Safe Harbour Dementia Care Home

Safe Harbour 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. The home accommodates up to 47 people who are living with dementia.

The home is required to have a registered manager and a registered manager was in post at the time 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 living at the home were protected from abuse because staff knew how to report any concerns they had and had access to the relevant contact details. Potential safeguarding incidents had been reported to the local authority and the Care Quality Commission as required. Training records showed that staff had received training about safeguarding.

During our inspection we found that there were enough staff and the use of Agency staff had reduced. Staff had time to chat with people and reassure them. New staff were recruited in a safe way that ensured they were suitable to work with people at risk of neglect or abuse.

Enough domestic staff were employed and on duty each day. The home was clean and fresh smelling. We found good records of repairs, regular tests, calibration and servicing of equipment and services at the home to ensure they were safe. People’s medication was managed safely.

Where people were identified as being at risk of harm, risk assessments were in place and action had been taken to mitigate the risks.

The home was compliant with the Mental Capacity Act 2005. Where people required the protection of a Deprivation of Liberty Safeguard, this had been applied for and records in the home showed who had a DoLS in place and who had had a DoLS applied for.

People told us they enjoyed their meals and arrangements were in place to support people who were at risk of malnutrition or dehydration.

Staff told us that they had access to a variety of training and were currently undertaking First Aid training. The training records we looked at during the inspection were incomplete, but following the inspection the manager sent us further information to show that the staff team were up to date with important training to ensure they knew how to work safely.

The care staff were based in the lounge areas to support people as and when required. We saw that throughout the day staff sat with people and talked to them. People's friends and relatives were free to visit at any time and some visitors told us they came every day.

People’s care files contained a series of assessments of the person’s care and support needs. Where an assessment indicated the person required care then a care plan was in place to guide staff. These had been reviewed on a monthly basis and were generally up to date.

The home employed an activities co-ordinator and there was a schedule of social activities on noticeboards throughout the home. During our inspection we saw people engaging in and enjoying group activities.

The home’s complaints procedure displayed in the home needed to be made clearer and more concise.

The manager held monthly relatives meetings and regular staff meetings.

The manager undertook various audits and checks to monitor and improve the standard of care provided at the home. These included monitoring of medication, care files, accidents, hygiene, and health and safety. There were reports of periodic night time visits to the home by the manager and the deputy manager and reports of mealtime observations.

Since our last inspection, CQC has received a number of complaints about the home made by former members of staff. The issues they raised have been fully investigated by an external company and none have been upheld. During our inspection we found no evidence to support the complaints.

The home had 47 bedrooms over two floors; there was access to each floor via a lift. Upstairs on the first floor the home provided nursing care for 26 people, on the ground floor the home provided residential care. At the time of our inspection 45 people were living at the home.

The home was clean, well maintained and tastefully decorated. Design factors had been added so that people with dementia may find it easier to navigate around the home. People told us they liked their rooms and the building. One person told us, “I like it here, it’s a lovely room”. People had been supported to personalise their rooms with family pictures, items of furniture and personalised signs on their doors.

The home had a registered manager; the registered manager had been registered with the CQC since 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.

During our inspection we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager had not always effectively assessed and monitored the safety, risks and quality of the service provided to people. You can see what action we told the provider to take at the back of the full version of the report.

A high percentage of nursing care was provided by agency nurses from three different agencies. The newly appointed clinical lead nurse was responsible for overseeing nursing care plans and monitoring nursing practice at the home. The clinical lead at the home did not have the allocated time to be able to do this effectively. There was no system in place or plan outlining how the clinical lead would fulfil their role of overseeing the nursing practice of the agency nurses used at the home. This meant they were not able to do so effectively and this could increase the risk of people not receiving appropriate care.

We were concerned with how agency nurses were introduced into the home and of the information available to them. The registered manager had limited information about many of the agency nurses. The registered manager told us that the current use of agency staff for nursing care was not a long term plan. We saw that recruitment was underway for the home to employ more nursing staff.

The registered manager undertook audits and checks to monitor and improve the standard of care provided at the home. We found that these audits had not always been effective in assessing and monitoring the quality of the care provided. For example in assessing the communication with and oversight of agency nursing staff that the home relied upon. Also audits of staff files had not highlighted that safe recruitment practices had not consistently been followed. Audits of people’s care plans had not highlighted problems with screening tools not been used correctly; which meant that the resulting score was not a true indication of the level of support the person needed. Audits had not highlighted some gaps in the supervision and appraisal given to staff. We spoke with the registered manager who told us they would review these areas of the home.

Some people at the home were at high risk of falling. We saw that each fall was recorded and action was taken by the managers and staff to reduce the risk of falls happening again. We saw people using protective equipment to reduce the impact of a fall and some people also had adaptations to their environment in place to reduce risks. The home made use of assistive technology to alert staff if people started moving independently, so they were able to assist promptly. Some people had increased support levels if they were at high risk of falling. The home worked in partnership with outside professionals in their approach to supporting people.

