About the service:

Harbour Residential is a residential care home for up to 108 people that was providing personal care to 12 people aged 65 and over at the time of the inspection.Since the last inspection the service has changed its name from Haven Lodge Care Centre to Harbour Residential and the provider registration has remained the same with CQC

People’s experience of using this service:

At our previous inspection we rated the service Inadequate. The failings were mostly regarding the provision of nursing care at the home. The provider has now cancelled their registration for nursing care and is no longer delivering this regulated activity. The service has been in Special Measures and has not achieved a rating higher than Requires Improvement since we began rating services in 2016.

We have rated this service as Requires Improvement as the provider needs to demonstrate that the improvements we found can be sustained with higher occupancy. At the previous inspection in September 2018 we found seven breaches of the Health and Social Care Act (2008). At this inspection we found the provider was no longer in breach of regulations.

People told us they were happy at the service. They felt safe and well-cared for by kind and caring staff. People’s relatives confirmed they were confident their loved ones received safe and kind care.

People were complimentary about the food. They had a choice of meals and were always able to have an alternative. Staff made sure people had enough to drink and received any support necessary to eat their meals. The kitchen staff were aware of any special dietary needs.

The environment was bright, well-maintained and clean throughout. There was a range of activities available including visits from a mother and toddler group which took place during our inspection.

Care was delivered by staff who were trained and supervised. Staff had undergone recruitment checks before being employed by the service. Staff morale was good and we observed staff interacting with people in a way they preferred.

People’s care needs were assessed and their care delivered in the way they preferred. Any risks to people were assessed and plans put in place to reduce risks. People’s emotional and social needs were included in their plans of care. Relatives were involved in planning and reviews of people’s care and could discuss any change in needs. They were informed of any incidents such as falls. People’s protected characteristics under the Equalities Act 2010 were not always considered in detail in people’s care plans. We have made a recommendation about this.

The provider sought feedback from people and their families. A satisfaction survey had recently been carried out which scored highly. The service had received a high number of compliments; many relatives expressed how satisfied they were with the care their loved ones received.

The registered manager demonstrated good leadership and staff morale was high. Staff told us they were well-supported and confident they would be listened to if they raised any concerns or had ideas for improving the service. The provider operated a clear governance system to identify and rectify any shortfalls.

Rating at last inspection: Inadequate (September 2018)

Why we inspected: This was a planned inspection based on the previous rating. The service’s rating had improved to Requires Improvement from Inadequate.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

This comprehensive inspection took place on the 8 August 2018 and was unannounced.

At our comprehensive inspection of this service in November 2016 seven breaches of legal requirements were found. The provider was not following the Mental Capacity Act 2005, people were not having their care provided in a dignified or respectful way. People were receiving unsafe care and treatment and were at risk due to inadequate care relating to their nutrition and hydration. The provider had inadequate systems in place that identified shortfalls and records were incomplete. Staff were not receiving training, supervisions or had the skills and knowledge to support people within the service. There were also inadequate checks undertaken on new staff prior to them starting employment at the service.

Following this inspection, we placed the provider on notice of urgent action and we put the service into special measures. This is when the provider is responsible for the care it provides and for improving quality and safety in response to our judgements and ratings. When a service is in special measures we expect the provider to seek out appropriate support to improve the service from its own resources and from other relevant organisations. The provider also wrote to us to say what they would do to meet legal requirements in relation to these breaches.

The service was inspected in February 2017. After this inspection we used our enforcement powers and served a Warning notice on the provider, in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in April 2017, as the provider's quality assurance systems were not in place or effective at identifying shortfalls relating to infection control, personal evacuation plans and medicines management. Some audits had been undertaken during and following our inspection those shortfalls were yet to be actioned This is a formal notice which confirmed the provider had to meet one legal requirement by May 2017 .

We undertook a comprehensive inspection in July 2017. This was to follow up our warning notice issued and previous breaches of legal requirements. At this inspection whilst there were some improvements there were still concerns relating to previous breaches including records that were inaccurate and incomplete and shortfalls in staffing numbers, staff receiving training, supervision and a regular appraisal of their performance yearly appraisal. The service was rated as Requires Improvement.

We undertook an unannounced focused inspection of Haven Lodge Care Centre on 22 February 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. We had received information that the management arrangements in the service were not consistent. This focused inspection looked at the breach of regulations 12, Safe Care and Treatment, 17, Good Governance and 18 , Staffing. At this inspection, we found the provider had taken action to comply with some of the legal requirements. However, further improvements were still required regarding the recording of medicines, support plans and effectiveness of quality assurance systems. We found continued breaches of Regulations 12 and 17.

You can read the reports from our last inspections, by selecting the 'All reports' link for Haven Lodge Care Centre, on our website at www.cqc.org.uk. The service remains rated as requires improvement.

Haven Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement . The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Haven Lodge Care Centre is a registered nursing home and can accommodate 106 people. At the time of the inspection there were 27 people living at the service. The accommodation at the time of the i

We carried out a comprehensive inspection of Haven Lodge Care Centre on 17 and 18 July 2017. Breaches of legal requirements were found in relation to regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were insufficient numbers of staff to keep people safe and meet their needs. Staff were not receiving training regular supervisions and yearly appraisals. There were ineffective quality assurance systems in place to make sure any areas for improvement, for example in the management of people’s medicines were identified and addressed.

We undertook an unannounced focused inspection of Haven Lodge Care Centre on 22 February 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. This focused inspection looked at the breach of regulations 17 and 18. This report only covers our findings in relation to this area. You can read the report from our last comprehensive inspection by selecting the, 'All reports' link for ‘Haven Lodge Care Centre’ on our website at www.cqc.org.uk

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Haven lodge provides accommodation and personal/nursing care for up to 108 people.

