Haviland House

Haviland House is a residential care home providing personal and nursing care to 35 people living with dementia and other health conditions at the time of the inspection. The service can support up to 67 people.

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

Risks to people, including management of particular health conditions, had not always been fully assessed with guidance and information for staff on how to support people safely. There were gaps in the recording of the application of topical creams in some of the medication records reviewed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policy and systems in the service did not always ensure consent was gained lawfully. The use of recliner chairs for some people was a form of restraint, but people had either not been asked for their consent or best interests decisions had not been taken in the use of these chairs. We have made a recommendation to the provider with regard to gaining consent.

Some improvements had been made since the last inspection, but further work was required such as the review of people’s care plans and risk assessments. Issues we found at inspection had not been identified by the provider’s auditing systems.

People told us they felt safe living at Haviland House. One person said, “Oh yes, I do feel safe and secure. I’m lucky. I have a beautiful view from my room and I do feel safe”. There were sufficient staff on duty to meet people’s needs and to provide support in line with their choices and preferences.

Dietary needs were catered for and advice sought from healthcare professionals as required. People were positive about the food on offer. One person commented, “I like cooking, but the chefs are fantastic. Today’s lunch was very nice; I can’t complain”.

Haviland House is a purpose-built nursing care home and the premises have been designed to support people living with dementia.

People were treated with dignity and respect by kind and caring staff. One person said, “Staff know me well, we have a good laugh”. People were encouraged to be as independent as possible, and their diverse needs were acknowledged and catered for.

People received personalised care that met their needs. The risk of social isolation was mitigated with visits from relatives and friends; social media also enabled people to stay in touch with those that mattered to them. A range of activities was on offer and people enjoyed participating in various events around the home.

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 (report published 5 August 2021).

The 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 some improvements had been made and the provider was no longer in breach of one regulation. However, the provider was found to be in continued breach of one regulation and to be in breach of another regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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 have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Haviland House is a residential care home providing personal and nursing care to 39 people living with dementia and other health conditions at the time of the inspection. The service can support up to 67 people.

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

Some people’s risks had not always been fully assessed or information and guidance provided to staff on their specific health conditions.

People were supported by kind and caring staff, but we observed occasions when staff were task orientated, so care was not always centred upon the person, or delivered in a way that met their needs and preferences.

Medicines were managed safely. Staff were trained to recognise the signs of potential abuse and knew what action to take. Staffing levels were sufficient to meet people’s needs.

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.

A manager had been newly appointed to the service and was in the process of registering with the Commission. The service had identified areas that needed to be improved as a result of their auditing systems, and had an action plan in place to address the issues.

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 (report published 24 December 2020).

Why we inspected

This inspection was prompted in part due to concerns we had received about the service with regard to the management of medicines, risk management and mitigation, and managerial oversight of the home. A decision was made for us to inspect and examine those risks. We also received concerns about one person who was living at the home. The information that was shared with us is the subject of a specific incident which is being investigated separately. As a result, this inspection did not examine the circumstances of the incident.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well Led sections of this full report. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report. We discussed the issues that were of concern during the inspection, and the provider has taken steps to address these.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment and a breach in relation to person-centred care at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Where possible, people living at the home were being supported in their bedrooms to reduce the risk of infection. Each household had its own designated staff team including a housekeeper. The manager had looked at the skill mix of staff to ensure that people on each household could be supported safely. Staff had been flexible with their shifts to support the service, this included management staff who had been working on the floor.

There were clear infection prevention and control procedures in the home that were being followed by staff. Staff wore full personal protective equipment (PPE) when supporting people and there were PPE stations at regular intervals around the home. The manager had considered where people may be at risk of interacting with the PPE stations and where needed, PPE stations had been moved to a safe place that remained accessible to staff. We observed PPE being disposed of safely by staff and good hand hygiene throughout the home.

Managers continued to hold weekly meetings for relatives. These meetings took place using video conferencing software and were well attended. The care manager told us that they had seen record levels of attendance from people’s relatives that were able to dial in from anywhere around the world. This was something that the manager intended to continue after the pandemic as it enabled more relatives to get involved in the running of the service and to keep them updated.

Staff and people were engaging with COVID-19 testing programmes. There was a designated testing area which had a one way flow system for staff to follow and there were screens between staff reading results and staff taking the test. The service had two volunteers who had been invaluable in supporting with the testing of staff. These volunteers had undertaken training to administer tests safely to people and supported with the administrative tasks associated with testing.

The proposed designated care setting consisted of eight bedrooms on one of the households which was currently operating to support the care of people who had received a positive COVID-19 test.

We found the following examples of good practice.

The designated care setting would have its own allocation of staff, including; care staff, senior care staff, housekeeping, night care staff and a registered nurse where required. The designated care setting was able to be accessed by staff via a separate entrance to the home. This meant that staff working on the designated care setting would not come into contact with other members of staff working across the home.

