Havelock Court Care Home

About the service

Havelock Court Care Home is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people and people with a learning disability and autism. At the time of our inspection there were 51 people using the service.

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

The service was not able to demonstrate how they were meeting some of underpinning principles of right support, right care, right culture.

Right Support:

People did not always benefit from an interactive and stimulating environment, or frequent support to take part in activities, so they did not have fulfilling and meaningful everyday lives. Staff supported people with their medicines in a way that promoted their safety and independence and achieved the best possible health outcome. Staff supported people to maintain their health and access healthcare services.

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.

Right Care:

The service had enough staff to keep people safe. Staff had training on how to recognise and report abuse and they knew how to apply it. The service worked with other agencies to do so. Staff received training and an induction to help them support people.

Right Culture:

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support. The provider had a clear vision for the service based on a culture of improvement to enhance people's quality of life.

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 good (published 31 March 2020).

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.

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

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. We have made recommendations in relation to risk assessments, staffing levels and activities.

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

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

We found the following examples of good practice.

Access to the care home had been restricted for non-essential visitors. Visitors who were exempt from the restriction included, for example, designated relatives of people receiving end of life care. All essential visitors to the care home were required to follow the providers strict infection prevention and control (IPC) and Personal Protective Equipment (PPE) guidance, which included having a recent negative COVID-19 test.

Alternative arrangements were in place to help people living in the care home maintain relationships with relatives and friends. For example, people were actively encouraged and supported by staff to keep in touch with their loved ones via telephone and video calls.

Managers and staff understood the principles of isolation and implemented them appropriately. For example, anyone living in the care home who tested positive for COVID-19 or showed signs of being symptomatic were required to isolate in their single occupancy room and not attend any communal areas for at least 14 days. In addition, staff or any of their household bubble who tested positive for COVID-19 or were symptomatic were required to immediately stop working at the care home and to self-isolate at home.

The provider was participating in a ‘whole home’ COVID-19 testing program. This ensured everyone living and working in the care home was regularly tested for COVID-19. For example, since the beginning of the outbreak all staff, including temporary agency staff, were tested daily for COVID-19. The provider knew how to apply for COVID-19 home testing kits and had adequate supplies.

Staff used PPE safely and in accordance with current IPC guidance. We observed managers and staff wearing their PPE correctly throughout our inspection. Staff had received up to date IPC and COVID-19 training, which was being routinely refreshed. The service had adequate supplies of PPE that met current demand due to the outbreak. Managers told us staff had now been given individual supplies of hand sanitiser which they could wear on their person for ease of access.

The care home was kept hygienically clean. There were detailed records kept of staffs new cleaning schedules, which included a rolling program of cleaning high touch surfaces, such as light switches, grab rails and door handles. During this outbreak an additional cleaner was being used and staff reminded they were all responsible for continuously cleaning the care home. The provider used an external cleaning company to routinely deep clean communal areas, including lounges.

The provider had thoroughly assessed infection risks to everyone living and working in the care home and where people were deemed to be disproportionately at risk from COVID-19, appropriate action had been taken to minimise the impact.

The service was now heavily reliant on temporary agency because a large percentage of the permanent staff team had recently tested positive for COVID-19 and were required to self-isolate. These agency staff received a thorough induction and were expected to work on the same units/floors of the care home to reduce the risk of spreading the infection. To help staff stay safe, in-person group shift handover meetings for staff had been suspended and replaced with just the shift leaders meeting.

The service worked closely with the Local Authority, Clinical Commissioning Group (CCG), Public Health England (PHE) and a local GP where they regularly sought these external professional agencies advice and support following this recent COVID-19 outbreak. For example, on the advice of a CCG infection control nurse who recently visited, the care home has introduced individual milk portions so people no longer had to share to help minimise the spread of infection.

There were IPC and PPE policies and procedures in place, which had been recently reviewed and updated to reflect ongoing changes to COVID-19 related guidance. This included contingency plans for managing adverse events, such as COVID-19 outbreaks and staff shortages at the care home. Managers routinely monitored and audited compliance with IPC practices. This included regular walkabout tours of the care home to check staff continued to wear their PPE correctly and high touch surfaces were routinely cleaned.

Most people living at the care home had received a COVID-19 vaccination. The managers of the service were working closely with the local authority, CP, CCG and PHE to implement an action plan to ensure all staff understood the importance of vaccinations against viruses and their role in keeping people safe.

