• Residential substance misuse service

Archived: The Haven

Overall: Inadequate read more about inspection ratings

280 Holly Park, London, N4 4AQ (020) 7263 3315

Provided and run by:
West London Mission

Important: This service was previously registered at a different address - see old profile

All Inspections

15 to 27 July 2021

During a routine inspection

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.

2 - 12 February 2021

During an inspection looking at part of the service

We carried out a focused inspection of this service to look at two of our key questions; how ‘safe’ and how ‘well led’ is the service?

Due to our concerns about how the service protected people from avoidable harm and how the service was led, we took enforcement action following this inspection. Our overall rating of this location went down. We rated it as inadequate because:

  • The service did not provide safe care. Staff did not assess or manage risk well which put clients at risk of avoidable harm. Safeguarding concerns were not always investigated in line with the provider’s own safeguarding policy.
  • The service did not have a good track record on safety. Serious incidents were not always investigated appropriately. Lessons learned were not always identified and measures put in place to prevent future incidents.
  • The service did not always manage medicines in a safe way. Clients did not always receive their medicines as prescribed. The competency of staff administering medicines was not always assessed to ensure they could deliver medicines safely.
  • New or temporary staff did not always receive an effective induction. Some staff delivering care and treatment did not know individual clients’ needs or how to support them in a safe way.
  • Staff could not always access the information they needed. Care plans and risk assessments were not always in place or kept up to date to reflect the needs of individual clients. The information management system in place was not fit for purpose.
  • The service was not well led. Governance processes were not implemented effectively to ensure quality and safety was maintained across the entire service. Managers and staff did not always have the information they needed to challenge and improve performance.
  • There had been a turnover of different managers at service level. This had led to some inconsistencies in how the service had been managed. Interim managers that were in place at the time of our inspection did not have experience of running a service that delivered the same regulated activities as this location.
  • Performance of the service and associated risks were not always managed well. Changes, due to the restructure of the service had impacted the quality of care clients received.
  • Staff did not always feel able to raise concerns without fear of retribution.

However:

  • The premises was clean and well-maintained. The provider had implemented appropriate infection prevention and control procedures.
  • Leaders responded well to the concerns we raised. The provider devised an urgent action plan to address our immediate concerns and had an ‘action plan delivery team’ to oversee this plan.
  • Following our re-rating of this service to inadequate it was placed into special measures. This means the service will be kept under review and, if needed, could face urgent enforcement action if it does not improve. Whilst a service is in special measures it is the provider’s responsibility to improve the quality and safety of it.
  • We also took enforcement action against the provider and issued two warning notices in relation to Regulation 12, ‘Safe Care and treatment’ and Regulation 17, ‘Good Governance’ of the Health and Social Care Act 2008.
  • The provider agreed voluntarily to suspend admission to new clients until improvements had been made. The warning notices served required the provider to make improvements to the overall service by 19 May 2021.

20 and 21 August 2019

During a routine inspection

We rated The Haven as Requires Improvement because

  • There was no record of calibration of equipment such as blood glucose machines, scales and blood pressure monitoring units.
  • We reviewed 11 medication administration records for completeness, legibility and inclusion of relevant client-specific information, such as allergies. Two medication administration records had not been signed by staff after medicine had been administered.
  • At the previous inspection the service did not have efficient governance processes to ensure the management of medicines was safe. In this inspection, the service had made a degree of improvement in its governance of medicines. The governance overall was not robust to sufficiently provider oversight of the service performance, quality and safety. This included low mandatory training, medication management, cleaning of clinic room, handover records and learning lessons.

However:-

  • The service provided safe care. The clinical area where clients were seen was safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included, or had access to, the full range of specialists required to meet the needs of clients under their care.
  • Managers ensured that staff had access to appraisals, and supervision. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
  • Some staff had received mandatory training and the team manager kept records of training and compliance figures. The overall compliance for mandatory and statutory training courses was at 77%.

31 August to 01 September 2016 and 12 September 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found we found the following areas of good practice:

  • With the exception of the clinic room, the environment was visibly clean and well maintained. Housekeeping staff attended the service on a daily basis and cleaned clients' rooms during the week.

  • The risk assessments we reviewed were detailed and informative. The service mitigated and recorded risk well.

  • Staff received feedback from incidents and attended reflective practice sessions. A psychologist facilitated the sessions externally.

  • Assessments we reviewed were detailed and comprehensive. Information included the clients’ social history, family history, drinking history, previous contact with alcohol services, history of drug use, previous convictions and criminal proceedings.

  • Care plans were comprehensive and personalised.

  • Staff attended in-house training sessions and externally facilitated training at team away days. Examples of training included working with change resistant drinkers and assertiveness skills.