The registered manager had thought about the separation of the designated care setting from the rest of the home. The registered manager had made arrangements to ensure that laundry and food provisions were separate from the rest of the home and limited interaction between staff.

The designated care setting had its own sensory room/lounge area, dining room and kitchenette. Bedrooms on the designated care setting had ensuite bathrooms.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Staff have different roles such as ‘house leaders’ who are in charge of the shift, management of care plans and risk assessment reviews. Staff who are ‘home makers’ ensure that people’s care and support needs are met in a personalised way, together with other care staff. People are known as ‘family members’.

At our last inspection we rated the service as ‘Good’ overall. We made a Recommendation in relation to staff supervisions and appraisals. We rated the key question of ‘Effective’ as ‘Requires Improvement’. At this inspection, we found that improvements had been made and this key question has improved to ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained ‘Good’.

People received an exceptional standard and quality of care that was personalised to meet their individual needs. The ethos of the home was one that put people at the heart of the service. The provider had sought advice from a number of professionals and organisations who were expert in the field of dementia. They had looked at the advice and applied it to all areas of the home, thus improving the lives of people living with dementia. People’s care was based on what was proved to be best practice in the field by these professionals and organisations resulting in an outstanding level of care. Great care and time had been taken with activities that were organised specifically around people’s interests, rather than being structured. Staff knew people extremely well and went out of their way to ensure that people led meaningful lives. End of life care supported people’s individual needs and preferences in a person-centred way.

People said they felt safe living at the home and relatives commented on the safe environment. Staff had been trained to recognise the signs of potential abuse and knew what action to take if they had any concerns. There were sufficient numbers of staff on duty to meet people’s needs. New staff were recruited safely. Medicines were managed appropriately and in line with good practice. The home was clean and odour-free. Lessons were learned by staff and improvements made when things went wrong.

Staff had completed essential training and received regular supervisions to enable them to provide care and support to people effectively. People were offered a choice of food at mealtimes and specialist diets were catered for. People had access to a range of healthcare professionals and services. An environment had been created that people living with dementia could understand and access easily. 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.

People were cared for by kind and friendly staff who were empathic to their needs. People were encouraged to be involved in all aspects of their care and were treated with dignity and respect.

The home was well led and staff felt supported by the management team. People and their relatives were asked for their feedback about the service and any improvements identified were acted upon. A system of audits had been implemented which was robust and drove continual improvement.

Further information is in the detailed findings below.

The last inspection took place on 9 August 2016. As a result of this inspection, we found the provider in breach of Rregulation 18 (Staffing). We asked the provider to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found the provider and registered manager had taken appropriate action and this regulation had been met. As a result, the overall rating for this service has improved from 'Requires Improvement’ to ‘Good’.

Haviland house is a purpose-built nursing home registered to provide accommodation and nursing care for up to 60 people with a range of care and nursing needs, including people living with dementia. At the time of our inspection, 58 people were living at the home. Haviland House is divided into five suites (known as ‘households’): Angmering, Bramber, Clapham, Durrington and Elmer. Each suite caters for up to 12 people who are at different stages on their dementia journey. For example, people accommodated in Clapham are living with more advanced dementia and are less able to communicate verbally. Staff have different roles such as ‘house leaders’ who are in charge of the shift, management of care plans and risk assessment reviews. Staff who are ‘home makers’ ensure that people’s care and support needs are met in a personalised way, together with other care staff. People are known as ‘family members’. Each suite has a separate sitting room, dining area/room and kitchenette. There is a variety of communal areas within the home for people to access, including gardens. All bedrooms have en-suite facilities.

A registered manager was 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.

Staffing levels were assessed based on people’s care and support needs. Following the last inspection, the provider put plans in place to ensure that staff were allocated to each suite based on people's assessed care and support needs. Staff were on duty within each suite of the home and two registered nurses were on duty during the day and one at night. At the time of our inspection, agency staff were employed to cover any gaps in staffing. Staffing levels were sufficient and people’s needs were met promptly. Safe recruitment practices were in place. People felt safe living at the home. Staff had been trained to recognise the signs of abuse and knew what action to take. People’s risks had been identified and assessed appropriately and guidance was in place for staff on how to mitigate risks. Premises and equipment were checked regularly and emergency evacuation plans were in place should people need to leave the building in the event of an emergency. Medicines were managed safely.

