Archived: Haven House Residential Care Home

Updated 18 March 2017

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.

This was an unannounced inspection which took place on the 06 February 2017. The inspection team consisted of three inspectors.

Before the inspection we reviewed the information we had about the service. This included information sent to us by the provider, about the staff and the people who used the service. We also reviewed information from the Local Authority Quality Assurance team. Due to concerns raised to us about the staffing levels at the service we inspected sooner than we had planned to. On that basis we did not have a Provider Information Return (PIR) to review before the inspection. This 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. We also reviewed notifications sent to us about significant events at the service. A notification is information about important events which the provider is required to tell us about by law.

As part of the inspection we spoke with 11 people and four members of staff. We looked at a sample of four care records of people who used the service, medicine administration records and supervision and recruitment records for staff. We looked at records that related to the management of the service. This included minutes of staff meetings and audits of the service.

The last inspection was on the 15 July 2016 where breaches were identified in the lack of appropriate mental capacity assessments, the lack of staff at the service and the lack of person centred care plans. We also made recommendations around mitigating risks to people.

Updated 18 March 2017

This inspection was carried out on 6 February 2017. Haven House Residential Care Home provides accommodation and care for people who have a long term mental health condition. The service is registered to accommodate up to 19 people. On the day of our inspection 15 people lived at the service with one person due to return from hospital.

There was no registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were not always enough staff deployed in the service to consistently meet people's needs. People were left on their own for long periods of time without the support of staff. Not all of the care staff on duty provided care to people; staff were undertaking kitchen, domestic and activity duties which left one member of care staff to provide the care for 15 people.

Risk assessments for people were missing and other assessments were not always detailed. There was not enough information to guide staff about how to reduce the risks to people. Incidents and accidents were not always followed up and lacked detail and actions to reduce the risk of repeated incidents. Staff were not following good infection control procedures. The premises and equipment was not well maintained. People's medicines were managed in a safe way.

Personal evacuation plans were not in place for every person who lived at the service. In the event of an emergency, such as the building being flooded or a fire, there was no service contingency plan to detail what staff needed to do to protect people and make them safe.

Although staff and the provider had knowledge of safeguarding adult's procedures and there was a safeguarding adult's policy in place. People who had capacity were having their liberties restricted. There were people who told us that they did not always feel safe. Recruitment practices were not always safe as relevant checks had not always been completed before staff started work.

People's rights were not always met under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty they have been authorised by the local authority as being required to protect them from harm. Assessments had not been completed specific to the decision that needed to be made around people's capacity. DoLS applications had not been submitted to the local authority where it may have been appropriate.

People were not always receiving care from staff that were competent, skilled and experienced. There was a risk that people were receiving care from staff who were had not had training to meet the needs of people with mental health issues. Staff competencies were not always assessed as they did not have appropriate supervision or appraisals.

People were not always provided choices that met their reasonable preferences and people did not always like the quality of the meals. However, people at risk of dehydration or malnutrition did have systems in place to support them. People had access to health care professionals to support them with their health needs.

Staff at the service did not always treat people with dignity and respect. There were times where people were ignored for periods of time throughout the day. There was evidence of lack of choices for people at the service around how their care was to be delivered.

People were not always consulted about the care they wanted. The routines of the home were imposed for staff convenience rather than to meet the personal choices of people. We did see times when staff were caring and considerate to people.

People's preferences were not consistently being sought by staff. The provider was not always responsive to people's needs. There was no detailed information in people's care plans around the support they needed. There was a lack of guidance around care for people with a mental health diagnosis.

There were not enough activities on offer specific to the needs of people. There were long periods of time where people had no meaningful engagement with staff. People that wanted to go out did not always have the opportunity.

There were not effective systems in place to assess and monitor the quality of the service. Although some audits had been undertaken these had not been used to improve the quality of care for people.

There was a complaints procedure in place however people were not encouraged or supported to voice their concerns.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The provider had informed the CQC of significant events.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service therefore remains 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 time frame. 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.

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.