This comprehensive inspection took place on the 8 August 2018 and was unannounced.
At our comprehensive inspection of this service in November 2016 seven breaches of legal requirements were found. The provider was not following the Mental Capacity Act 2005, people were not having their care provided in a dignified or respectful way. People were receiving unsafe care and treatment and were at risk due to inadequate care relating to their nutrition and hydration. The provider had inadequate systems in place that identified shortfalls and records were incomplete. Staff were not receiving training, supervisions or had the skills and knowledge to support people within the service. There were also inadequate checks undertaken on new staff prior to them starting employment at the service.
Following this inspection, we placed the provider on notice of urgent action and we put the service into special measures. This is when the provider is responsible for the care it provides and for improving quality and safety in response to our judgements and ratings. When a service is in special measures we expect the provider to seek out appropriate support to improve the service from its own resources and from other relevant organisations. The provider also wrote to us to say what they would do to meet legal requirements in relation to these breaches.
The service was inspected in February 2017. After this inspection we used our enforcement powers and served a Warning notice on the provider, in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in April 2017, as the provider's quality assurance systems were not in place or effective at identifying shortfalls relating to infection control, personal evacuation plans and medicines management. Some audits had been undertaken during and following our inspection those shortfalls were yet to be actioned This is a formal notice which confirmed the provider had to meet one legal requirement by May 2017 .
We undertook a comprehensive inspection in July 2017. This was to follow up our warning notice issued and previous breaches of legal requirements. At this inspection whilst there were some improvements there were still concerns relating to previous breaches including records that were inaccurate and incomplete and shortfalls in staffing numbers, staff receiving training, supervision and a regular appraisal of their performance yearly appraisal. The service was rated as Requires Improvement.
We undertook an unannounced focused inspection of Haven Lodge Care Centre on 22 February 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. We had received information that the management arrangements in the service were not consistent. This focused inspection looked at the breach of regulations 12, Safe Care and Treatment, 17, Good Governance and 18 , Staffing. At this inspection, we found the provider had taken action to comply with some of the legal requirements. However, further improvements were still required regarding the recording of medicines, support plans and effectiveness of quality assurance systems. We found continued breaches of Regulations 12 and 17.
You can read the reports from our last inspections, by selecting the 'All reports' link for Haven Lodge Care Centre, on our website at www.cqc.org.uk. The service remains rated as requires improvement.
Haven Lodge is a 'care home'. 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. Haven Lodge Care Centre is a registered nursing home and can accommodate 106 people. At the time of the inspection there were 27 people living at the service. The accommodation at the time of the inspection was arranged over two floors. The first floor is Willow and the second Sycamore. Each floor could have up to 27 people living on them. The third and fourth floors were not being used at the time of the inspection. Both Willow and Sycamore floors had a communal lounge, dining area, bathrooms and toilets.
Since the last inspection in February 2018 the previous registered manager had left the service. At the time of our inspection the manager was not registered with CQC. The manager had been in post for two months, and was the third manager in four months. 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 the last inspection in February 2018, the service was rated, 'Requires Improvement'. We found breaches in Regulation 12 and Regulation 17. Some protocols for the use of ‘when required’ (PRN) medicines were missing in care files. Quality checks on the service were not robust enough and lessons learnt not passed on to staff to improve the service. We asked the provider to take action to make improvements to medicines and quality monitoring. At this inspection we found there had been no improvements and the issues remained regarding the review of these and in the management of quality checks. This is the second time the service has been rated 'Inadequate’. We found there remained breaches of Regulation 17 and 12. In addition we found four other breaches.
Medicines were not managed consistently safely. Where people received their medicines without their knowledge (covertly) the provider had not followed best practice guidelines.
The issues associated with Regulation 11 we had found in our last comprehensive inspection in July 2017, had been addressed but a new breach of Regulation 9 (Person centred care) of the Health and Social Care Act was identified with regards to the ongoing review of people's care to ensure it remained appropriate to their needs and preferences.
We looked at six care plans and found some improvements to the information relating to people's needs and wishes had been made but other information was poor. Some of the information relating to people's level of risk was contradictory, some of the risk management advice stated was inadequate and some people's risk management plans were not followed. This meant that there was a risk that people's health and welfare were not being managed properly.
Improvements were needed to the way people's ability to make decisions about their care had been assessed and the way people's legal consent was obtained in line with the Mental Capacity Act 2005.
People had access to a limited range of social or recreational activities in support of their emotional well-being.
People and the relatives told us that there were not enough staff on duty to meet their needs.
Staff supervisions and staff appraisals were not up to date. Nursing staff had not received clinical supervision for some time.
The provider had audits in place to check the quality of the service but these were ineffective. Improvements to the care planning and the delivery of care identified at the last inspection had not been sustained through good management and some aspects of service delivery had declined in terms of quality and safety.
The audit and governance systems in place failed to pick up and address the issues found at this inspection.
Managerial and provider oversight was insufficient and by consequence the ability to mitigate risks to the health, safety and welfare of people who lived at the home was seriously compromised. This service was not well-led. The provider had failed to inform us about one incidents.
People on Willow floor told us that staff were kind, however on Sycamore floor, staff found it difficult to care for people as they would like to due to lack of staff.
Staff had been recruited safely.
Staff interacted with people well and were kind and considerate in most of their support interactions.
People who required special diets were provided with the diet they needed and people's food and drink charts were completed appropriately.
The environment was clean and safe but there was a noticeable odour on Willow floor. The home's gas, electric and moving and handling equipment had all been certified as safe to use .
The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to: - Ensure that providers found to be providing inadequate care significantly improve. - Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the