The Care Quality Commission
  • Care Home
  • Care home

Archived: Haven House Residential Home

Overall: Inadequate read more about inspection ratings

Warwick Road, Kineton, Warwick, Warwickshire, CV35 0HN (01926) 641714

Provided and run by:
M Hermon

All Inspections

20 and 21 October 2015

During a routine inspection

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.

5 January 2015

During an inspection looking at part of the service

We carried out an unannounced, comprehensive inspection of this service on 7 and 8 October 2014. We found breaches of legal requirements and issued compliance actions for Regulations 15, 18, 20 and 21 and warning notices for Regulations 10 and 12. Following this we undertook a focused inspection on 5 January 2015, to check that action had been taken for Regulations 10 and 12, within the timescales set out in our warning notice. The provider sent us an action plan which explained how they will meet the requirements of regulations 15, 18, 20 and 21. We will inspect the home again to check that the provider has taken further action.

You can read a summary of our findings from both inspections below.

Comprehensive inspection of 7 and 8 October

We carried out this inspection on 7 and 8 October 2014. The inspection was unannounced. At our previous inspection in December 2013 the provider was meeting the regulations relating to the Health and Social Care Act 2008. The service provides accommodation and personal care for up to 26 older people who may have a diagnosis of dementia.

Twenty one people were living at the home at the time of our inspection. The service had a registered manager. 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 and associated Regulations about how the service is run.

During the inspection we saw the kitchen and communal areas were not clean and staff did not wear personal protective equipment appropriately. We decided to include checks on how the provider made sure people were protected from the risks of infection. Staff had not received up to date training in infection prevention and control and there was no clear guidance for staff. Staff did not recognise the importance of infection prevention or of maintaining a hygienic environment. The provider had not followed the Department of Health Code of Practice for infection control.

The provider and manager were unaware that some areas of the home needed maintenance work. The manager could not tell us when they last conducted a risk assessment of the premises or when they last checked the premises for ongoing repair or maintenance requirements. The provider had not ensured people were protected from unsafe or unsuitable premises.

The provider’s recruitment procedure was not robust. Three recently recruited staff started working at the home before the provider, who was also the owner, had checked their suitability for their role. The provider did not operate a safe recruitment procedure in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The manager told us they assessed people’s capacity to make decisions and, for those people who lacked capacity, decisions were made in their best interests. However, the manager could not show us documentary evidence that they acted in accordance with the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. There was insufficient evidence that people had an appropriate representative or advocate and staff told us they had not received training to support them to understand the requirements of the MCA.

We found the provider did not have an effective system to monitor risks in the premises. Staff told us there was no formal process for reporting or recording when repairs and maintenance work was needed, so they did not know whether action was planned or taken. The manager and provider were not able to tell us when they had last inspected the premises to check for cleanliness or ongoing maintenance and repairs.

We found improvements were needed in supporting, guiding and leading staff to ensure that the quality of care and support was consistent. Staff’s training was not up to date and this was reflected in their practice. Actions taken to cover staff sickness and annual leave did not consider whether relief staff had the appropriate skills to deliver care of the expected quality. The relief cook had not received appropriate training to ensure people were offered nutritious meals and the manager did not have enough time to maintain effective supervisory, administrative or quality monitoring work. Improvements were needed to ensure arrangements were in place to cover unplanned staff absences.

We found improvements were needed in recording and managing medicines to make sure they were administered safely and as prescribed. The provider did not have an effective system for maintaining and storing people’s or staff records and other management information. Some of the records and information we asked to look at was not available on the day of our inspection. The manager could not tell us where the information had been stored. The manager had not sent us the information we asked for prior to our inspection and it was still not available on the day of our inspection.

People and relatives told us they felt safe with the staff. Staff we spoke with understood how to protect people from harm and knew who to contact if they had any concerns about people’s safety. The manager had assessed people’s needs, abilities and dependencies and there were enough staff to support people with their individual care and support needs.

People’s individual risks were identified and their care plans minimised the identified risks. Care staff monitored people’s health and wellbeing and shared information with other staff and relevant health professionals. This ensured people were supported by other health professionals, according to their needs, and changes in people’s needs were known by all the staff.

People told us the staff were kind and caring. We saw many positive interactions between staff and people who lived at the home. People’s privacy and dignity were respected and they were supported to maintain their independence. All the people we spoke with were satisfied that staff cared for and supported them in the way they wanted. The manager responded to people’s complaints appropriately and took action to improve the service as a result of complaints.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Focused inspection of 5 January 2015

In our warning notice we told the provider they needed to take action by 5 December 2014 to meet the requirements of Regulation 12 for Infection prevention and control. We told the provider they needed to take action by 19 December 2014 to meet the requirements for Regulation 10 for Assessing and monitoring the quality of the service.

We found that the provider had responded to our warning notices and taken appropriate actions to meet the legal requirements for Regulations 10 and 12.