Havelock Court Care Home is a care home providing personal and nursing care for older people. The service can support up to 58 people. There were 47 people using the service during the inspection. The provider is Bupa Care Homes (ANS) Limited and the home is situated in the Brixton area of London.

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

People told us living at the home was enjoyable, and a nice experience. The staff thought it was a good place to work. People using the service and staff we spoke with thought the home was also a safe place to live and work in. People had any risks to them assessed, which enabled them to take acceptable risks and enjoy their lives, whilst living safely. The home reported, investigated and recorded accidents and incidents and safeguarding concerns. There were suitable numbers of appropriately recruited staff to meet people’s needs. Medicine was safely administered.

The home met people’s equality and diversity needs, and people said they had not experienced discrimination against them. At the last inspection the mental capacity assessments, carried out by the service, were not completed appropriately and a recommendation was made. At this inspection we found the mental health capacity assessments were appropriately completed.

Staff who were well-trained and supervised, spoke to people in a clear way that they could understand. Staff encouraged people to discuss their health needs, and people had access to community-based health care professionals, as well as the staff team. People were protected, by staff, from nutrition and hydration risks and they were encouraged to choose healthy and balanced meals that also met their likes, dislikes and preferences. At the last inspection call bell alarms were not responded to in a timely way and a recommendation was made. At this inspection call bell alarms were responded to in a timely way. The premises were adapted to meet people’s needs and transitioning between services was based on people’s needs and best interests.

The home had an atmosphere that was warm and welcoming. Staff were friendly and provided care and support in a way that people liked. The staff we spoke to were caring, compassionate and we saw positive interactions taking place between people and staff throughout our visit. Staff respected people’s privacy, dignity and confidentiality and encouraged and supported them to be as independent as possible. Advocates were available to people, as required.

Staff provided people with person-centred care and their needs were assessed and reviewed with them and their relatives. They did not experience social isolation, had choices, and pursued their interests and hobbies. People were provided with information, to make decisions and end of life wishes were identified and respected. Complaints were investigated and recorded.

The home’s culture was open and honest with transparent management and leadership. There was a clear organisational vision and values. At the last inspection we found that the quality assurance processes in place were not always effective and the concerns we identified were not found during the auditing processes. At this inspection service quality was reviewed, areas of responsibility and accountability established, and any quality shortfalls were identified and actioned. Records were kept up to date and audits regularly carried out. Good community links and working partnerships were established and registration requirements met.

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.

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

Rating at the last inspection and update

The last rating for this service was requires improvement (published 14 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Havelock Court Care Home provides care and support to up to 58 people, many of whom have physical disabilities, HIV (human immunodeficiency virus), mental health needs and are living with dementia. On the day of our visit there were 58 people using the service.

At the last inspection, carried out on 15 and 19 June 2017, the service was rated GOOD.

This inspection was brought forward due to a number of safeguarding concerns raised in relation to medicines management at the service. This unannounced inspection was carried out on 22 January 2019 and we rated the service requires improvement overall. Their previous rating for the key questions, Is the service effective? and Is the service well-led? Has however deteriorated from good to requires improvement at this inspection.

The service had a registered manager 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.

During the inspection we found that the quality assurance processes in place were not always effective and the concerns we identified were not found during the auditing processes, including issues related to people's medicines, mental capacity assessments and DoLS notifications not being sent to CQC as required by law. We made a recommendation about this.

Staff were aware of potential risks to people and took actions to protect people from risk of abuse and incidents and accident taking place. The service followed appropriate staff recruitment processes to employ suitable staff to take care of people. However, during the inspection we identified some errors related to medicines management practices.

Staff had support to up-date knowledge and skills to ensure they carried out their duties in line with their role requirements. People’s nutritional needs were identified and met as necessary. Staff supported people to make everyday choices and they worked in partnership with the local authority to assist people in the decision-making process if they required help. However, the mental capacity assessments carried out by the staff team were not accurate and contradicted the principles of the Mental Capacity Act 2005 (MCA). Records also showed that call bells were not answered within the time frame that the provider considered appropriate.

People and their family members described staff as kind, friendly and caring. People had their religious and cultural needs identified and met by the staff that supported them. Staff knew people’s preferences and had time to have conversations with people which ensured that people were listened to. People were encouraged to carry out activities when they wanted to.

