The Haven

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated safety events. We found lessons had been learned following incidents to continually identify and embed good practice.

Incidents had been evaluated to assess what had worked well and what if anything could be done differently should a similar event occur. Following a fall on the stairs, one person was moved to a ground floor room as it was felt the risk of further falls was increasing.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different homes.

Two people had been supported to move to alternative placements in the past year. Staff were involved in the transition process, and we were told they made sure that information about people’s key needs were passed on to their new placements. The registered manager told us that staff chose to cancel leave to support the move and to provide continuity and reassurance for a person when they moved.

There was an annexe to the main building that had become vacant and included a bedroom, bathroom and a kitchenette/lounge diner. One resident was offered the choice to move to this area. We were told this would be decorated first and there would be a transition process to make sure the person fully understood and was happy with the move.

‘Hospital passports’ were used to share information should people be admitted to hospital. This set out important information for hospital staff to understand people’s individual needs including their daily routines. Staff accompanied people on appointments and hospital stays to promote their safety and comfort.

The registered manager understood their role in managing safeguarding concerns. We found a safeguarding matter that had not been reported but appropriate actions had been taken to ensure the person’s safety. The registered manager assured us that this had been an oversight. Staff were able to tell us what they would do if they suspected abuse. They confirmed they had received training and were confident in reporting any concern to their manager who would pass this on for investigation.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the home was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Potential restrictions had been assessed to determine if people had capacity to agree. Where people did not have capacity, a best interest (BI) meeting had been held. One person had recently started using a helmet when out on activities. However, there was no risk assessment in relation to the use of the helmet. A best interest meeting had been held with the person’s relative but there was no evidence of a mental capacity assessment for this specific need in line with guidance.

For one person, a mental capacity assessment and a BI meeting had been carried out in relation to the use of cameras at nighttime. In addition, a risk assessment was carried out. There were some conflictions in the wording used and this was evident from speaking with some staff, relatives and a visiting professional. The registered manager acknowledged the need for greater clarity on all documentation for consistency and to make sure everyone was clear about the use of the cameras.

People had a good rapport with staff and they appeared content. This was evident as people smiled regularly when staff spoke to them. People’s relatives told us they felt their loved ones were safe and happy. One relative said, “We would know if our son was not happy, he might not be able to tell us [verbally], but he is able to let us know when he is unhappy.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Each person had a positive behavioural support plan that detailed what a good day might look like for them, how they presented when they were slightly anxious and how to help them be calm. In addition, the plan highlighted how the person might present when they were distressed and how staff should de-escalate the situation.

Risk assessment documentation was in place that detailed possible risks that might occur in carrying out the activities people enjoyed. This meant staff knew what to expect and this encouraged positive risk taking in line with the principles of right support, right care, right culture to help people complete tasks they wanted to do, for example, swimming and cooking and using buses with staff support.

One person was funded to receive 2:1 support for community activities. This was not always provided as it was felt this was no longer necessary. The registered manager told us the local authority had been asked to review this. In the interim there was no risk assessment to ensure safe measures were in place. The registered manager acknowledged this and confirmed this would be addressed.

Staff knew people well and were able to tell us how they supported people who were at risk of choking. People also had health conditions that meant they needed additional supervision. Staff were aware of what to do in an emergency.

Staff had completed training on positive behaviour support (PBS) and on non-abusive physical and psychological intervention (NAPPI). Staff told us that due to better staff retention and consistency in approach NAPPI was rarely used now.

People had individual emergency evacuation plans which highlighted the level of support they required to evacuate the building safely in the event of an emergency. Staff were able to tell us what would happen if the alarms sounded and where the assembly points were located.

A staff member told us, “Often when staff are new and are supporting [Person] in the park or on activities, he will say home now if he is not confident in the staff. However, when he knows staff well this rarely happens.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home was well maintained. Environmental checks were carried out at regular intervals and urgent matters were attended to promptly. There was an annual maintenance development plan for all non-urgent matters.

Staff had completed online training in fire safety. There was information that described the support people needed to evacuate the building in an emergency. People knew what to do when the alarms sounded. Safety checks had been carried out on fire safety equipment, and a fire risk assessment had been completed and recommended actions addressed.

Regular health and safety monitoring ensured that all servicing of gas, electric, portable appliances and water safety were kept up to date. Where recommendations had been made as a result, the registered manager assured us that they had all been addressed. Where appropriate, people had equipment to support their needs and to keep them safe. These included bed sensor mats and pagers and cameras. There were systems to make sure these were checked daily and were kept in good working order.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. There were some staff vacancies and sick leave. Staff had been recruited subject to satisfactory recruitment checks. There was a good team of sessional (bank) staff and where necessary they, or regular agency staff were used to fill vacant hours. Staff also confirmed that the registered manager and deputy also worked ‘on shift’ when needed. In the unlikely event that staffing levels fell below minimum safe levels, there was advice in the business continuity plan that ensured mitigation measures were to be taken to ensure as far as possible people’s safety.

People received one to one support from staff, and one person was funded to receive 2:1 support outside of the home. The registered manager confirmed the 2:1 support was under review and was not currently being provided.

Staff completed mandatory training and were offered opportunities to complete additional courses for personal development. Staff told us the training met their needs. Care plans included at a glance information to guide agency staff in finding the key information needed to support people.

The provider followed safe recruitment procedures to ensure people were supported by staff who were safe to support them. Recruitment records included satisfactory references, employment history, and criminal records checks. Once appointed staff received a detailed induction to the home.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff cleaning schedules were completed daily, and audits were carried out to ensure all cleaning had been completed as planned. A relative told us, “It’s always spotless.”

Care staff had received training in infection prevention and control (IPC) and had access to personal protective equipment. A staff member was the designated IPC champion. Staff had completed food hygiene training to ensure they understood how to handle, prepare, and store food properly to prevent illnesses.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Each person had a medicine cabinet in their bedroom although staff told us one person did not like having their medication stored in their room, so this was located in the office. This person’s medicines were prepared in the office and taken to them. There were systems to monitor the temperature at which medicines were stored. Records were kept that detailed how people liked to receive their medicines. There were also protocols for the use of ‘as required’ medicines for pain relief along with guidance on how staff would know when to give each medicine.

Staff had accurately completed people’s medicines administration records, which confirmed that people had received the correct doses of medicines at the right times. Staff received medicine related training which supported them to safely carry out their role, and they were assessed in relation to their competency before they started to support people with their medicines.

People received an annual health review that included a review of medicines needed. The local medicines optimisation team had assessed the home’s systems. A couple of minor recommendations had been made and addressed. A health professional told us, [Staff member] knows the service users very well and there have been examples of interventions that the home has implemented that have helped to reduce medication burden.” An example given included, “Diets of service users have been improved to incorporate more vegetables which allowed laxative use to be reduced/stopped.”