The home was clean. Permanent and temporary staff had attended training in infection prevention and control. The manager checked that staff put their learning into practice. The provider demonstrated that they understood the Department of Health Code of Practice for infection control and had appointed a member of staff to lead on infection prevention and control.

We saw the provider had assessed the quality of the premises and had taken action to repair, refurbish and replace items that presented risks to people’s health or welfare. We saw records of action plans, which were signed off as each identified risk was addressed and minimised.

The manager had reviewed the skills required to cover staff vacancies and absences. The provider had engaged permanent and temporary staff with the appropriate skills to cover vacancies and staff absences. There was a qualified cook on duty who understood their responsibilities for planning, cooking and serving food safely.

The manager showed us records of their renewed quality assurance and audit programme. The records showed that when issues were identified, actions were planned and taken to maintain the quality of the service.

7 and 8 October 2014

During a routine inspection

We carried out this inspection on 7 and 8 October 2014. The inspection was unannounced. At our previous inspection in December 2013 the provider was meeting the regulations relating to the Health and Social Care Act 2008. The service provides accommodation and personal care for up to 26 older people who may have a diagnosis of dementia.

Twenty one people were living at the home at the time of our inspection. The service had a registered manager. 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 and associated Regulations about how the service is run.

During the inspection we saw the kitchen and communal areas were not clean and staff did not wear personal protective equipment appropriately. We decided to include checks on how the provider made sure people were protected from the risks of infection. Staff had not received up to date training in infection prevention and control and there was no clear guidance for staff. Staff did not recognise the importance of infection prevention or of maintaining a hygienic environment. The provider had not followed the Department of Health Code of Practice for infection control.

The provider and manager were unaware that some areas of the home needed maintenance work.  The manager could not tell us when they last conducted a risk assessment of the premises or when they last checked the premises for ongoing repair or maintenance requirements. The provider had not ensured people were protected from unsafe or unsuitable premises.

The provider’s recruitment procedure was not robust. Three recently recruited staff started working at the home before the provider, who was also the owner,  had checked their suitability for their role. The provider did not operate a safe recruitment procedure in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  

The manager told us they assessed people’s capacity to make decisions and, for those people who lacked capacity, decisions were made in their best interests. However, the manager could not show us documentary evidence that they acted in accordance with the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.  There was insufficient evidence that people had an appropriate representative or advocate and staff told us they had not received training to support them to understand the requirements of the MCA.  

We found the provider did not have an effective system to monitor risks in the premises. Staff told us there was no formal process for reporting or recording when repairs and maintenance work was needed, so they did not know whether action was planned or taken. The manager and provider were not able to tell us when they had last inspected the premises to check for cleanliness or ongoing maintenance and repairs.  

We found improvements were needed in supporting, guiding and leading staff to ensure that the quality of care and support was consistent. Staff’s training was not up to date and this was reflected in their practice. Actions taken to cover staff sickness and annual leave did not consider whether relief staff had the appropriate skills to deliver care of the expected quality. The relief cook had not received appropriate training to ensure people were offered nutritious meals and the manager did not have enough time to maintain effective supervisory, administrative or quality monitoring work. Improvements were needed to appropriate arrangements were in place to cover unplanned staff absences.

We found improvements were needed in recording and managing medicines to make sure they were administered safely and as prescribed. The provider did not have an effective system for maintaining and storing people’s or staff records and other management information. Some of the records and information we asked to look at was not available on the day of our inspection. The manager could not tell us where the information had been stored. The manager had not sent us the information we asked for prior to our inspection and it was still not available on the day of our inspection.

People and relatives told us they felt safe with the staff. Staff we spoke with understood how to protect people from harm and knew who to contact if they had any concerns about people’s safety. The manager had assessed people’s needs, abilities and dependencies and there were enough staff to support people with their individual care and support needs.

People’s individual risks were identified and their care plans minimised the identified risks.  Care staff monitored people’s health and wellbeing and shared information with other staff and relevant health professionals. This ensured people were supported by other health professionals, according to their needs, and changes in people’s needs were known by all the staff.

People told us the staff were kind and caring. We saw many positive interactions between staff and people who lived at the home. People’s privacy and dignity were respected and they were supported to maintain their independence. All the people we spoke with were satisfied that staff cared for and supported them in the way they wanted. The manager responded to people’s complaints appropriately and took action to improve the service as a result of complaints.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

16 December 2013

During a routine inspection

Most of the people who lived at the home were not able to talk to us in detail about their care and support because of their complex needs. We observed how staff engaged with people throughout the day of our inspection. We saw that people chose how to spend their day. People were relaxed and at ease with staff. Relatives told us they were always welcomed at the home.

In the care plans we looked at, we saw that people or their relatives signed to say they consented to being cared for and supported by staff. We observed that staff checked that people consented to receiving care and support before they delivered care.

The manager assessed people's needs and abilities before they moved into the home. The manager identified risks to people's health and welfare and the care plans we looked at included actions for staff that minimised the identified risks. Care plans were regularly reviewed and updated.

Care staff received training in safeguarding people from abuse. Care staff knew the signs to look out for and the actions they should take if they had any concerns about people's safety.