Care records included relevant information about people, including their social care needs. People and their relatives were involved in care planning and provided regular feedback about the service delivery. Regular group meetings were facilitated to gather people’s views about the changes they wanted to make. Although we saw people being encouraged to engage in conversations and use their preferred ways of communication, people did not always receive appropriate support to make food choices.

People, their relatives and the healthcare professionals told us there was good leadership at the service which ensured that actions were taken to improve where necessary. The service was led by a registered manager who we found transparent and caring about people’s wellbeing. The staff team were encouraged to develop and knew what was required of them in their role.

We undertook a focused inspection on 7 July 2016, where we found that the registered manager and provider had followed their action plan in respect of the breaches identified during our comprehensive inspection of March 2016. Despite meeting the legal requirements in relation to staffing and management support to staff we did not revise the rating for the key questions ‘Is the service safe?’ and ‘Is the service well-led?’ because to do so required a record of consistent good practice over time.

We undertook this unannounced comprehensive inspection on 15 and 19 June 2017 and found the provider had sustained the improvements put in place after our previous inspections of March and July 2016.

Havelock Court Care Home provides care and support to up to 60 people with mental health needs. The first floor caters for younger adults who are physically mobile. The second floor caters for older adults or those that are physically frail or have limited mobility. At the time of our inspection, 54 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 were safe at the service. Staff knew how to identify and report abuse because they had received training on how to protect people from harm. Appropriate safeguarding procedures were in place and were followed to keep people safe. Staff understood their responsibilities in relation to safeguarding and reporting concerns.

Risks to people were identified and managed. Staff had sufficient information about how to mitigate risks to people’s health and well-being. Positive risk taking was encouraged to support people to live an independent life as far as practically possible.

People were supported to take their medicines safely by staff trained and assessed as competent to do so. Staff followed the provider’s procedures and current practice when managing people’s medicines.

People received effective care from trained staff who were supported in their role. Staff had supervisions and appraisals to reflect on their performance. Personal development plans were put in place to address any knowledge gaps and skills.

People’s care was delivered in line with the requirements of the Mental Capacity Act 2005. People were asked for their consent before care was provided and staff respected their decisions. Relatives and healthcare professionals were involved in best interests meetings to support people who were unable to make decisions about their care. People enjoyed their freedom in adherence with the restrictions placed on them by the Deprivation of Liberty Safeguards.

People enjoyed the food provided at the service and their nutritional and dietary needs were met. Refreshments, fruits and snacks were available. Staff supported people to access healthcare services and to maintain good health.

People’s needs were assessed with their involvement and that of their relatives and healthcare professionals when appropriate. Care plans reflected people’s individual needs and preferences. People received individualised care in a manner they preferred. Staff respected people privacy and promoted their dignity.

People were encouraged to pursue their interests and supported to access the community. People knew how to make a complaint. Complaints were resolved in line with the provider’s procedures.

People received support from a sufficient number of suitably skilled staff to meet their needs. Reviews of people’s needs ensured staffing levels were adjusted when needed to enable staff to provide effective and safe care.

Staff were happy with how the service was managed. The provider and registered manager gave staff an opportunity to raise concerns about the service and addressed matters raised. There was an open and honest culture at the service. The registered manager was visible at the service and demonstrated a passion about the care provided.

Regular checks and audits of the quality of care were carried out to improve on service delivery. The service worked in close partnership with other healthcare professionals.

Due to our concerns and the breach of regulation we issued a warning notice which the provider and the registered manager were required to comply with by 30 June 2016.

We undertook a focused inspection on 7 July 2016 to check that the service now met the legal requirement. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Havelock Court Care Home’ on our website at www.cqc.org.uk.

Havelock Court Care Home is a care home with nursing. The service provides personal care and nursing care to older people, those living with dementia and mental ill health. The service can accommodate up to 60 adults. 58 people were using the service at our inspection on 7 July 2016.

At our focused inspection on 7 July 2016, we found the registered manager and provider had followed their plan and met the legal requirements in relation to staffing. We saw staffing levels had been reviewed and increased. The registered manager ensured there were sufficient staff to meet people’s needs safely. Staff responded to call bells and people’s requests promptly and spent time engaging people in conversation and activities. There were enough staff to enable them to complete their duties in an unhurried manner.

