Havendene Residential Home

Havendene Residential Home provides residential care for up to 25 people, some of whom were living with dementia. There were 14 people living at the service at the time of our inspection.

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

People felt safe. Medicines were well managed. The premises had undergone an extensive programme of improvements and decorating was now to be completed.

Record keeping had improved and care documentation, including risk assessments were being fully rewritten.

Quality assurance, oversight and upkeep of the service had improved. There were some areas still to work on, but an action plan was in place and being followed.

Infection control measures had improved, and the home was overall clean and tidy. The provider had some actions to take, including moving a PPE dispenser and completing the decoration of the service after the upgrade of the premises but this was in hand.

There were enough trained and safely recruited staff who felt supported. We have made a recommendation to enhance the interview process. Staff morale had improved.

People enjoyed the food and drink prepared and were offered choice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice and records were in the process of being fully reviewed.

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 26 January 2023).

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found evidence that the provider had made improvements. Please see the safe, effective and well-led sections of this full report.

Recommendations

We made 3 recommendations. These regarded reviewing and updating interview processes, ensuring accident and incident forms were fully completed and reviewing activities to ensure they meet all people's needs.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Havendene Residential Home provides residential care for up to 25 people, some of whom were living with dementia. There were 21 people living at the service at the time of our inspection.

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

Improvements needed to be made with regards to medicines management, including in connection with their storage in a designated medicines room and record keeping.

The premises were being improved and refurbished, however, this had not been done in a timely manner, including in relation to fire safety.

Records were not well maintained, including care plans and risk assessments. Oversight of the governance and safety procedures within the service was not robust, including failing to identify omissions in connection with medicines management and the upkeep of the premises.

Infection control procedures were not robust, as the home was dirty in many areas. Staff followed the safe use of PPE and encouraged visitors to do the same.

There were enough staff at the service, although at times agency was used to cover staff sickness and holidays. We have made a recommendation the provider reviews staffing levels in light of the work at the home which needs to be undertaken. Staff were supported but this was not always formally documented. Staff training needed to be improved in some areas.

People told us they enjoyed the food provided; however, a choice was not always offered.

People and relatives told us the registered manager and staff worked hard to ensure their care needs were met and were complimentary about their caring nature. People said they felt safe and relatives said their family members were safe too.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but records were not always up to date.

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 good (published 3 December 2021).

Why we inspected

This was a focused inspection and was prompted by concerns received about the care people received and the environment. A decision was made for us to inspect and examine those risks.

We looked at the safe, effective and well-led domains. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. At the end of the inspection, the provider was asked to send us an action plan on how they would immediately address the issues we found.

Enforcement and Recommendations

We have identified 3 breaches in relation to safe care and treatment, premises and equipment and good governance. We made one recommendation to review staffing to support the work which needed to be undertaken.

Please see the action we have told the provider to take at the end of this report.

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 and fire service to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Havendene Residential Home is a residential care home providing personal care for up to 25 older people. At the time of the inspection there were 20 people living there, including three people who were staying for a short-break.

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

People praised the way the service was managed and had confidence in the service. People had good relationships with the registered manager and staff team. They told us, “Staff are always very nice to us”, “I feel safe and well-looked after” and “We get very good care.”

Safe infection control and prevention practices were followed. People and staff had regular testing for COVID-19. Staff received training in the appropriate use of PPE. We saw staff followed current government guidance.

The provider and registered manager carried out regular checks of the safety and quality of the service. People and staff were asked for their views and these were acted upon.

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 March 2020).

At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 January 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the display of the service performance assessment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key question Well-led which contain that requirement.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

We found the following examples of good practice.

• There were measures in place to support people to access and visit the service safely. There were alternative arrangements in place to support people to maintain contact with their loved ones when face to face visits were not possible.

• Staff had received training in infection prevention control. Staff were observed wearing appropriate PPE during the inspection and were able to explain the process of putting on and taking off their PPE.

• People using the service and staff had accessed to regular testing in line with government guidance. Comprehensive recording of when tests were conducted, test reference numbers and results were completed by the manager.

• People were supported to socially distance and self-isolate as needed. Where people experienced difficulty with isolating, staff were creative in supporting the person to be able to leave their room safely, whilst keeping their distance from other service users.

• Quality assurance audits were completed to ensure safe infection control practices were being followed and to identify any improvements. Staff spoke positively about the support and guidance they had received from the manager.

