Archived: New Haven Care Home

New Haven Care Home is a residential care home providing accommodation for up to 50 people, who require personal care. The service provides support to people who have physical health needs and conditions such as dementia. At the time of our inspection there were 37 people using the service, this increased to 39 by the end of the inspection.

The home is set out across 3 floors, one floor was dedicated to providing care for people living with dementia. Two floors contain communal areas and each bedroom has an en-suite. There is also a hairdressers and beauty space available for people.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found people being deprived of their liberty without the principles of the Mental Capacity Act being followed. This practice was addressed by the registered manager during our inspection.

We found people were at risk of harm as medicines and risks associated with people’s care were not safely managed. Risk assessments and care records for people were either not in place or not reflective of people’s needs. We found staff and the management team were not always assessing risks and reporting incidents appropriately.

The provider was not actively involved in the running of the service and we found no evidence of provider audits. The provider hired a consultancy firm to complete periodic reviews and provide support at the service, however the provider had not acted on concerns raised by the consultancy. The head of the consultancy firm was the nominated individual of the service and was not completing audits on behalf of the provider.

The shortfalls from previous inspections had not been adequately addressed. There was a new registered manager in post at the service who had identified multiple concerns with poor care and was actively working to improve people’s experience. The governance processes in place had been implemented by the new registered manager but needed embedding in practice.

We found staff were not knowledgeable about mental capacity, consent and dementia care. The consultancy firm confirmed they would provide additional training after the inspection.

We found staff were not always reporting safeguarding concerns to the management team and potential safeguarding concerns were not always appropriately reviewed by the management team.

People, relatives and staff raised concerns about staffing levels. We saw some positive interactions between staff and people; however, people were not always supported in a timely manner and staffing was not calculated in line with people’s needs. The registered manager was actively working to improve the dining experience for people.

Feedback from staff was mostly negative about the culture of the service and the support they received.

People and their relatives told us they felt people were safe. Recruitment was managed safely. Staff were trained in safeguarding and some staff could give examples of different types of abuse. The service was well maintained providing a spacious and hygienic environment. People and relatives spoke positively about the care provided by care staff. We saw evidence of and gained positive feedback from visiting professionals around good partnership working to meet the needs of people living at the service.

The registered manager and consultancy firm were responsive to our inspection findings and responded during the inspection. We received updates about what actions they were taking to address concerns.

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 04 March 2020) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations and found new breaches of regulation. This service has been rated requires improvement for the last 2 consecutive inspections and is now rated inadequate.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received in relation to the management team at the service. As a result, we undertook a focused inspection to review the key questions safe, effective and well-led. The provider has taken action to mitigate some of the risk identified at this inspection. Please see the safe, effective and well-led sections of this full report.

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 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 inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent, staffing and good governance. Please see the action we have told the provider to take at the end of this 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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

New Haven Care Home is a registered care home providing residential care for up to 50 people. It is a modern, purpose-built facility. On both days of our inspection, there were 46 people living in the home.

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

Medicines were not safely managed at this inspection. Gaps in medicine administration recording in one area of the home were not followed up. One person did not receive a controlled drug for pain relief on a date in December 2019.

Some incidents requiring the registered provider to notify the Care Quality Commission were not reported to us. We have dealt with this outside the inspection process. Insufficient action had been taken in response to the previous breach of regulation concerning the safe management of medicines. This was a continued breach of regulation at this inspection. Not all incidents were recorded and reported to the management team. A key building safety document had expired.

There were sufficient numbers of safely recruited staff to meet people’s care needs. People felt safe and were protected from abuse by staff who knew how to recognise and report abuse. Risks to people were assessed and action was taken to reduce levels of risk.

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 and relatives spoke highly about staff ensuring their prompt access to healthcare. People received sufficient amounts to eat and drink which they enjoyed. Staff received ongoing support through training and supervision.

People told us staff were kind and caring. We observed positive interactions between staff and people. Staff were familiar with people’s routines and care needs. Privacy and dignity was maintained and people were supported to remain as independent as possible.

Care plans were person-centred and contained sufficient detail for staff to follow. There was evidence to show people and relatives were involved in care planning. People and relatives knew how to complain and said the management team were responsive.

Meetings were taking place for people, their relatives and staff. A recent satisfaction survey for people and relatives showed positive feedback was received. Evidence of partnership working was seen. Feedback received showed the management team were known and liked.

