Archived: Havendene Residential Home

We last inspected the service on 30 June 2016 to follow up concerns from the previous inspection in March 2016 where we issued warning notices in relation to the safe, effective and well-led domains of the report and were rated as Requires Improvment. At the inspection in June 2016 we found that the requirements stipulated in the warning notices had been met. On this visit we found improvements made to the safe, effective and well-led domains had been sustained and were now rated as Good.

Havendene Residential Home provides residential care for up to 25 older people, some of whom were living with dementia. At the time of this inspection there were 18 people living at the home.

The service had a registered manager in place who was on leave at the time of our visit. 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. The registered providers were in attendance during the course of our inspection and we saw they were fully involved in all aspects of the day to day running of the home.

Staff and the registered providers understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults. People we spoke with told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. We found that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and pre-planned for the future. Staff told us they were supported to develop themselves personally and professionally by the home’s management.

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 supported this practice.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking. We met with the cook who was trained in the support of people with nutritional needs. Some people had been referred to external healthcare professionals for additional specialist support, for example those with diabetes.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times. We saw that the service worked to uphold people’s rights and supported open discussion on issues relating to equality and diversity in a pro-active and caring manner.

People’s needs were assessed before they came to live at the service. Personalised care plans were developed and regularly reviewed to support staff in caring for people the way they preferred.

An activity coordinator provided a wide range of activities and support for people to access the community. They also held regular discussion groups and meetings where people could raise any issues or concerns. The discussion groups that had taken place focussed on people’s rights and choices and issues of equality and diversity such as voting, anti-discrimination and the deprivation of liberty safeguards.

People and staff were very positive about the management of the home and we saw that the registered providers had a daily presence at the service. Many staff had worked at the service for a number of years and this added to the feeling of a caring, well-run home.

The registered provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint. Feedback systems were in place to obtain people’s views about the quality of the service.

The service had good links with the local community and local organisations.

At this inspection we only reviewed the shortfalls highlighted in our warning notices to establish if the provider had met legal requirements. We found improvements had been made. This report only covers our findings in relation to those requirements. 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.

This inspection was carried out on 30 June 2016 by one inspector. There were 16 people living at the home and in receipt of care from the service at the time of our inspection.

There is a condition on the provider's registration of this service that a registered manager must be in place. The same registered manager who was in post at the time of our last inspection continued to manage the service. She has been registered with the CQC as the registered manager of the service since May 2011. 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. We were assisted at our inspection by both the registered manager and provider, both of whom were present on the day that we visited the home.

Environmental risks that people had previously been exposed to had been addressed. Window restrictors had been fitted in line with Health and Safety Executive guidance, fire doors closed fully into their rebates, infection control practices had been improved to prevent cross-contamination and the storage of medicines had been made safe. In addition, a legionella risk assessment which was not in place at our last inspection, had been carried out by an external contractor and control measures to prevent the growth of legionella bacteria in the water supplies had been implemented.

We found some concerns related to the cleanliness of communal bathing and toilet areas and have made a recommendation that the provider reviews the management of cleaning within the home to improve standards.

The application of the Mental Capacity Act (2005) (MCA) was now evidenced and records maintained about this were detailed. The provider had drafted audits in health and safety, infection control and medicines management, but not all of these were fully operational at the time of this focused inspection. We have recommended the provider fully implements these as soon as possible to assist in effective quality monitoring of the service.

The provider had met the requirements of the Care Quality Commission (CQC) (Registration) Regulations 2009 and had taken steps to correct errors in their registration with the Commission that had previously existed. They had amended their statement of purpose and service user guide to reflect they provided a service to people with a learning disability. Staff had also received training in learning disabilities awareness and epilepsy to ensure they had the skills they needed to meet the care needs of the people who lived at the home.

This inspection was carried out on 3 and 4 March 2016 by one two inspectors. There were 18 people living at the home at the time of our inspection.

There is a condition on the provider's registration of this service that a registered manager must be in place. At the time of our inspection there was a registered manager in post who had been managing the service and registered with the CQC since May 2011. 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. We were assisted at our inspection by both the registered manager and provider, both of whom were present on the days that we visited the home.

We received positive feedback about the service from people who received care and healthcare professionals who worked with the provider. People told us that the service met their needs and healthcare professionals told us they thought the service cared for people well and provided people with a "lovely home". People told us they felt safe living at the service and in receipt of care from staff. Staff were knowledgeable about what would constitute a safeguarding incident and they had received training in safeguarding. The provider had dealt with historic safeguarding matters appropriately reporting them to the local authority safeguarding team for investigation.

Risks that people were exposed to in their daily lives had been assessed, reassessed regularly and mitigated against. However, we found failings in respect of the provider's assessment of risks within the premises; they had not identified fire safety risks or risks of people falling from heights. The provider had also not risk assessed the possibility of legionella bacteria developing within the water supplies of the building. Risks associated with cross contamination were also present at our inspection as the provider did not follow best practice guidance related to infection control.

Staffing levels appeared sufficient to meet people's needs. People told us that when they called for assistance staff arrived promptly to help them. Staff training was refreshed and supervisions and appraisals were carried out regularly. However, staff had not always been trained in areas related to the needs of the people they supported, such as epilepsy or learning disabilities. We have set a recommendation in respect of this. The environment was also not reflective of best practice guidance relating to the care of people with dementia. We have set a recommendation in respect of this also.

