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Haven Court Requires improvement

Reports


Inspection carried out on 23 September 2019

During a routine inspection

About the service

Haven Court is a service providing personal and nursing care to up to 80 people, including people who may live with dementia in one purpose-built building. On the day of inspection there were 56 people using the service. The resource provides long term care and also a short-stay service to maximise people’s independence following illness or injury and to facilitate an early discharge from acute hospital. A multi-disciplinary team of health and social care professionals provide care and treatment to people.

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

Improvements had been made since the last inspection and these included improvements to the premises, people’s safety, displaying the rating from CQC and governance. People, relatives and staff were positive about the changes.

There was a stronger governance system in place, but some improvements were still required to ensure person-centred care. Two managers had been appointed since the last inspection who were responsible for the daily running of the service.

People told us they felt safe with staff support and staff were approachable.

Due to our observations we have made a recommendation to keep staffing levels and staff deployment under review to ensure timely and person-centred care to people at all times.

Records reflected the care provided by staff and they were regularly evaluated but improvements were required to ensure people received person-centred care.

The service was well-maintained with a good standard of hygiene.

We have made a recommendation about following best practice guidance for the design of the environment to ensure people who live with dementia are kept orientated and engaged.

Improvements were required in relation to activities to keep people engaged and motivated.

People received their prescribed medicines. People were supported to access health care professionals when required. People had food and drink to meet their needs.

We have made a recommendation with regard to catering arrangements so people receive their meals in a timely way and at regular intervals.

Appropriate checks were carried out before staff began work with people. Communication was effective, staff and people were listened to. Staff said they felt well-supported and were aware of their responsibility to share any concerns about safeguarding and the care provided.

People were provided with care by staff who were trained and supported in their roles. One person told us, “The staff are really good and pleasant. A relative said, “Staff create a home from home and a lovely ambience, but more importantly treat [Name] as one of their own family.”

Risk assessments were in place which identified current risks to people as well as ways to reduce those risks. Staff worked well with other agencies to ensure people received appropriate care.

People were supported to have maximum choice and control of their lives with staff supporting them in the least restrictive way possible, the policies and systems in the service supported this practice.

People and relatives told us the service was well-led and said they would recommend it to others.

The management team carried out a regular programme of audits to assess the safety and quality of the service. Processes were in place to manage and respond to complaints and concerns.

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 requires improvement (published 28 September 2018) and there were four breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Since the last inspection we recognised that the provider had failed to display their rating. This was a breach of regulation and we issued a fixed pe

Inspection carried out on 25 June 2018

During a routine inspection

We carried out an unannounced comprehensive inspection of Haven Court on 25, 27 and 28 June 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

At the last comprehensive inspection of the service on 14, 16 and 22 March 2017 and the home was rated as ‘Requires Improvement’ overall. We identified breaches of regulation 12, safe care and treatment, and regulation 17, good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the key questions of safe, effective, responsive and well led as ‘requires improvement’. The provider did not have safe and effective systems in place in relation to people’s medicines. The provider also failed to ensure that there was an effective system in place to monitor the quality and safety of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. At this inspection we found sufficient improvements had been made to address the key question of effective and responsive but the home continued not to meet all the fundamental standards we inspected against for the key questions of safe and well-led. This is the second time the service has been rated requires improvement.

Haven Court is a 'care home' located in South Shields. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate 80 people in one adapted building and on the date of this inspection there were 54 people living at the home.

During this inspection we found a breach of regulation 12 (Safe care and treatment), 15 (Premises and equipment), 17 (Good governance) and 20A (Requirement as to display of performance assessments) of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents. This was because the provider had not adequately assessed the risks to the health and safety of people using the service, the premises were not safe, there was no robust overarching governance framework in place, renewal applications for the Deprivation of Liberty Safeguards (DoLS), safeguarding incidents and serious injuries were not notified to the Commission,

You can see the action that we have asked the provider to take at the back of the full version of this report.

At the time of the inspection was no registered manager in post and we were supported by the home’s quality and patient safety coach. A registered manager is a person who has registered with the 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 told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The management team continued to provide on-going training for staff and monitored when refresher training was required. Staff had received training in end of life care and the service worked closely with partnership agencies to deliver this when required.

Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. We observed that there were enough staff on duty to support peo

Inspection carried out on 14 March 2017

During a routine inspection

This inspection took place on 14, 16 and 22 March 2017. The first day of the inspection was unannounced. The second and third days of inspection were announced.

This was the first inspection of this service. It was registered with the Care Quality Commission on 4 August 2016.

Haven Court is a residential home which provides nursing care, personal care, short term care and reablement (short term support usually after people are discharged from hospital). There were 53 people living there at the time of our inspection, some of whom were living with dementia. 25 people were receiving short term care on the reablement unit which is located on the ground floor. All bedrooms have en-suite facilities.

The service had a registered manager. 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 this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always managed in the right way. There were gaps and inaccuracies on some medicine administration records and guidance relating to ‘when required’ medicines was not detailed. The provider's quality assurance processes needed to be sustained over time to address the areas for improvement we identified during this inspection in relation to care records being unclear on the observations people required, support plans not always being person centred and support plans not being reviewed often enough. We have made a recommendation about staff training.

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

People we spoke with told us they felt safe living at the home. Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people who lived there. Staff said they felt confident the registered manager would deal with safeguarding concerns appropriately. Staff also understood the provider's whistle blowing procedure.

Medicines that are liable to misuse, called controlled drugs, were stored appropriately. Records relating to controlled drugs had been completed accurately. People received their prescribed creams when they needed them in line with the instructions on their prescriptions.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Risks to people's health and safety were recorded in care files. These included risk assessments about people’s individual care needs such as nutrition, mobility and skin care.

Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

People, relatives and staff had mixed views about whether there were enough staff to attend to people's needs. During our inspection we saw people’s needs were met in a timely manner and call bells were responded to promptly.

Some people’s care plans were unclear in relation to the frequency of health related observations and checks they required. For example, in one person’s care plan it was unclear whether their weight should be checked weekly or monthly. People’s individual support plans were not always reviewed when required. Support pla