Archived: The Haven

Updated 29 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors, one of whom was a member of the CQC medicines team.

Service and service type

The Haven is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Haven is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 15 February and ended on 03 March 2022. We visited the service on 16, 17, 21, 23 and 25 February 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we observed interactions between staff and people who used the service. We spoke with two relatives, five member of staff and the manager, and three visiting professionals. We looked at five care plans and other associated care records and toured the building. We checked people’s medicines records and looked at arrangements for administering, storing and managing medicines.

After the inspection

We looked at information the manager sent us, which was not available when we were at the service. This included staff training and infection prevention and control audits.

Updated 29 March 2022

About the service

The Haven is a residential care home providing accommodation and personal care for up to 12 older people in one adapted building. There were seven people using the service at the time of the inspection, some of whom were living with dementia.

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

The service had been without hot water since 15 January 2022, a period of five weeks, before it was restored. This meant people were unable to have a bath or shower, which increased the risk of skin damage and lessened the opportunity for relaxation from distressed behaviours. The lack of hot water compromised good infection control practice, such as effective handwashing. There was an increased risk of scalding, as staff were using a domestic kettle and then carrying the water to people’s handwash basins in their bedrooms.

Less visible areas of the home were not clean and additional cleaning to work safely during COVID-19 was not evidenced. This included the cleaning of high levels of contact touch points. Night staff completed some cleaning, but there was only one housekeeper who worked for five hours each day in the week. Other aspects of the environment did not enable effective cleaning. There was chipped paintwork on door frames, skirting boards and the tops of radiator covers.

Staffing arrangements at the service was fragile. Some staff had left and recruitment was a challenge. There was a high reliance on agency staff and permanent staff were working excessive amounts to help cover. The manager completed some shifts, which took them away from their management responsibilities. Records did not evidence robust recruitment procedures were being followed. There was a lack of information about the process or the applicant’s attributes, to enable a successful appointment.

Some aspects of the environment did not ensure safety. This included an open door to the sluice, which gave access to hazardous substances, and two fire doors to people’s bedrooms that were propped open. Other aspects of the environment needed maintenance. This included a radiator in a person’s bedroom which did not work, another radiator that had a broken cover and a tap on a hand washbasin in a bathroom which had been turned off. At the time of the inspection, there was no date for these items to be fixed.

Systems were not sufficiently robust to ensure people’s safety. Accidents, incidents and injuries people had sustained had not been properly investigated or reported. Records were incomplete or insufficiently detailed to evidence what had happened and the injuries sustained. There was no information about what action had been taken to minimise a re-occurrence or any learning moving forward.

Risk management was not effective. Risk assessments were not regularly reviewed, or updated following an accident or injury. Not all assessments were accurate, which did not ensure control measures in place were sufficient. Care records did not clearly demonstrate the assistance people received. This did not enable an accurate review of people’s needs or the care they received.

There had been some improvement to the way people’s medicines were managed. However further improvements were needed.

The service has a poor history of compliance, with a lack of oversight from the provider. There has been a lack of auditing, and shortfalls in the service have not been identified and addressed in a timely manner. There had not been any urgency to rectify problems such as restoring the hot water and previously, repairing the broken dishwasher and passenger lift. These shortfalls and the injuries sustained to people following an accident or injury were not reported to CQC or the local authority as required. People, their relatives or advocates were also not appropriately informed.

As a result of our inspection in November 2021 and December 2021, we issued two warning notices to ensure improvements were made to the service. One warning notice was in respect of regulation 15, which related to the premises and equipment. The second notice was in respect of regulation 17, good governance. We returned to the service in January 2022 to check compliance with the notice related to premises and equipment. We found this had not been met in full, and shortfalls remained. The compliance date for meeting the second notice is not yet due. However, we can inspect if we have new concerns about people’s health or safety.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 25 February 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to a high level of bruising people had sustained and there not being any hot water in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Haven on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the systems to protect people from the risk of abuse, risk management, infection prevention and control, and good governance including not reporting notifiable events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.