so all information is kept up to date.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider followed best practice guidance and used recognised tools to monitor people’s nutrition and hydration, skin integrity and pain levels. This ensured care and support was delivered in an evidence-based way.

People’s nutritional needs were supported and where people were identified as being at risk of not eating and drinking well, they were referred to other healthcare professionals for advice and support. There was a designated staff member with responsibility for encouraging people, particularly those who had been identified as having low nutritional intake, to remain hydrated and increase their calorie intake.

We asked people for their views on the variety and quality of food offered. People responded positively. Comments included: “I get plenty of food and it is nice. I get choice every day for all the meals”, “I get 2 choices for lunch, and it is hotter now because they bring the oven up. You can have as much as you like at breakfast” and “I’m happy with the meals; there is always a choice. If you don’t want what’s offered, they will give you something else.”

Staff received regular refresher training, so their work reflected best practice and up to date guidance.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There were effective processes to ensure information about people was shared between staff and any changes in needs were known. One staff member told us, “Every day starts with a handover (meeting). The night staff write everything that has happened from 7pm to 7am. We know about any resident who is poorly, has had a fall or hasn’t slept or needs something doing. Handover is a good start to a shift. It keeps you up to date.” Another staff member explained, “The nurses fill in the handover book so you can always go back, and check if you need to.”

Staff described good communication with other health and social care professionals involved in people’s care. One staff member commented, “We are a real team and work together. We share information with the nurses and management, and they share information with the social workers, the doctor or the hospitals. It’s like a big circle of sharing information.” A visiting healthcare professional confirmed staff implemented any advice communicated to them.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s healthcare was monitored and where a need was identified, they were referred to the relevant healthcare professional. Records showed that people were supported to attend routine health appointments to maintain their wellbeing such as the chiropodist and optician. A visiting healthcare professional told us, “Referral times are more than satisfactory in my opinion.”

The registered manager told us they had a good relationship with the local GP surgery and a frailty nurse visited the home each week. Every person living in the home had recently had a full health review with the frailty nurse, advance nurse practitioner, pharmacist, physiotherapist and occupational therapist. The registered manager explained how this had helped to identify any underlying health conditions and given a base line for monitoring any changes in people’s presentation. This meant they could be proactive in responding to any changes in people's health which had reduced the number of hospital admissions.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff monitored people’s health and wellbeing. Records were kept for monitoring food and fluid intake, medical conditions, weight and when people needed to be repositioned to prevent skin damage. Staff recorded care interventions, and clinical staff and the management team monitored records to ensure care was provided appropriately and safely.

An external healthcare professional confirmed that staff completed any monitoring of people’s health requested of them. Another healthcare professional commented, “If we require certain information for an assessment, for example a request for an up-to-date weight, this is always promptly carried out.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider used CCTV within the care home which involved collecting and recording information. The provider had failed to complete a comprehensive appraisal before installing CCTV to ensure compliance with relevant legislation and guidance. This included the Mental Capacity Act 2005, Human Rights Act 1998 and the General Data Protection Regulation. The provider had not formally consulted with people about the installation of CCTV or informed people about their rights around consent to the use of CCTV. Where people lacked capacity to consent to the use of CCTV, a ‘best interests’ process had not been considered.

In other areas of their life, people’s capacity to make specific decisions about their care and treatment had been assessed and ‘best interests’ processes had been followed.

Clinical and care staff worked in accordance with the Mental Capacity Act 2005 and were observed seeking people’s consent throughout our inspection. Staff offered people choices and respected the decisions they made. One staff member explained how they monitored people’s responses to ensure they had consented to the support being offered. They told us, “It can be hard to get permission when we are supporting a resident with dementia, but you learn to read their behaviours and gestures. If a resident pushes you away, they are telling you no. If a resident smiles or wants a cuddle, they are telling you yes.”

People's right to refuse offers of care and support was respected, but staff understood the importance of ensuring this did not impact on people's health and wellbeing. One staff member told us, “If a resident refused to give consent, I would explain why what I was asking consent for was important and try to encourage them. If they still refused, I would leave it and try again later.”