Care staff told us they felt supported by the manager. They told us the manager was approachable and helped them make decisions about their practice, training and career development.

The provider's complaints policy and procedure was on display in the hallway where everyone could see it. A relative we spoke with said that staff dealt with complaints promptly and effectively.

27 December 2012

During an inspection in response to concerns

We made an unannounced inspection on 27 December 2012, because we received information that led us to believe that there may be concerns about this service. We focused our inspection on the issues that were raised with us.

We checked that people lived in a comfortable and clean environment and received the personalised care and support they needed. We checked that staff were trained effectively to care for and support people, and that staff respected people's right to make choices.

Many of the people who lived at the home were not able to speak with us about their care because of their complex needs. We saw that people moved freely around the home and they looked relaxed and comfortable with staff. We heard one person who lived at the home say to staff, 'I'm pleased to be here, I'm lucky to be in a nice home like this.' A relative we spoke with told us, 'X is happy here.'

Care staff we spoke with understood people's individual needs and preferences. We saw care staff supporting people to eat their lunch and heard staff speaking affectionately with people. We saw detailed records of how staff cared for and supported people.

We found that the manager and senior staff regularly checked that the home was clean and tidy. Care staff we spoke with had a good understanding of the importance of infection control and described the actions they took to minimise the risks of infection.

After our visit we did not have any concerns about people's care and support.

During an inspection looking at part of the service

On a previous inspection at the home on 5 January 2011, we had some concerns about how the provider maintained compliance with the essential standards of quality and safety.

We had a minor concern about how the provider co-operated with other providers. Our judgement was that the records used for detailing wounds were not always clear to make sure up-to-date and accurate information could be provided to other healthcare professionals when required.

We had a minor concern about the accuracy of records. Our judgement was that records relating to the care and treatment of people living in the home were not always up-to-date or accurate because they did reflect what was happening in practice.

We issued compliance actions for both of these concerns. This meant we asked the provider to send us a report explaining the actions they would take to become compliant with the regulations.

After that inspection the provider sent us a report. The report said that the provider would introduce a body map sheet, which would be used by staff to describe where people had sore skin. They said that staff would sign and date the form every time they used it.

The report said the provider would write some guidance for staff about the level of detail that should be recorded when care was given to people, and how frequently they should record it. They said this would ensure a complete, up-to-date and accurate record of care would be made.

During our visit on 31 July 2012 we looked at a number of standards and checked that the provider had taken the actions they had described in their report.

We found that the provider had taken the actions described in their report and was compliant with all the outcomes we checked at that visit. However, the report we published after that visit did not clearly relate the evidence, that the specific compliance actions had been taken, to the outcomes where we had previously identified concerns.

This report has been written to confirm that we currently have no concerns about this provider because they were compliant with all the outcomes we inspected at our visit on 31 July 2012.

31 July 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people using this service.

On our previous visit to the home on 5 January 2011, we had some concerns about how the provider maintained compliance with the essential standards of quality and safety for records of care and for sharing information with other service providers. After that inspection the provider sent us a report explaining the actions they would take to become compliant. During this visit we found that the provider had taken the actions they said they would take and that the actions were effective to meet the standards.

Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We spoke with three relatives of people who lived at the home and two staff and looked at the results of relatives' surveys that the manger had undertaken. We looked at the care plans for four people who lived at the home to see how their needs should be met and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw that people behaved as if they felt at home and spent their day doing things that pleased them. We saw that staff recognised which people wanted to spend time alone and which people liked to spend shared time together. Staff supported people to make their choice and encouraged them to do the things they wanted to do. We saw one person dancing with staff in the lounge and two other people having their hair done by the hairdresser.

Relatives we spoke with were very happy with the care and support their relations received. They told us the staff were thoughtful and kind to their relations. One relative told us, 'I am happy with the way things are' and another relative said, 'You can feel the warmth, they treat people properly.'

Relatives told us they always felt welcome to visit their relations at any time. One relative said, 'The staff know me too, they always have a chat' and another relative said, 'The food is lovely, I have eaten there before.'

14 January 2012

During an inspection looking at part of the service

People were positive in their comments about the home. Comments included "I am looked after well", "I think its very good and so do my relatives", "staff are very good and very attentive", "staff are very ready to help but not enough to help, if they had better organisation they could manage with less staff". One person told us "I have a stick and a frame '.I couldn't get around without it. "I can't move all that well but when I came out of hospital I was worse" indicating their health had improved since they had come to live in the home.

We saw that people were treated with respect and staff were friendly in their approach when interacting with people. People told us how the care workers supported them each day with personal care and helping to make sure they were safe when mobilising around the home.

People told us they were able to access a doctor when they needed one. We saw that when one person raised the issue of seeing a doctor, staff followed this up and kept the person informed on what was happening. We saw that people had various types of specialist equipment to support their needs including walking aids. People told us that district nurses and physiotherapists had visited them to find out what their needs were and organised appropriate equipment for them.