People’s medication was stored safely and clearly identified in people’s medication files. Medication was audited by the registered manager by selecting a rotating sample. We found that medication was not always administered safely. We found some recording errors; one person’s stock of medication was incorrectly recorded and there were three blanks where a nurse should have signed to record medication was administered.

Staff had not always been recruited in a safe way. We spoke with the manager about the need to be more robust with regard to obtaining references from previous employers, particularly those in health and social care.

The home was clean and fresh smelling. There was good hygiene and infection control practices at the home. The home had scored 94% on an infection control audit in February 2017. The building was safe and regular, tests, servicing and repairs of the services and equipment had been made and records kept of risk assessments and safety audits.

People told us they felt well cared for. One person said, “I find it perfect, excellent staff, they are very good”. Another said, It’s great, the staff are lovely”. People’s relatives told us that they liked the approach of the staff at the home. One relative told us, “Here it’s excellent. Staff are very pleasant and they have always got time for my mum. Nothing is too much trouble for my mum”.

We saw and people told us that they had been supported to maintain their faith and celebrate special occasions in the way they wanted to. People were communicated with in a variety of ways, for example by having a picture of their keyworker so they could recognise them.

People and their relatives told us that they found the staff, the deputy manager and the registered manager approachable and helpful. Relatives told us when they had reason to speak with the manager they were happy with his approach.

We saw that people were offered regular drinks and snacks throughout the day both in the lounges and in their rooms. People told us they liked the food offered to them and that there was a varied menu and choices available.

When we spoke with people’s relatives told us they were involved in care planning for their family members. Care plans contained important personal information about the person, including their care and support needs and preferences. The plans we looked at were person centred and contained appropriate detail about the person.

People and their relatives that we spoke with told us that they liked the activities offered at the home. There was a mix of individual and group activities both in and outside of the home. The home had recently recruited a second activities co-coordinator to be able to offer more variety of activities.

During our inspection the registered manager was open, candid and was keen to make improvements. He had taken or started to take considered action on information that he became aware of before and during the inspection. He held daily update meetings at the home. The registered manager kept in communication with people’s relatives through monthly relatives meetings. People relatives told us they were well communicated with in significant and day to day matters.

We saw records that showed that the owners of the home made periodic unannounced visits and completed audits to help them remain up to date with how the home was operating.

The home is in a purpose built detached building in a residential road in Bebington, Wirral. There were courtyard gardens in the centre of the building and small well maintained grounds around the building. There was a car park to the side of the building.

The home had 45 bedrooms over two floors, there was access to each floor via a lift. Some of the rooms were ensuite. Other people had a choice of shower room or bathroom along a corridor. Each floor had its own dining room and lounge. Upstairs on the first floor the home provided nursing care, on the ground floor the home provided residential care. At the time of our inspection 33 people were living at the home.

The home had undergone recent refurbishment, was clean, well maintained and tastefully decorated. Design factors had been added so that people with dementia may find it easier to navigate around the home. People relatives we spoke with commented positively on the improvements that had been made. There was a friendly, relaxed and warm atmosphere at the home. One relative told us, “The home has come a long way, it takes time. It’s improved, there is a new outlook, it’s all been redecorated and there are more activities”.

There was a registered manager in place 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.

We noticed several areas of improvement since the new owners had taken over the home and the manager has been in post. There have been improvements made to the environment which have brought the home up to a good standard. These included designing the décor of the home so that people using the home who have dementia may find it easier to get around independently. There was also thought and design put into making the environment interesting for people living in the home.

The manager oversaw a timely and thorough schedule of health and safety checks on the building, the environment and the equipment used by people living at the home. People’s relatives and the staff at the home we spoke with expressed confidence in the manager and spoke positively about the work they had done. One relative told us about the home, “There is a new outlook, it’s all been redecorated and there are more activities”.

We found people were effectively supported in their health needs. At the time of our inspection nobody at the home was experiencing pressure sores. Care plans were individualised, and detailed, there was evidence that effective planning had helped some people have positive outcomes in their health. One visiting health professional said about Safe Harbour, “There is lots of communication with health professionals. I trust them”.

We saw and there was documentary evidence that people’s support was caring and people were treated with dignity and respect. Because of the nature of their dementia many of the people living in the home were not able to describe their care to us in detail. We were able to observe people’s care using the SOFI (Short Observational Framework for Inspection) tool. This showed us that people were treated with patience, understanding and respect. It was clear that care staff were familiar with people’s support needs.

We found that there was enough knowledgeable, experienced and trained staff on duty to meet people’s support needs. Staff were supported with on-going training, regular one to one supervision with a senior member of staff and appraisals. We observed part of a staff meeting which was well attended.

The manager and staff communicated a lot with people’s relatives. People’s relatives were involved in the planning of their family members care. We were able to observe part of a well-attended relatives meeting. Information was readily available for people’s relatives.