The Haven

The Haven is a residential care home providing personal care to up to 5 people. People were living with complex care needs relating to autism and learning disabilities. At the time of our inspection, there were 4 people using the service. One of the 4 people lived in an annex to the building, but they also had access to the main building when they wanted.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The model of care took people’s individual needs and risks into account. Communal areas were used to ensure people had space and some people enjoyed spending time in their rooms. There were plans to refurbish a small garden summerhouse to create additional space for people to spend their time.

People were not able to tell us they felt safe living at the Haven, but we observed people to be relaxed in the company of staff. Safeguarding concerns had been responded to promptly. The number of incidents had reduced significantly. 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. Additional work was being carried out to reassess people’s capacity to understand and make choices and decisions. Staff told us and we observed that people were making more choices about what they did during the day.

Right Care:

There were enough staff to meet people’s needs and wishes. Emphasis had been placed on ensuring that staff had the skills, knowledge, and experience to meet people’s needs. A lack of staff who could drive had an impact on the number and quality of activities that were provided. However, the manager was in the process of recruiting more staff who were also drivers. Staff had plans to introduce people to new activities and two people had recently started swimming on a regular basis.

People received their medicines safely. The frequency of medicines given on an as required basis had reduced significantly.

Right Culture:

Audits were comprehensive and effective in identifying shortfalls which were then promptly addressed. The home had identified some improvements needed in relation to developing some areas of record keeping and work was underway to address this.

A new manager had started in post and staff spoke positively of the culture and ethos that had been created. Improvements made in relation to how people were communicated with had led to a reduction in incidents. People had been involved in choosing new bedding, in making choices about the food they ate and the activities they wanted to take part in. People’s relatives felt that there was good communication, and they were kept informed of any changes to people’s wellbeing. Equally they told us they felt comfortable contacting the service if they had any concerns.

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 June 2022) and there were breaches of regulation. We served the provider a Warning Notice under Section 29 of the Health and Social Care Act 2008. The notice required the provider to become compliant with a breach relating to governance.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

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 remained requires improvement.

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.

The Haven is a residential care home providing personal care to up to five people. People were living with complex care needs relating to autism and learning disabilities. At the time of our inspection there were four people using the service. One of the four people lived in an annex to the building, but they also had access to the main building when they wanted.

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

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the safe, effective, responsive and well led key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The service did not always support people to have the maximum possible choice, independence or have control over their own lives.

The service did not always review incidents when people were restrained, which meant that it was not possible to assess if the need for restraint could have been avoided or reduced. There was also no opportunity for staff to learn from these situations and improve practice.

Due to staff vacancies, meal choices, activities and goal planning had not been as actively promoted as they would have been if there was a full staff complement.

Right care:

The service did not have enough appropriately skilled staff to meet people's needs and keep them safe.

People's support plans gave conflicting advice to staff on how to promote people’s wellbeing and enjoyment of life. Although there were some protections to ensure people’s privacy balanced alongside their health needs, there were no policies or procedures in relation to this to safeguard people and staff.

Right culture:

Care was not always person centred and people were not empowered to influence the care and support they received. There was a tendency to do things a certain way because that was what had always been done. We could not be assured people’s guidelines were followed or that when specialist support was needed this was always followed up. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

Despite the staff shortages, staff remained positive and felt supported. They felt the home was getting back on track and felt motivated to do the best they could for people.

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 (Report published 9 September 2019) and there were breaches of regulations. 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 the provider remained in breach of regulations. The service has now been rated requires improvement twice.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For the key question not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement.

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, Mental Capacity and a lack of person-centred care. We found continued breaches in relation to safety, staffing and good governance.

Please see the action we have told the provider to take at the end of this report. 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a domestic style property that was similar to surrounding property. There were deliberately no identifying signs, to indicate it was a care home. Staff wore casual clothing and did not wear anything that suggested they were care staff when coming and going with people.

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

There had been changes in the management and staffing of the service that had caused some instability for people and staff. A temporary manager was covering the service and had provided a strong leadership with an emphasis on engaging with staff and involving them in the running of the service.

Staff turnover had been high and staff supervision and support provided following incidents had not been effective. Staff told us they felt unsupported. The provider had not ensured staff were suitably supported and supervised to complete their jobs in a safe and effective way.

Some medicines were not managed safely. Guidelines to support people to take ‘as required’ medicines when they should, were not available. The provider could not be assured that people received these medicines as prescribed in a safe way.

Quality monitoring and governance systems had not been fully established or maintained. They had not identified some of the shortfalls identified at this inspection. For example, the lack of records confirming the suitability of agency staff used and complaint records.

The service applied the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to enjoy their lives and to achieve their full potential

People felt safe and received care from staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take risks, to ensure they had as much choice and control of their lives as possible. One relative told us, “I know he is happy and feels safe. He is always happy to go back to the service. He calls it his home and he truly thinks of The Haven as his home”.

Staff had received training to meet people’s specific needs. Staff were committed to delivering care in a person-centred way. Staff were knowledgeable about the people they supported and had built trusting relationships with them. 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. When people did not have capacity any restrictions to their liberty had been authorised by the local authority. People’s nutritional and health needs were met with involvement from a variety of health and social care professionals.

Staff recognised people as unique individuals and supported them and their families in a caring way. People were relaxed, comfortable and happy in the company of staff and engaged with them in a relaxed and positive way.

People were supported to take part in activities to meet their individual needs and wishes.

People were encouraged to go out and form relationships with members of the community. Most people needed some support with communication, these needs had been assessed and staff were skilled in responding to them. One staff member described how one person communicated with facial expressions and body language. “When he is happy he has a massive smile, when he is not he can go to the floor.”

People, their relatives and health care professionals had the opportunity to share their views about the service and to be involved in the planning of appropriate care and support.

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

Rating at last inspection: The service registered with the Care Quality Commission in August 2018 and this was their first inspection.

Why we inspected: This was a planned comprehensive inspection, following the registration of the location.

Enforcement: At this inspection we found the service to be Requires Improvement with three breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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