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Haven Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 5 August 2019

During a routine inspection

About the service

Haven Care Home provides nursing and personal care for up to 40 older people living with a range of health care needs. This included people who live with diabetes, a stroke and physical disability. Some people had memory loss or frailty associated with the age. Most people required support from two members of staff for personal care and mobility. There were 22 people living in the Haven Care Home at the time of the inspection.

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

The quality assurance and monitoring system was not effective. It had not identified the concerns we found at this inspection, and there was no evidence that management had responded to the improvements needed that had been found by HC-One, using their own internal inspection process.

There were not enough permanent staff, care staff and nurses, working in the home. This meant there was a reliance on agency staff, which had a negative effect on the support and care provided. The manager was from another of the provider’s homes and was managing on a temporary basis. Care plans had not been updated and reviewed when people’s needs changed; risk had not been identified and person-centred care was not consistently provided. Medicines were not well managed and safeguarding referrals had not been made in line with current guidance. Staff training was provided but had not included training to support people who had specific health care needs, such as mental health needs.

People were not consistently supported to have maximum choice and control of their lives. Where people had disabilities, such as poor eyesight, staff had not taken this into account when they developed their care plans. Staff had not consistently supported people in the least restrictive way possible and in their best interests; the policies and systems in the service had not ensured good practice.

Staff were kind and caring and enjoyed working at the home. A range of activities were provided, and people were positive about these and joined in if they wanted to. The home was clean and tidy, and people were protected from the risk of infection.

People, relatives and staff were positive about the current manager and felt they provided good support at a difficult time. This was due mainly to the changes in management at the home since the last inspection; which meant there was no consistent day to day management of the care and support provided.

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 7 August 2018) and there were two breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of two regulations and we identified two further breaches of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the legal requirements related to safe care and treatment; safeguarding people from inappropriate care and treatment; person-centred care and good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 8 May 2018

During a routine inspection

This inspection took place on the 8 and 10 May 2018 and was unannounced.

This was the first inspection of Haven Care Home following the change of provider to HC – One on 15 December 2017.

Haven Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 is registered to provide nursing and personal care and accommodation for up to 40 older people and people with disabilities. At the time of the inspection there were 27 people living at Haven Care Home. People had different health care needs. Some required continual nursing care due to complex health care needs; including end of life care. Other people needed support with personal care and assistance to move around the home safely due to frailty or medical conditions and some people were living with dementia.

The registered manager was present during 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.

There were not enough permanent staff working in the home, which meant there was a reliance on agency staff, particularly agency nurses. This had a negative impact on the support and care provided; medicines were not given out as prescribed, there had been errors and safeguarding referrals had not been made in line with current guidance. This meant people may have been at risk of harm or injury.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and safeguarding. They said they were aware of current guidance to ensure people were protected. However, not all staff had demonstrated a clear understanding of protecting people from harm and had restricted a person without following current guidelines. For example, a best interest meeting with appropriate health and social care professionals.

Care plans had been personalised, they identified people’s specific needs and included guidance for staff to follow and provide the care and support people needed. However, the information recorded was not consistent and had not been effectively reviewed by the nurses, due to the lack of permanent staff. Records showing the support and care staff offered daily had not been completed and did not accurately reflect the actual care provided.

HC - One quality assurance and monitoring system had not been set up at the time of the inspection and staff were unable to access policies and procedure at the home. Policies requested were available after the inspection and were sent to CQC. Following the inspection an improvement plan had been completed that identified areas where improvements were needed and what action would be taken to address them. These improvements would take time to implement and embed into practice.

Risk had been assessed and people were encouraged to be independent in a safe way, with the provision of walking aids and assistance from staff as required. Emergency procedures had been developed to support people if they had to leave the building; there were regular checks of the environment and staff followed the providers infection control policies with a cleaning schedule that ensured people were protected.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can