  • Staff had access to specialist training. One member of staff was about to begin cognitive behavioural therapy (CBT) training.

  • We observed staff to be caring and thoughtful in their approach with clients.

  • The care plans we reviewed demonstrated attempts by staff to engage clients with their families.

  • The service had clear admission criteria.

However we found the following issues that the service provider needs to improve:

  • Medicines were not stored at a safe temperature and staff were unaware of recommended temperature ranges for fridges. Instructions for administration of medication on some medical administration records were unclear and staff did not demonstrate a good understanding of directions.

  • The service did not have efficient governance processes to ensure the management of medication was safe.

  • Staff were not up to date in two modules of mandatory training. Twenty five percent of staff had not completed training in food hygiene training and in managing challenging behaviour.

  • Staff did not demonstrate a sound understanding of safeguarding adults. Safeguarding training was not mandatory and some staff said they had not received any safeguarding training since beginning employment. The service did not offer safeguarding children training to staff. The manager told us children were not allowed on the premises unless supervised, however, clients may have contact with children either through family and friends or in the community.

  • When asked about the risks of alcohol intoxication to clients, staff highlighted the risk of withdrawal. Staff described signs that would indicate a resident was experiencing alcohol withdrawal. However staff did not demonstrate how they would monitor or manage the risk.

28 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We also spoke to a Community Psychiatric Nurse and a Care Manager.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The accommodation had been well maintained and was clean. A member of the management team was available on call in case of emergencies.

Staff training records showed that staff had undertaken training relevant to their role. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Staff demonstrated an extensive knowledge of the policies and procedures of the home and how they would respond to different emergencies. There was an effective security system installed which meant that staff were able to monitor people coming and going from the building.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they had developed a trusting relationship with them. One person who used the service told us 'I have the Haven to thank for getting me to focus on recovery. Without their help, I would be done in.' Staff had received training to meet the needs of the people living at the home and were equipped to deal with the complexities of behaviours presented. A Care Manager whom we spoke to told us 'They do a fine job supporting my client who is very challenging. Their family is also very happy with the service as staff are always so accommodating.'

Is the service caring?

People were supported by dedicated and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We observed how staff engaged with those who used the service and treated them with respect. We noted that at lunchtime, support workers moved from table to table, engaging in conversation with those who used the service. A volunteer told us 'It is a very positive experience being here. It is obvious to me that people are treated with a lot of respect.' We saw in one record of a person who used the service who had severe memory impairment how special efforts were made to ensure that they did not forget to attend medical appointments. A person who used the service told us how 'The staff always have a kind word. I can have a good laugh with them.'

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they met with their key workers once a month to discuss what was important to them. We were also told that 'My keyworker will meet with me in-between times if I need to see them. They will always do what they say they will do, for example help me to buy equipment for my room.' Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their needs. People had access to activities that were important to them and had been supported to maintain relationships where possible. A member of staff told us that 'Re-establishing family contact is a big thing here.' The registered manager told us 'It is all about small steps at the Haven, according to each individual's ability and wish.'

Is the service well-led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. People told us they were asked for their views on the service they received and that they had also filled in a customer satisfaction survey, with support from a person who was not a member of staff. They confirmed they had been listened to and as a result of the survey changes to the menu had been made and increased activities had been introduced. Staff told us they were clear about their roles and responsibilities. They attributed this to "a good induction schedule, a robust training programme and a management team that was always available to lend support and advice.' They said someone from the senior management team was always on call and that the manager was very 'hands-on and approachable.'

7, 14 June 2013

During a routine inspection

We spoke with five people who use the service. They were all extremely positive and told us:

"I like my room - it has an ensuite bathroom. I can decide whether I want to stay in my room or mix with other people", "The staff are really good, they understand your problems and really support you", "Being here has really helped me, my life has got much better" and "I can go out when I want and my family can come and see me".

We also spoke with staff. We found that people's views and experiences were taken into account in the way the service was provided and that people experienced care and support that met their needs and protected their rights.

We found that people who use the service were protected from the risk of abuse and that there were enough qualified, skilled and experienced staff to meet people's needs. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

13 July 2012

During a routine inspection

The home was clean, warm and had a relaxed and friendly atmosphere. There were three members of staff and the manager on duty when we arrived for this inspection. All the people living at the home and the cook were also present.

We talked to three people using the service and observed many others in the lounge and dining room. We also observed and spoke to staff, a visitor, and examined the records kept at the home. We noted that staff treated people using the service with respect and dignity. We saw that people could make drinks and snacks when they needed. Each person using the service had a programmed 'fob' (key) which the used for accessing communal areas and their bedrooms.

People told us they were happy living at the home. They said they could talk to staff and they felt staff listened to them. They said they were treated with respect and they could choose meals that reflected their individual, cultural and dietary needs.