Archived: Haven Lodge

At the last inspection in August 2016, we asked the provider to take action to make improvements to the safety of the service, leadership and quality assurance. During this inspection we found the required improvements had not been made.

The service is operated by an individual and so does not require a registered manager. The registered provider is the ‘registered person.’ 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 provider had employed a manager who supervised the day to day running of the service.

During this inspection we found the service was not safe. Environmental risks were not consistently identified or addressed, consequently people were exposed to the risk of serious harm. People were not always protected from risks associated with their care and support. Action had not been taken to protect people from the behaviour of others living at the home. Systems to review and learn from accidents and incidents were not consistently effective and this meant we could not be assured that action was taken to protect people from harm. Action was not always taken to protect people from improper treatment or abuse. There were a number of safeguarding investigations underway at the time of our inspection visit.

Medicines were not stored or managed safely. There were enough staff to provide care and support to people when they needed it. However, safe recruitment practices were not followed.

Where people lacked capacity to make choices and decisions, their rights under the Mental Capacity Act (2005) were not always respected. Staff felt supported, but did not receive sufficient training to enable them to effectively meet people’s individual needs. People were supported to attend health appointments. However, there was a risk that people may not receive appropriate support with specific health conditions, as support plans did not contain enough information. People were supported to have enough to eat and drink, however choices were limited.

People did not always receive person centred support which met their needs. Staff had a limited understanding of how to support people with mental health needs and this resulted in people not receiving appropriate support. People were subject to institutionalised practices. Policies and practices were not person centred. Staff respected people’s privacy.

People were at risk of receiving inconsistent support as care plans did not provide an accurate or up to date description of people’s needs. People’s feedback about opportunities provided by the service was mixed and we found there were limited opportunities for meaningful activity. People knew how raise issues and concerns, however some people did not feel comfortable doing so.

The service was not well led. Systems in place to monitor and improve the quality and safety of the service were not effective and this placed people at risk of serious harm. There were no systems in place to record, analyse and investigate incidents which posed a risk to the health and wellbeing of people who used the service. Swift action was not always taken in response to known issues. Staff felt supported and were able to express their views in relation to how the service was run.

You can see what action we told the provider to take at the back of the full version of the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service is operated by an individual and so does not require a registered manager. The registered provider is the ‘registered person.’ 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 provider had employed a manager who supervised the day to day running of the service.

At the last inspection on 5 May 2016, we found a breach of the legal requirement related to good governance. We told the provider to make improvements in this area. We took action against the provider and issued a Warning Notice to ensure that improvements were made in this area. The provider was required to be compliant with this notice by 22 July 2016. In this inspection we found that the provider had made some improvements in this area but further improvements were required.

People felt safe in the service and staff understood their responsibility to protect people from the risk of abuse. Medicines were stored and administered safely and people received their medicines as prescribed.

Risks in relation to people’s care and support managed appropriately. However, risks in relation to the environment were not always identified and acted upon. The environment was not clean and hygienic and basic food hygiene practices were not followed.

People were supported to eat and drink enough although healthy options were not always made available. People had access to healthcare and people’s health needs were monitored and responded to.

There were sufficient numbers of staff available to meet people’s needs. Safe recruitment practices were followed and staff were provided with regular supervision and support. However, people were supported by staff who had not always received adequate training.

People’s rights under the Mental Capacity Act (2005) were not always respected and people were not always involved in making decisions about their care and support. People’s dignity was not always respected.

People were involved in planning their care and support, staff knew people’s individual preferences and tailored support to meet their needs. People were encouraged to be as independent as possible. People were provided with the opportunity to get involved in activities and supported to maintain relationships with family and friends.

Systems in place to monitor and improve the quality of the service were not based upon good practice and were not effective.

The management team were approachable. People and staff were given the opportunity to get involved in giving their views on how the service was run. People were supported to raise issues, concerns and complaints and felt assured these would be acted upon.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The service is operated by an individual and so does not require a registered manager. The registered provider is the ‘registered person.’ 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 the last inspection on 9 September 2015, we found a breach of the legal requirement related to safe care and treatment, specifically the way environmental risks were managed. We also found breaches in the legal requirements relating to notifications a provider must make to CQC. We asked the provider to make improvements in these areas. We received an action plan from the provider which showed that all actions had been completed by 29 October 2015. In this inspection we found that the provider now met the legal requirements in these areas.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Haven Lodge on our website at www.cqc.org.uk.

In this inspection we found that some improvements had been made to the way environmental risks were managed. We found that improvements had been made to fire safety checks and also the testing of portable electrical appliances. Further improvements were required to protect people from the risk of scalding from hot water. We also found that the provider did not always have robust infection control measures in place.

Quality assurance audits were not undertaken by the provider which meant areas for improvement within the service were not identified by the provider. Sensitive personal information was not always stored securely.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were prescribed and given to people appropriately. We spoke with four people using the service about their prescribed medicines. They told us that staff gave them their medication and they were given at the times prescribed by their doctor. We found medication was being stored and administered safely and staff had been given the appropriate training.

The last time we inspected this service we found there were improvements needed to the environment and we asked the provider to put this right. When we visited this time we found the improvements had been made and people were happy with the environment.

There were meetings held for people using the service and people were given the opportunity to discuss the service and give suggestions on improvements. We spoke with four people and they told us they felt they were listened to by the manager and assistant manager. One person said, 'I asked for an alarm in the bathroom and this is being sorted out.'

People told us they felt they were generally well cared for and the staff members understood the needs of people. One person said, 'On the whole, the staff are very good here.' Care plans provided person-centred guidance about how to meet the person's needs.

We found people were safe living in the home. People told us they felt safe with the support they were being provided. One person said, 'I feel safe and I wanted to move here.'

During our inspection we identified a number of areas within the home in need of redecoration or updating. There were no records to demonstrate a plan of when repair or redecoration would take place.

We found that staff were supported to provide care that met people's needs. One member of staff said, 'The supervision I had recently was beneficial.'

The service did not make use of questionnaires to assess and monitor the quality of the service provision and there was little evidence of information from different sources being analysed and actioned to demonstrate service improvements in response to feedback provided. One person said, 'The home could be better, but it could be worse. I do feel that it is run like a business rather than a home.'