Recruitment procedures were thorough and although the administration of medicines was carried out safely, we identified concerns about the storage of medicines. This was not always safe and appropriate.

People's nutritional needs were met and they were supported to eat and drink in sufficient amounts to remain healthy. In addition people received the support they needed from healthcare professionals such as GP's and opticians to ensure that they remained healthy. Where necessary people received specialist input into their care from professionals including psychiatrists and speech and language therapist teams.

Care records were personalised and highlighted how people should be supported safely and in line with their needs, likes, dislikes and preferences. They were regularly reviewed and up to date. Care was person-centred and there was evidence that people and their relatives were involved in their care. People's privacy and dignity were protected and promoted and they were encouraged to be as independent as possible. Staff displayed caring and compassionate attitudes towards people, they enjoyed good relationships and people were given everyday choices around their lives and the support they received. Regular activities were available to stimulate and occupy people.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ and it also ensures that unlawful restrictions are not placed on people in care homes and hospitals. There was a lack of evidence to show that the MCA was appropriately applied and applications had not always been made to the local authority supervisory body for those people who required assessment for a deprivation of liberty safeguard to be put in place. There were no systems in place to ensure that people's capacity was appropriately assessed and applications made in respect of any potential deprivation of liberty.

Some systems were in place to monitor the service provided and care delivered but these were limited and did not identify and address environmental risks within the home. A legionella risk assessment and control measures were not in place and we identified some fire safety issues within the home which we referred to Northumberland Fire and Rescue Service, Fire Safety Department. In addition, the provider had no health and safety audit in place to identify risks related to people falling from height and also infection control shortfalls.

In respect of the provider's registration, we identified that they had not notified us of all deaths and other incidents that they are legally obliged in respect of the Care Quality Commission (Registration) Regulations 2009. We are dealing with this matter outside of the inspection process.

By the end of our inspection the provider told us they had taken steps to address all of the issues and shortfalls that we had identified and informed them of.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 12, Safe care and treatment, and Regulation 17, Good governance.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

Is the service safe?

All the people we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I am happy here. I could speak to the staff if I was not alright with anything.' Another person told us, 'I have frequently complained. The manager always listens. I would go to her about any worries'. All the relatives we spoke with told us they felt their relatives were safe at the home, one of them told us, 'That's the one thing here, I feel our mother is safe'. Another relative told us, 'I would go straight to the manager if there was anything. My mother is well looked after and is safe at this home'.

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The registered manager told us that there had been no applications in the last year. They showed us the policy and procedures they followed and we found these were appropriate. They told us that all staff had received relevant training and had access to the policy and procedures.

Is the service effective?

One person told us, 'If I want to do anything I just ask. I like to go out shopping and do things. The activities co-ordinator helps keep us busy and occupied'. A relative told us, 'They have helped my mother since she came here. She was having falls at home before coming here. She goes out regularly now, the staff have been so good. They try their best'.

People explained how their care and welfare needs were met. All people told us that they had support with health appointments and felt that the service was flexible. One person told us, 'I have to go to a doctor's appointment. The staff help remind me and keep me right'. All the people we spoke with told us that staff told always asked them if they needed help or assistance and provided this when necessary.

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, 'We work as a staff team. We have regular staff briefings. We have all completed our N.V.Q.'s (National Vocational Qualifications).' They all told us that they felt supported by the manager and could approach them at any time for support or to raise any issues or concerns.

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. People were not rushed when care was delivered and we saw that staff interactions with people were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, 'They are very caring. We are always involved in care reviews, I have no worries.'

We saw that staff treated people with respect and dignity. We saw that people were given choices in relation to their care. Both people and their relatives told us they were very happy with the care they received.

Is the service responsive?

All the people we spoke with told us that staff would respond to any of their requests for support. One person told us, 'I am going out shopping today and on Thursday. I sometimes ask to go to the coffee mornings on Thursdays as well.' Another told us, 'You just need to tell the staff and they will help you. I can come and go as I please'.

All the relatives told us that they were very happy with the service. We saw that staff responded to people's requests for help in a timely manner.

Some of the people we spoke with told us they were involved in decisions about their care. They told us that staff were flexible and responded to their requests promptly. One person told us, 'I like to get up at 7.30 a.m. and be downstairs for my breakfast. The staff will help me'.

We saw that there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaints.

People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded appropriately and altered the care and support they delivered in line with these changes.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the registered manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people, relatives and staff had been regularly gathered, recorded, analysed and responded to.

We saw the home had systems in place that ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received good quality care at all times.

We spoke with six people about the care and support they received from this service. People told us they were happy with the care and support they received. One person said, "I am very happy here." Another person said, "The staff are so kind."

We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard.

People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control.

We found there were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager.

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "I enjoy going out to the local coffee morning" and "I can go and see my family."

People said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us that staff spoke to them respectfully and they were consulted about their care preferences. We saw good interactions between staff and people during our visit. There were sufficient number of skilled staff to meet the needs of the people who lived at the home. People told us, "Staff are always around to help you" and "Plenty people to help you get out and about to socialise."

There were effective complaint procedures in place and people were aware of how to make a complaint. People were satisfied staff listened to their views.