At our previous comprehensive inspection on 23 and 24 March 2016, we found some staff felt unable to approach the registered manager and felt unsupported in their role. The staff told us they felt their concerns were not taken seriously. At this inspection of 7 July 2016, we found the provider and the registered manager had increased their engagement with staff. Staff told us they felt their relationship with the registered manager and management continued to improve and said their concerns were being addressed.

A registered manager was in post at the time of our inspection. 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 previous inspection of the service took place on 3 January 2014. The service met all the regulations we checked at that time.

We identified that the provider was not meeting regulatory requirements and was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, we found that people had not always received safe and appropriate care. There were not always sufficient staff on duty to meet people’s needs safely. The provider used a robust process to recruit staff suitable to support people at the service. Staff assessed and reviewed people’s needs and put plans in place to support them. Staff had identified risks to people’s health and had sufficient guidance on how to manage those risks safely.

Staff knew how to protect people from abuse and neglect. People told us staff were kind and caring. Staff upheld people’s dignity and respected their privacy. Staff knew people well, understood their communication needs, and provided them with the support they required. Staff promoted people’s health and provided them with support that reflected their choices and preferences. People received the support they required to take their medicines safely. Medicines were securely stored and administered in line with people’s prescriptions.

Staff involved people and their relatives where appropriate in the planning and delivery of their care. Staff understood their role in line with the requirements of the Mental Capacity Act 2005 (MCA) and ensured people consented to the care and support they received. The registered manager ensured decisions were made in people’s ‘best interests’ if they were unable to do so. Staff upheld people’s rights and appropriately supported those whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards (DoLS).

The provider supported staff to develop their skills and knowledge to meet people’s needs. Staff received relevant training in caring for people and received clinical supervision. Staff discussed their learning and development needs in regular one to one meetings and action was taken to address any knowledge gaps. Staff received the support they required to develop their knowledge and skills by attending in-house and external training organised by the provider. The service held regular staff meetings.

People took part in individual and group activities that they enjoyed at the service and in the community. The service worked in partnership with healthcare professionals to ensure people receive appropriate care and treatment. People enjoyed the food provided at the service.

The service valued people’s and their relatives’ views and opinions about the service and acted on their feedback to develop their support and care. People knew how to make a complaint and felt confident to raise a concern with the registered manager or staff.

The provider was in the process of recruiting more nursing and care staff. Staff morale varied at the service and the spirit of good teamwork was not shared by all. Some staff felt management did not listen to their concerns and were not confident the provider took note of their issues seriously. There was an atmosphere of distrust amongst some care staff, nursing staff and among staff of diverse nationalities.

The registered manager reviewed the quality of the service and took action to address any areas requiring improvement. The registered manager worked with the provider’s senior management team to keep them abreast of developments at the service and any action taken to address complaints and incidents.

People received care and support that was tailored to their individual needs. Assessments were undertaken and care was planned to ensure the safety and welfare of people using the service.

A choice of nutritious meals was available and people were able to request meals to be added to the menu. The service was able to cater for people's cultural preferences.

The provider worked with other health and social care professionals to ensure people's needs were met. There was regular input from a GP, dentist, and chiropodist. Specialist advice was available through referral to dieticians, occupational therapy and tissue viability services.

People told us they felt safe at the service. Staff were knowledgeable in recognising signs of potential abuse and were aware of the safeguarding vulnerable adults reporting processes.

There were processes in place to monitor and assess the quality of service provision. There were a number of audits and meetings in place to review service delivery.

People who use the service told us, 'I like being here' and the staff were 'helpful and happy people.' Another person told us, 'No matter how busy the staff are they will come and help you.'

People's diversity, values and human rights were respected. One staff member told us when they started they were introduced to people using the service and told about their likes and dislikes, what they can do for themselves and what support they need.

Care and treatment was planned and delivered in-line with individual needs. The provider had started to work towards the Gold Standards Framework in order to further strengthen their end of life care.

Training programmes, supervision and appraisal systems were in place to support workers, and to enable them to maintain skills and increase their knowledge to support people using the service. Staff told us, 'The training is so good. You get lots of training.'

An effective quality checking process was in place with regular auditing of key elements of service provision. The electronic system allows for analysis of incidents and complaints.