Archived: Haven Lea Residential Care Home

Haven Lea Residential Care Home is registered to provide accommodation and personal care for up to 26 adults. The service is located in the Whiston area of Merseyside and is close to local public transport routes. Accommodation is provided over two floors. These floors can be accessed via a stair case or passenger lift. There were 20 people using the service at the time of our inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in October 2016. 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.

The last inspection of the service was carried out in December 2016 and we found that the service was meeting all regulations. However at this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The management of medication was unsafe. People did not receive their prescribed medication at the right times. Medication administration records (MARs) for some people had been signed to indicate they had received prescribed medication which was not given. Handwritten MARs had not been signed by two staff to ensure the accuracy of the information recorded and some MARs did not provide instructions about the use of medication. This put people’s health safety and wellbeing at risk. Immediate action was taken on the first day of inspection to improve the management of medication.

The premises were unsafe. There were hazards both inside and outside of the premises which had the potential to cause people harm. This included the unsafe storage of harmful substances and obstructions which placed people at risk of slips, trips and falls. External doors, including a fire door, were left open and the areas were unsupervised. This placed people’s safety at risk. Action was taken on the first day of inspection to improve the safety of the environment.

The cleanliness and hygiene of the service was not maintained and clinical waste was not secured. This placed people at risk of acquired infection. Areas of the service, including the kitchen, food stores and floorings on corridors and people’s bedrooms were unclean. The clinical waste storage container kept at the front of the building on a space open to the public not secure. The lid on the container was open and there was no lock fitted to it. This increased the risk of the spread of infection. The Euro bin was secured by the second day of inspection.

The recruitment of staff was not always safe. Recruitment records for nine members of staff working at the service did not evidence that checks required by law were carried out on their criminal record.

New staff had not received a thorough induction into their roles and there was a lack of initial and ongoing training for all staff. Staff had not received an appropriate level of support to enable them to discuss their performance, training and development needs. Staff were given the responsibility to carry out tasks without being provided with the relevant training and support. This meant that people were not supported by staff that had received the right training and support

People who lacked capacity were not fully protected because staff lacked an understanding of the Mental Capacity Act 2005 and the associated deprivation of liberty safeguards (DoLS). Staff were unsure which people had an authorised DoLS in place and what is meant for people.

There was a lack of stimulation for people and opportunities for them to engage in things of interest. People spent most of their time sat in the lounge either watching the television or sleeping. The environment lacked items of interaction and stimulus to help engage people.

Personal records belonging to people were left unsupervised on a table in the communal lounge areas which were accessed by visitors to the service. Items belonging to people who no longer lived at the service were left in bedrooms which other people now occupied. People’s clothing was not stored in a dignified way; laundered clothing was left in an unoccupied bedroom which smelt strongly of urine. This meant that people’s confidentiality, dignity and privacy were not respected

Pre-admission assessments did not contain sufficient information about people’s needs and care plans were not in place for people’s needs which were identified. Aspects of people’s care were not monitored in line with their care need requirements. This included fluid intake, weight, positional changes and skin integrity. This meant that there was a risk that people’s needs were not assessed and planned for

There was a lack of management oversight at the service. The registered manager delegated the task of carrying out audits and checks across the service to staff that were not appropriately skilled and qualified. The checks were not carried out as required which meant risks to people’s health and safety were not identified and mitigated. Records were not maintained securely, accurate and complete.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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.

Haven Lea Residential Care Home is registered to provide accommodation and personal care for up to 26 adults. The service is located in the Whiston area of Merseyside and is close to local public transport routes. Accommodation is provided over two floors. These floors can be accessed via a stair case or passenger lift.

The service has a registered manager who was registered with the Care Quality Commission in October 2016. 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.

The last comprehensive inspection of the service was carried out in December 2015 and we found that the service was not meeting all the regulations. We asked the registered provider to take action to make improvements to the management of people’s medication. The registered provider sent us an action plan following the inspection detailing how and when they intended to make the improvements. During this inspection we found that the required improvements had been made.

The required improvements had been made to the way people’s medication was being managed and recorded. The registered provider had developed their medication policy to bring it in line with national guidance and current legislation. Systems for recording quantities of medication received into the service and medications returned to the supplying pharmacist had been improved. The allergy section of people medication administration records (MARs) had been completed to show any known or unknown allergies. Staff responsible for the management of people’s medication and associated records had completed training and competency checks to ensure they were suitably skilled for the task.

We have made a recommendation about making the environment more dementia friendly. The environment had been improved since the last inspection, including some re decoration and the replacement of old, and tatty furniture and fittings. However there was a lack of stimulus and signage to help orientate and stimulate people living with dementia. On the second day of the inspection the registered manager evidenced that they had researched dementia friendly environments. Items to improve the environment for people living with dementia had been purchased and plans had been made to make further improvements to the environment to make it more dementia friendly.

We have made a recommendation about the complaints procedure. The procedure did not include the details of the registered provider or any external body such as the local Ombudsman. This meant people did not have the information they needed to escalate their complaint should they wish to.

The recruitment of new staff was robust. Applicant’s suitability to work at the service was assessed based on information which they were required to provide. This included details about their previous employment history, skills and experience. Before an offer of employment applicants were also subject to a series of pre-employment checks on their suitability, including reference checks and a check with the Disclosure and Barring Scheme (DBS).