Further information is in the detailed findings below.

Havendene is a residential care home providing personal care for up to 25 people. At the time of this inspection, there were 15 people living at the home, some of whom were living with dementia.

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

People and relatives had many positive comments about the service at this home. They praised the care and kindness shown by staff. The home had a very welcoming and friendly atmosphere. Staff were engaging and supportive of people and embraced their diversity. The home was run in the interests of the people who lived there.

People said they felt safe at the home. Staff knew how to report any concerns and said these would be acted upon. The home was clean, warm and comfortable. Some bedrooms were ready for decoration and there were plans to do this as rooms became vacant.

There were enough staff to assist people and they were quick to respond to calls for assistance. People’s needs were assessed to make sure their care could be provided by this service. Staff were very knowledgeable about each person and how they wanted to be supported.

People said the meals were good and they got enough to eat and drink. People had good input from other care services to support their health needs. Staff provided sensitive and compassionate care to people when they reached the end stages of their lives.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

People received individualised support that matched to their personal preferences. There was a good range of activities and engagement in the local community to maintain people’s social inclusion.

People and relatives commented positively on the way the service was run and the approachability of the registered manager and staff. People and relatives were happy with the management of the home. They were asked for their views and these were acted upon.

The provider, registered manager and staff had worked hard to improve the way the service was run. There were better systems in place to check the quality and safety of the service.

The provider had failed to display the rating since the previous inspection. This was a breach of regulation. We are dealing with this outside the inspection process.

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 28 January 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of those regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

During the inspection we recognised that the provider had failed to display the rating since the previous inspection. This was a breach of regulation. We did not take any enforcement action in respect of this breach.

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.

Havendene is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Havendene has accommodation for up to 25 people in one adapted building, including two shared rooms. The home is a former vicarage and the accommodation is over two floors. There were 18 people living here at the time of this inspection, including older people with learning disabilities, physical disabilities or living with dementia.

There was registered manager in place but they were not present during this inspection. An acting manager had been employed to cover the absence of the registered manager. 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 this inspection we found the provider had breached two regulations of the Health and Social Care Act 2008. Practices in relation to bedrooms fire doors, laundry door, food safety and medicines storage were not always fully safe. The provider’s quality assurance systems had not always been operated effectively to monitor the safety of the service and to ensure compliance with the regulations.

This is the first time the service has been rated as Requires Improvement overall. You can see what action we told the provider to take at the back of the full version of the report.

All the people and relatives we spoke with felt the home was a safe and comfortable place to live. Staff were clear about how to recognise and report any suspicions of abuse. The home was clean and odour-free.

The provider carried out checks to make sure only suitable staff were employed. Some staff had worked at Havendene for many years but had not had any recruitment refresher checks taken up since they were appointed. We have made a recommendation about this.

People told us they were happy with the care and felt there were enough staff to assist them. Staff had essential training in health and safety and care. However, they had not had supervision sessions for most of the year. The acting manager was addressing this.

People’s consent and permission was sought before staff carried out any care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice. For example, where people were subject to any restrictions to keep them safe, such as lap straps on wheelchairs, this had not always been recorded as being in their best interests. The acting manager was addressing this.

Before people moved to the home their needs were assessed to make sure the home could provide the right care. Staff worked well with other health care professionals and people were supported to access health services.

Relatives and health professionals said the staff responded quickly to any changes in people’s well-being. People said the meals were very good. Staff encouraged people to eat and drink enough and they had choices about where to dine.

The building was a converted vicarage. Although it was warm and comfortable it had narrow, dim corridors and few design features to help people living with dementia. We have made a recommendation about this.

People, relatives and visitors said the staff were caring and kind. There were good relationships between people and staff and a warm, friendly atmosphere in the home. Staff spoke to people in a positive and encouraging manner. People’s individual choices were respected and their dignity was upheld. Staff spoke about people with compassion and were sensitive to people’s needs at the end stages of their lives.

People received personalised care that was based on their preferences and needs. Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People had opportunities to join in lots of activities and go out with staff into the local community.

People had information about how to make a complaint they were confident that these would be acted upon. They were asked for their views and felt listened to. People and relatives felt the acting manager and staff were approachable.

There had been a number of challenges to the home since the new provider was registered in March 2018. There had been a period of lack of management and changes to established staff. Relatives and staff felt there had been recent improvements but hoped that staff changes reduced.