Archived: Haven House Residential Care Home

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.

There was no registered manager on the day of the inspection however since the inspection the new manager has been registered. 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.

At our last inspection on 12 April 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service was Inadequate and the service was placed in special measures. We carried out this inspection to establish whether the requirements were being met. We found on the this inspection that sufficient improvements had not been made and the service therefore remains in ‘Special measures’.We found that whilst improvements had been made there was a lack of confidence in the Provider that improvements would be sustained.

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.

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

There were not always enough staff at the service to ensure that people’s needs were being met in relation to activities and meal preparation. However all other aspects of care were being delivered by the correct numbers of staff.

People’s rights were not always met under the Mental Capacity Act 2005 (MCA). Assessments had not always been completed specific to the decision that needed to be made. DoLS applications had been submitted to the local authority but these were not always supported by the appropriate mental capacity assessments.

People were not always receiving care from staff who had received appropriate training specific to the needs of people that lived at the service. However supervisions and appraisals for staff were taking place.

People were not always involved in the planning of their care although this was being addressed at the time of the inspection. People did not always have access to meaningful and person centred activities.

There were occasions that staff were not responsive, respectful and attentive to people. However we did find that, overall, people were treated with dignity and respect and there were times where staff were caring.

Incidents and accidents were recorded however there was not always evidence of any learning from these in order to reduce the risk of falls and incidents in the service.

People did not always receive care and support that met their needs in relation to their mental health. However all other aspects of care was being delivered by staff who understood their needs.

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. We had not been informed of all significant events in the service.

Risk assessment guidance for people were detailed and being followed by staff. Staff had knowledge of safeguarding adults procedures and what to do in the event of abuse occurring. Appropriate checks were undertaken on staff before they started work. In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

Medicines audits medicines took place. Medicines Administrations Records (MARs) charts for people were signed for appropriately and all medicine was administered, stored and disposed of safely by staff that were trained to do so.

The food choices and quality had greatly improved since the last inspection because a chef had been employed. People said that they enjoyed the food at the service. People at risk of dehydration and malnutrition had their needs met and people were supported to remain healthy.

There was a complaints procedure and complaints were recorded appropriately with information around how there were responded to.

People and staff said that the management of the service had improved and they felt listened to.

There were effective systems in place to assess and monitor the quality of the service. Although improvements had started to be made since the last inspection the quality of life for people remained below what people had a right to expect. Audits and meetings had been undertaken with people and had been used to improve the quality of care for people. People’s records were kept securely.

During the inspection we found three continued 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.

There was no registered manager in place on the day of the inspection. 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 Regulations 2014 and associated Regulations about how the service is run. We were assisted by the provider and a new manager that had recently been recruited. They were waiting for their initial checks before submitting their application to become the registered manager.

On the 30 September 2015 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service was rated as ‘Inadequate’. We found on this inspection that sufficient improvements had not been made 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.

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 .

At the last inspection of this service on the 30 September 2015 there were breaches around the staffing levels at the service, the lack of Mental Capacity Act assessments, people’s nutritional needs were not always being met, safe care and treatment was not always provided, care plans were lacking in detail around the specific needs of people and there was a lack of good governance at the service. We found on this inspection that there were still concerns and none of the breaches had been met.

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, some were undertaking kitchen and laundry duties which left other staff to provide the care for 16 people.

Risk assessments for people were not always detailed. There was not enough information around of what staff needed to do to reduce the risks to people. Incidents and accidents were not always recorded in details or actions put in place to reduce the risk of incidents. There were aspects to the environment that were not safe for people, there were not always window restrictors in place and the bannister on one stair case was loose.

The premises and equipment was not well maintained. Areas that needed improvement had been reported to the provider had not been addressed for example in relation to people’s bedroom furniture and fittings.

Medicines were not always being safely stored and there was a risk that people did not receive their medicines when they needed them. Medicines Administration Records (MARs) for people were signed for appropriately however medicines were not always disposed of safely by staff.

Although staff had knowledge of safeguarding adult’s procedures they were not putting this into practice. Safeguarding incidents were not always being reported to the local authority. There was a safeguarding adult’s policy in place. However the policy was not up to date with current legislation and did not have any contact details of the local safe guarding team. There was no safe guarding information on display in the home, this meant that people, visitors and staff would not know who to contact if they had concerns. The appropriate recruitment checks had not always been undertaken before staff started work. There were gaps in people’s employment histories and references had not always been obtained before someone 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, these 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 around whether people’s liberties were being restricted.