People were kept safe from abuse and harm. People told us they felt safe at the service and that staff treated them well. Staff had completed training in relation to keeping people safe, including safeguarding and emergency procedures. Staff knew the different types and potential signs of abuse and what their responsibilities were for reporting any incidents which impacted on people’s safety. Equipment was checked to ensure it was clean and safe to use and it was stored away when not in use to avoid the risk of trips and falls. Risks to people in relation to the environment and their individual care and support needs had been assessed and planned for.

The environment was generally clean and tidy throughout. A recent visit by the local authority infection control team had identified some concerns in relation to the prevention and control of infections. However, the registered manager demonstrated that they had taken action to make improvements and they had put plans in place to make further improvements. Disposed clinical waste outside the premises was not stored safely because the lock on the bin was broken. The registered manager acted upon this immediately. A new lock was fitted to the bin by the second day of our inspection and a system was put in place to check it was in good working order and being used appropriately.

The right amount of suitably skilled and qualified staff were on duty to meet people’s needs and keep them safe. People told us that they thought there was enough staff on duty to keep them safe and this was echoed by family members.

People were happy with the food and drink available at the service, they told us they enjoyed the meals and had always been offered plenty to eat and drink. People’s nutritional and hydration needs were assessed and an appropriate care plan was put in place for those whose needs required one. The care plans detailed things such as food textures, consistency of fluids and assistance and equipment people needed to eat and drink. People who required it had their weight, food and fluid intake monitored. Staff had access to guidance to help them recognise when a person required input from an external professional such as a dietician and/or speech and language therapist and referrals were made promptly.

Care plans clearly set out people’s needs and how they were to be met. Care plans were reviewed regularly and updated when required to reflect any changes to people’s needs. A daily record was maintained of the care and support people received and they showed that care plans had been followed in accordance with people’s needs, wishes and preferences. Staff interaction showed they had a good understanding of people’s needs, likes and dislikes. Staff used their knowledge of people to help generate conversations of interest and people reacted positively to this.

People’s privacy, dignity and independence was respected and promoted. Staff were patient when assisting people and they spoke with people in a kind and caring manner. Staff sat down next to people, maintained eye contact when speaking with them and they showed interest in what people had to say. Staff knocked on doors before entering bedrooms and bathrooms and waited to be invited in. Staff knew and respected people’s preferences such as their preferred titles and gender of carer when receiving personal care.

Staff received appropriate training and support for their roles. New staff were inducted into their role over a twelve week period and throughout induction staff underwent regular supervision and assessments of their learning. Induction and ongoing training for all staff included topics such as safeguarding, infection control, safe people handling and dementia care.

Staff, people who used the service and their family members made positive comments about how the service was managed. They said the registered manager had made a lot of improvements at the service since they became the manager. The registered manager was described as being supportive and easy to approach.

There were systems in place to check on the quality of the service and to make improvements. Checks were carried out at various intervals on things such as people’s care records, medication and the safety of the environment. Action plans were developed to address any identified areas for improvement.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found '

Is the service safe?

Staff knew how to deal with an emergency situation. Risk assessments had been carried out and risk management plans were in place to ensure people received safe care and support. Staff knew what their responsibilities were for safeguarding people and people told us they felt safe living at the home. There were the right amount of skilled and experienced staff working at the home to safely meet people's needs. Regular checks were carried out at the home to ensure people were safe.

Is the service effective?

Staff had all the information they needed to meet people's needs and they ensured people received the right care and support. Staff were respectful and polite towards people who used the service and they involved people in their care and the day to day running of the home. People's preferences and choices were understood and respected.

Is the service caring?

Staff were polite, caring and compassionate towards people who used the service and their relatives. Staff spent time reassuring people and provided them with emotional support when needed. People were supported to take part in meaningful activities and were encouraged to maintain contact with people who were important to them.

Is the service responsive?

People were able to freely express any concerns or ideas for improving the service and they were listened to. People's requests for assistance were responded to in a timely way and they told us they had never had to wait too long for staff to help them. Staff communicated with people in a way they could understand.

Is the service well-led?

People knew who the manager was and told us they felt they could approach her at any time. Staff were clear of their roles and responsibilities and they knew the management structure of the home. The provider visited the home each month to carry out checks on the quality of the service people received. People who used the service and their relatives were invited to comment about the service and put forward any ideas for improvements.

People told us they were happy at Haven Lea and were very positive about the support provided by staff. Comments included, "Staff will sit and talk, this helps me cope when I get upset" and "I like living here, the staff are really patient."

Staff said that they felt well supported by the manager, that they have regular supervision and were able to access training opportunities appropriate to their role.

We found that the service maintained accurate records.

The service was purpose built and the environment was clean and comfortable. The home was being appropriately maintained to protect people's health and welfare. People told us they were happy with the home environment and the quality of furnishings provided in their own rooms and in communal areas.

Staff told us they felt appropriately trained and well supported to carry out their roles and responsibilities. However, we found that some staff had not undergone a supervision or appraisal of their work for a significant period of time.

The quality of the service was being checked on a regular basis by the provider and people who used the service were asked their views on the home as part of this.

We found some records, including care plans, were not always being appropriately maintained and were not detailed enough to be fit for purpose.