Archived: The Haven

Updated 8 October 2021

The Haven is an independent, residential substance misuse service provided by the charity ‘West London Mission’. The Haven is dual registered with the CQC to provide the following regulated activities:

• accommodation for persons who require treatment for substance misuse
• accommodation for persons who require nursing or personal care

The service can provide accommodation for up to 26 male clients. At the time of the inspection there were 14 clients staying at the service.

This inspection was completed to check the progress of improvement and look at all areas of service quality to understand if the service was safe, effective, caring, responsive and well-led.

We last inspected this service in February 2021. At that inspection we found serious failures relating to the safety and leadership of the service. In response to these failures we took enforcement action and issued two warning notices telling the provider they must improve in several areas.

Since our last inspection, the service had faced many operational challenges which had undermined the rate of improvement within the service. For example, the provider had faced difficulties in recruiting and retaining a competent team to deliver the day to day support that clients needed. There had not been a full-time registered manager in post since February 2020. The provider had attempted to recruit to this post and had recruited agency service managers to oversee the service at different points.

Prior to our inspection, the provider indicated they were considering the closure of the service due to some of the operational challenges mentioned above. The provider also indicated that they were aware that the service no longer fitted within the organisational strategy and was not their area of expertise.

During this inspection we found a number of issues relating to the safety of the service and took urgent enforcement action. We issued a notice of decision to tell the provider we planned to cancel their registration. The provider accepted our decision and the service has now closed. Senior managers within the provider worked with the local authority and commissioners to ensure that all clients residing at the service found suitable placements to move onto.

What people who use the service say

Overall, the feedback we received from people staying at the service was positive. We spoke with five clients over the telephone who said staff were available to provide support when they needed it and were polite.

Clients said the service was comfortable and clean and they felt safe. Clients felt that staff treated them with kindness and respect, and they could ask for help when they needed it. Some clients had previously been homeless prior to their stay and the service had provided them with a place ‘to call home’.

We also spoke to four relatives of clients staying at The Haven. We received mixed feedback from relatives and carers of clients. Some felt without the service their relative would have remained homeless and that the service had provided them with an invaluable alternative. Others felt that staff missed opportunities to engage with clients and did not meet all their needs including personal care.

Updated 8 October 2021

Our rating of this location stayed the same. We rated it as inadequate because:

• Clients living at the service were at risk of avoidable harm and did not always receive the care and treatment they needed. Despite the provider’s attempts to improve, we found significant issues relating to the safety, effectiveness and leadership of the service.
• A clear model of care was not in place. Staff had not ensured they reviewed, assessed or responded to the changing needs of individual clients. For example, staff did not assess or manage risks such as falls, personal care or nutrition well.
• The service was not well led. Clear processes and procedures were not in place to ensure the service ran smoothly. Staff did not use audits effectively to identify issues and take action to rectify them in a timely way. The provider had faced delays in improving its information management system and the roll out of a new governance ‘quality framework’ for the service.
• Aspects of the environment were not well suited to client’s individual needs.
• The team did not have easy access to the full range of specialists required to meet the needs of clients under their care. Staff had not coordinated client access to additional community services such as memory clinics and advocacy in the local area.
• Staff did not always plan and manage discharge well. Some clients had remained at the service when it was no longer suitable based on their individual needs. The service did not have a clear admission criteria in place.
• Staff had not developed holistic, recovery-oriented care plans informed by comprehensive assessments of clients’ mental and physical health. Staff did not provide or ensure clients had access to a range of treatments they needed in line with national guidance about best practice around harm minimisation.
• Managers had not ensured the new staff team had access to adequate training to perform their role. Staff did not always work well together as a team.
• Staff treated clients with kindness but did not actively involve clients in decisions and the care planning process.

However:

• The service was clean.
• Despite challenges with the recruitment and retention of staff, the service ensured there were enough staff to support clients, using bank and agency staff where necessary.
• The provider had remained transparent and was cooperative in working with us to take enforcement action to rectify issues we identified.