Archived: Haven House Residential Home

Updated 11 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 20 and 21 October 2015 and was unannounced. The inspection was undertaken by two inspectors.

We had not asked the provider to complete a provider information return (PIR) because we had already inspected the service in January 2015. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The previous registered manager had sent us an action plan setting out how they would make the required improvements that were identified at our previous inspections in October 2014 and January 2015.

We reviewed the information we held about the service. We looked at information received from relatives, the local authority commissioners and the statutory notifications the previous registered manager had sent us. A statutory notification is information about important events which the provider is required to send to us by law. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority.

We spoke with five people who lived at the home and two relatives. We spoke with the provider, the manager, the deputy manager, three care staff and the cook. We observed care and support being delivered in communal areas and we observed how people were supported at lunch time.

Many of the people living at the home were not able to tell us, in detail, about how they were cared for and supported because of their complex needs. However, we spent time in the communal areas observing care to help us understand the experiences of people who could not talk with us.

We reviewed three people’s care plans and daily records to see how their care and treatment was planned and delivered. We checked whether staff were recruited safely and trained to deliver care and support appropriate to each person’s needs. We asked to review the results of the provider’s quality monitoring systems to see what actions were planned to improve the quality of the service, but relevant and up to date records were not made available to us.

Updated 11 January 2016

We carried out an unannounced inspection at the service on 20 and 21 October 2015. The service provides accommodation and personal care for up to 28 older people who may be living with dementia. Fourteen people were living at the home at the time of our inspection.

There was not a registered manager in post. The previous registered manager had left the service in May 2015. 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. A new manager had been appointed, but they had not applied to register with us.

At our first ratings inspection in October 2014, the service had been rated as ‘Inadequate’. We found six breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. The provider was failing to identify, assess and manage risks to people and to maintain appropriate standards of cleanliness. We issued Warning Notices for both of these breaches because people were at immediate risk. We told the provider they must take action to meet the regulations within four weeks of our serving the Warning Notices.

We undertook a focused inspection on the 5 January 2015 to check that the service had made improvements related to the Warning Notices. We found some improvements had been made. The service was re-rated as ‘Requires Improvement’.

Because our inspection in January 2015 was focussed on checking whether the provider met the Warning Notices, there were still four breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008 that we did not check. We had identified failings in the requirements to maintain the premises, to maintain accurate records, to ensure suitable staff were recruited to deliver the service and to ensure people, or their legal representative, consented to care. We told the provider they should send us an action plan setting out the actions they would take to remedy these four breaches and the date the actions would be completed.

The previous registered manager had sent us an action plan in February 2015, explaining the actions they planned to take, but did not say when the actions would be completed by.

At the inspection in October 2015 we found there had been no progress in addressing the outstanding breaches. The provider had not acted in accordance with their action plan and we found that. The provider’s quality assurance processes had not been maintained since the registered manager had left the service in May 2015.

Assessments to identify the potential risks within the building were not undertaken, or effectively delegated. We identified a risk to people’s safety in relation to the building that the provider had been unaware of. The provider had not taken action required by the Fire and Rescue service in a timely manner. People were at avoidable risk of living in unsuitable premises.

The provider had not implemented a safe recruitment procedure. Staff were employed without appropriate assurance they had the necessary skills, experience or qualifications. Support staff were deployed in a care role without assurance they were trained or competent to deliver care. Two recorded accidents happened when there was an unqualified member of staff on duty.

The provider’s policy and procedures for safeguarding people were not made known to all staff. The requirement to investigate concerns raised by staff was not understood or followed.

There were not always enough suitably skilled staff on duty, particularly during the evenings and weekends, which affected people’s safety and the management of their individual risks. Incidents and accidents that occurred during these periods were not accurately recorded or investigated, which meant actions that could be taken to minimise risks were not always taken.

Improvements were still needed in staff’s understanding and practice of safe medicines management, particularly about stock control.

Staff’s understanding of the requirements and their responsibilities under the Mental Capacity Act (2005) was inconsistent. Mental capacity assessments were not completed in accordance with the legal requirements. Staff did not always obtain people’s consent for care and support. People were not supported to make their own decisions. People living with dementia did not receive the support they needed to effectively minimise risks to themselves or others.

Training for staff to have the necessary skills to undertake their role was not monitored and no care related training had been delivered to staff since January 2015, although new staff had been recruited to work as care staff. Two staff had been recruited without appropriate evidence they had had the necessary knowledge or qualifications to undertake the role. A member of support staff, who had not been given appropriate training, was deployed to deliver care during the evenings and weekends. This was of particular concern because, there was minimal management oversight to ensure people received the care they needed.

Care plans had not been reviewed for five months, but were being updated during our inspection. They were not all sufficiently detailed for staff to know about people’s preferences or how to support people to follow their interests. Care plans were not available for staff to read during the evenings or at weekends. People were not given the opportunities to engage in conversations or activities that reflected their interests.

People were supported to eat nutritionally balanced meals of their choice and which met their dietary needs. People were supported to maintain their health and were referred to other health professionals appropriately. Care staff understood people’s moods and behaviours and were kind and compassionate in their interactions. Care staff understood people who were not able to communicate verbally.

A CCTV monitoring system was in use in the communal areas of the home, but the provider had not sought to obtain people’s views or consent about the use of CCTV before this had been installed. People were being filmed in the communal areas of their own home without their knowledge.

The provider was not able to explain or show us evidence of how they monitored the quality of the service. They had not kept up the system of management checks of the premises or of staff’s practice since May 2015. People did not have the opportunity to voice their opinions about the quality of the service.

The culture of the service was not open, transparent or empowering. The provider had not displayed the rating they were awarded in January 2015. Staff were treated differently in relation to their supervision, support and benefits. The provider did not maintain accurate records in accordance with the regulations. The provider did not respect staff’s confidentiality. Staff were not well led and did not always act as a team, which affected understanding of how their actions might impact on people’s well-being.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.