We have made a recommendation to the provider about staff supervisions. Not all staff had received regular supervisions in 2017 and the registered manager looked into this issue following our inspection. Some valid reasons had been provided where supervisions had not taken place, however, 13 staff had not completed supervisions recently. This had not impacted on the care people received. Staff meetings took place and some were used as group supervisions for staff. Staff had completed a range of training considered essential to carry out their responsibilities in line with their job role. Staff had also completed training on mental capacity and associated legislation and put what they had learned into practice. Catering at the home was managed by an external contractor which the provider had employed. People had a choice of what to eat at mealtimes and specialist diets were catered for. People were supported to maintain good health and had access to a range of healthcare professionals and services. The provider was in the process of changing much of their practice in relation to caring and supporting people living with dementia. Changes had been made to the environment and in the way staff supported people.

People received care from kind, warm and friendly staff who knew them well. People and relatives spoke positively about the caring attitude of staff. As much as they were able, people expressed their views about the way they wished to be cared for and were involved in decisions relating to their care. Staff knew people’s likes, dislikes and preferences. People were treated with dignity and respect by staff.

Care was delivered in a person-centred way to meet the individual needs of each person living at the home. Care plans contained detailed and comprehensive information about people, their life histories and care needs to enable staff to support them in a personalised way. Activities were provided based on people’s preferences. Some activities, such as occasional outings, were organised, whilst other 1:1 activities were more spontaneous between people and staff. People were observed to enjoy the activities they had engaged with. People and relatives knew how to raise any concerns they might have. Complaints were managed appropriately.

People and their relatives were asked for their views about the home through surveys and meetings. Responses were analysed and any actions arising dealt with. Feedback was positive. Staff felt valued in their employment at the home and commented that the management team was accessible and responsive. Staff were aware of the whistleblowing policy and who to contact if they had any issues to raise. Staff were asked for their feedback about working in a dementia care setting. Care provided at the home was monitored and measured through a serious of audits. Positive comments from relatives had been recorded.

Haviland House is a home registered to provide nursing and residential care for up to 60 people with a variety of health needs, including people living with dementia. At the time of our inspection, 57 people were living at the home. Haviland House is a modern, purpose-built nursing home situated within a residential estate to the west of Worthing. The home comprises five x 12 bedded suites housed on the ground, first and second floors: Angmering, Bramber, Clapham, Durrington and Elmer. Each suite has two separate living rooms, a dining room with kitchenette, assisted bathroom and all rooms are of single occupancy with en suite facilities. Gardens are well maintained and provide seats and shady areas for people to enjoy.

At the time of our inspection, there was no registered manager in post. The acting manager was due to be replaced by a permanent manager when their employment commenced on 5 September 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.

At times, staff were not deployed flexibly to meet people’s needs in some parts of the home which placed people at potential risk. Gaps within staffing rotas were filled by agency staff. Staff felt that staffing levels were an issue and the management team was aware of this; new staff were being recruited. Only a small number of staff had received training on the Mental Capacity Act 2005. We have made a recommendation to the provider that all care staff should be trained to understand their responsibilities under this legislation. Staff had been trained in all essential areas and received supervision as needed, although the regularity of 1:1 meetings had slipped recently. Group supervisions and staff meetings took place. New staff studied for the Care Certificate, a universally recognised qualification.

People were supported to have sufficient to eat and drink and their risk of malnourishment had been assessed. Catering was provided by an external organisation. Some staff were not always sensitive to people’s assessed needs and risks during the lunchtime periods we observed at inspection. Some staff displayed a lack of empathy when discussing people’s needs with other staff. However, the majority of staff were kind, understanding and supportive of people and treated them with dignity and respect. People had access to healthcare services and professionals. Care plans were detailed and provided comprehensive advice and guidance to staff on how to meet people’s needs and preferences.

People’s risks had been identified, assessed and were managed appropriately. Arrangements were in place, and staff were trained on the action to take, in the event of an emergency such as fire. People’s medicines were managed so they received them safely. A number of safeguarding concerns had been raised recently and the provider was working collaboratively with the local safeguarding authority to ensure these were investigated thoroughly and managed appropriately.

The environment at Haviland House had been designed to meet the needs of people living with dementia and to provide stimulation and a homely atmosphere. However, we observed one area of the home which the provider had also identified as an area for improvement in a corridor on one suite. Some activities had been organised for people in parts of the home, but overall, during the inspection period, there was a lack of regular, inspiring activities to engage with people. The provider was in the process of recruiting staff who would oversee people’s health and well-being and who would provide a person-centred approach, based on people’s preferences, hobbies and interests.

A range of audits was in place to monitor and measure various aspects of the service. A Continuous Improvement Plan identified ways of monitoring and improving new systems which were still being embedded. The audits had identified several areas for improvement, however, improvements had not always been carried out where issues had been previously identified.

People and their relatives were asked for their views about the service through questionnaires and surveys. Feedback generally was positive. ‘Family and Friends Meetings’ updated people and their relatives on what was happening at the home and were a forum for receiving comments and questions.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations

2014. You can see what action we have asked the provider to take at the back of this report.