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 9 January 2019) when there was a breach of regulation relating to the safe management of medicines. The registered 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 insufficient improvements had been made and the provider was still in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines and governance which was not robust. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

New Haven 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. New Haven accommodates 50 people in one adapted building. On the day of the inspection there were 40 people living at New Haven, three of whom were on respite care.

There were two registered managers who job-share the role, and both were present on each day of the 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.

We found numerous issues with medication including stock levels, administration and record keeping. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment as medicines were not managed safely.

People were safe from abuse as staff could recognise and knew how to respond to possible safeguarding concerns. Risks were managed well as assessments reflected individual need and provided staff with clear guidance in each instance. Falls were effectively managed as the number in the home was low.

Staff were visible and knew people well, although there were intervals where staff were not in communal areas. Staff worked well as a team and communicated efficiently, providing support to each other when needed. They displayed kindness and compassion and were highly supportive of people’s specific needs. Staff ensured people’s dignity and privacy was respected at all times.

The home was clean and well maintained. People utilised the dementia friendly signage. Seating was available in alcoves and at the end of corridors and we observed people access the whole home freely, making full use of the pleasant environment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Some staff did need further support in understanding the significance of Deprivation of Liberty Safeguards (DoLS).

The registered managers demonstrated current best practice knowledge and staff responded quickly to people’s changing needs, which was reflected in care documentation. People were supported with a balanced and nutritional diet and staff understood people’s specific needs, and were also supported to access health and social care services as needed.

Complaints were handled well and the home had received many compliments.

New Haven was clearly people’s home and people were happy and settled. Support offered by staff was discreet and promoted people’s independence. A calm atmosphere pervaded the home during both days of the inspection and this encouraged people’s wellbeing.

Quality assurance measures showed scrutiny over all aspects of care delivery took place, and the registered managers were responsive to feedback from both people living in the home and their relatives. The medicines audit system was not robust or frequent enough to identify the issues we found but we were confident the registered managers would take immediate action to remedy the concerns as they did with other concerns they themselves found.

You can see what action we told the provider to take at the back of the full version of the report.

The home has two registered managers who job-share. We spoke with both on the day of the 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.

People told us they felt safe and this was a view endorsed by relatives who spoke of ‘peace of mind’. Staff were able to identify possible signs of abuse or poor care and knew how to report such concerns. We observed staff to be observant during the day, noticing people’s moods or agitation, and responding appropriately. The home reduced the risks to people of falls by pre-empting unsafe manoeuvres by people and managed people’s level of distress to avoid the likelihood of altercations.

We saw staff respond promptly to people and because they were so vigilant meant that people had support as they needed it rather than having to wait too long for attention. The staff worked well together and had clear direction.

Medicines were administered, recorded and stored in line with requirements, and the home was pro-active in seeking reviews if they felt people’s needs had changed.

Staff had received a comprehensive induction and their knowledge was developed through ongoing supervision and regular training. It was evident through the day to day interactions that staff knew the importance of seeking consent prior to offering any support and the home had effective capacity assessment tools in place to support this decision-making.

People were given plenty of drinks during the day to ensure they maintained a good level of hydration and had a positive and pleasant lunchtime experience where they engaged with each other well and received discreet support as needed. Access to external health and social care provision was requested and the advice received followed in practice and recorded in care records.

We observed staff to be kind, caring and patient, and often pre-empted people’s needs showing that they knew and understood people well. There was a high level of awareness of how to support people living with dementia which was evident at all times. Staff paid due regard to respecting people’s right to privacy and promoting their dignity through discreet support.

The home had an activities co-ordinator who showed initiative and drive, helping shape a programme of activities which were relevant and fulfilling for people. This was supported by pro-active staff who also engaged with people ensuring everyone received attention.

Care records were person-centred and reflected people’s current needs, highlighting key pieces of information to ensure staff were able to be provide assistance at an appropriate level and in line with people’s wishes. The home had managed complaints and compliments in a timely manner, paying due attention to any actions required.

The home had a friendly and welcoming atmosphere and people said they were happy living there. This was supported by comments from relatives and from feedback we reviewed.

Staff were supported by effective registered managers who had a sound knowledge of their responsibilities and a clear direction for the home to grow towards. This was reinforced by a robust quality assurance programme which identified issues quickly and ensured action plans were in place to remedy any concerns.