People were not always receiving care from staff who had received appropriate training. There was a risk that people were receiving care from staff who were had not had training around the needs of people with a mental health issues or behaviours that may challenge others.

Staff competencies were not always assessed with staff as they did not always have regular supervision with their manager. However the manager had started to undertaken supervisions with people.

People at risk of dehydration or malnutrition did not always have effective systems in place to support them. People whose diet was restricted were not provided with fresh and nutritious alternatives. Where people’s food intake needed to be recorded this was not being done. However 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 and people’s dignity was not always maintained. People were not always consulted about the care they wanted. 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 detail 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. Other people were able to go out independently.

Staff had not received annual appraisals to discuss their performance or training and development needs and some staff told us they didn’t feel valued. However staff did say that they liked the new manager and felt supported by them.

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. Records were not always completed accurately and were not always complete. 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 not informed the CQC of significant events.

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 a service contingency plan which detailed what staff needed to do to protect people and make them safe.

There was a complaints procedure in place however not everyone knew how to access this. Complaints were not always appropriately responded to.

People had access to a range of health care professionals including GPs, community nurses, the community mental health team, dentist and opticians.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. People told us they felt safe with the staff that provided care. We saw information displayed from Surrey County council regarding abuse and how to report it.

Systems were in place to make sure that staff learnt from events such as accidents, incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Care plans demonstrated that people's healthcare needs were addressed. Staff carried out regular checks to ensure that people were cared for in a safe environment and risk assessments had been carried out to identify and manage any risks to people.

Is the service effective?

People told us that they could make choices about how they spent their time and that they had opportunities to take part in activities they enjoyed.

Guidelines were provided for staff in the way people preferred their care and support to be delivered. Staff communicated information about people's needs effectively and provided care and support in a consistent way. People were supported to access their local community, and to maintain relationships with their friends and families.

Records, including care records reflected the needs of the person. There were clear operating procedures in place, which were known and understood by staff.

Is the service caring?

People were supported by kind, caring and attentive staff. A person who used the service told us 'They treat me well.' Another person told us 'Staff always help me, as I need help with bathing and getting dressed.'

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

Staff had worked with the people who used the service for some time and knew their needs well. This meant that people received consistent care from staff they knew and understood their needs.

The provider obtained feedback about the quality of the care and support provided as they were in regular contact with relatives and health and social care professionals.

Is the service responsive?

People's needs had been assessed before they began to use the service to ensure that the service was suitable for them. People received a personalised service based on their individual needs and preferences. People's needs were reviewed regularly and the provider responded appropriately if their needs changed. The provider had systems in place to record and monitor complaints. We noted that there had been no complaints since our last inspection.

Is the service well-led?

The registered manager had been in post since September 2013. The service worked well with other agencies and services to make sure people received their care in a person centred way.

The service had a quality assurance system, we saw systems in place that identified shortfalls and documented action taken. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service This helped to ensure that people received a good quality service at all times.

We have been given evidence by the provider which shows us they now have updated information related to staff recruitment.

All of the people we spoke with were happy living in Haven House. One person said 'It's relaxed here' and another told us 'Some of the stuff is very good.'

All of the relatives and healthcare professionals we spoke with felt that the people who used the service were well cared for. For example, one relative told us 'She's really lucky to be in a home like that' and another relative said 'It's the best he's had.'

We heard from the people who used the service that they felt safe living in Haven House and none of the relatives that we spoke with expressed any concerns. We were told by one person who used the service 'I feel secure here.'

We found that although the service had a recruitment policy, there were some gaps in the information required in staff files.

All of the people that we spoke with told us they could approach the staff if they were unhappy about anything.

People told us that they were encouraged to make decisions about their lives and that staff respected their choices. They said that they had opportunities to give their views about the home and the support they received. One person who used the service told us, 'I enjoy it here. Staff are good to us. It's a wonderful place.' Another person said, 'I'm very happy to be here'.

The healthcare professional we spoke with told us that people received good care and support at the home. They said that the home made referrals to community healthcare services promptly when needed and followed any guidelines put in place by healthcare professionals. The healthcare professional told us, 'All the people I see are happy with the support they get. I'm very pleased with how they're supporting people.'

The relative we spoke with told us that their family member had received good support since moving to the home, which had improved their health and wellbeing. They said that staff understood their family member's needs well and always kept them up to date with any issues about their care.