At the time of the inspection there were 24 people living at the home. The accommodation at the time of the inspection was arranged over two floors. The first floor is Willow unit and the second floor is Sycamore unit. Each floor could have up to 27 people living on them. The third and fourth floors were not being used at the time of the inspection. Both Willow and Sycamore units had a communal lounge, dining area, bathrooms and toilets.

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 this inspection, we found the provider had taken action to comply with some of the legal requirements. However, further improvements were still required in regards to the recording of medicines, support plans and effectiveness of quality assurance systems.

People's care plans did not always contain support plans relating to their individual care needs including catheter care or Parkinson's disease.

People did not always have accurate records that confirmed if they had been administered their medicines or had protocols for medicines that were given as required.

Whilst the provider had a system in place to monitor the quality and safety of the service. It was still not effective enough to identify shortfalls found during this inspection.

People who required medical supplements were given medicines belonging to other people.

We found medicines belonging to people who were no longer living at the service.

People’s medicines were stored accurately and creams administered to people. Where people were at risk of dehydration; records relating to the amount people had drunk had improved.

People were now supported by staff who had received training and an annual appraisal.

People were supported by sufficient numbers of staff.

People were now receiving correct support relating to their skin care due to accurate handover sheets and staff were all familiar with people's care needs.

People's air mattresses were now accurately set when they were at risk of their skin developing pressure sores. When daily checks were being undertaken these identified mattresses that had been incorrectly set due to accurat

Haven lodge provides accommodation and personal/nursing care for up to 108 people.

At the time of the inspection there were 42 people living at the home. The accommodation at the time of the inspection was arranged over two floors. The first floor is Willow unit and the second floor is Sycamore unit. Each unit could have up to 27 people. The third and fourth floors were not being used at the time of the inspection. Both Willow and Sycamore units had a communal lounge, dining area, bathrooms and toilets.

At our last comprehensive inspection of this service on 10, 11, 14 November 2016. Seven breaches of legal requirements was found as the provider was not following the Mental Capacity Act 2005, people were not having their care provided in a dignified or respectful way. People were receiving unsafe care and treatment and were at risk due to inadequate care relating to their nutrition and hydration. The provider had inadequate systems in place that identified shortfalls and records were incomplete. Staff were not receiving training, supervisions or had the skills and knowledge to support people within the home. There was also inadequate checks undertaken on new staff prior to them starting within the home.

Following this inspection we placed the provider on notice of urgent action and we placed the service into special measures. This is when the provider is responsible for the care it provides and for improving quality and safety in response to our judgements and ratings. When a service is in special measures we expect the provider to seek out appropriate support to improve the service from its own resources and from other relevant organisations. The provider also wrote to us to say what they would do to meet legal requirements in relation to these breaches.

The home was last inspected on the 23 and 24th February 2017. At the last focussed inspection we found breaches of legal requirements. After this inspection we used our enforcement powers and served a Warning notice on the provider on the 4 April 2017. This is a formal notice which confirmed the provider had to meet one legal requirement by the 25 May 2017.

We undertook this unannounced comprehensive inspection on the 17 and 18 July 2017. This was to follow up our warning notice issued and previous breaches of legal requirements. At this inspection whilst there were improvements there were still concerns relating to previous breaches including records that were inaccurate and incomplete and shortfalls in staffing numbers, staff receiving training and a yearly appraisal.

People could be at risk of not receiving support relating to their skin care due to inaccurate handover sheets and staff being unfamiliar with people’s care needs.

People’s air mattresses were not always accurately set when they were at risk of their skin developing pressure sores. When daily checks were being undertaken these did not identify mattresses had been incorrectly set due to no record of what the mattress should be set to.

Medicines were not always stored accurately and creams administered to people did not always have accurate records that confirmed if people had been administered their medicines. Where people were at risk of dehydration; records relating to the amount people had drank needed improving. People’s care plans did not always contain support plans relating to their individual care needs including catheter care, Parkinson’s and bowel care. There was a lack of robust systems and checks in place that identified shortfalls found during this inspection.

People were not always supported by staff who had received training or an annual appraisal. People, staff and relatives all felt the home did not have sufficient staffing levels. At the time of the inspection the home had a number of vacant hours and there was a 14.34% use of agency. The registered manager and provider were trying to reduce the amount of agency being used. They felt it was about getting the right staff in wit

This inspection took place on 23 and 24th February 2017 and was unannounced. It was carried out by one ¿adult social care inspector, an expert by experience and a specialist advisor. Following the first two days of the inspection we gave notice to the provider and registered manager that we needed to return to conclude the inspection. This visit was announced and was undertaken by one adult social care inspector on the 22 March 2017.

Haven Lodge provides accommodation and personal/nursing care for up to 108 people.

At the time of the inspection there were 41 people living at the home. The accommodation at the time of the inspection was arranged over two floors. The first floor is Willow unit and the second floor is Sycamore unit. The third and fourth floor were not being used at the time of the inspection.

Both Willow and Sycamore units had a communal lounge, dining area, bathrooms and toilets.

At the time of this inspection the home had a registered manager. 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. ¿

We carried out a comprehensive inspection of this service on 10, 11 and 14 November 2016.

Breaches of legal requirements were found as people were not receiving safe care and treatment in relating to their nutritional needs, skin care and medicines. There were unsafe recruitment practices in place as staff were not receiving checks prior to starting their employment. There were insufficient numbers of staff to keep people safe and meet their needs. We also found ineffective quality assurance systems were in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we placed the provider on notice of urgent action. This was because people were receiving unsafe and inadequate care. The management of the home was inadequate along with the quality assurance systems in place. The provider provided an action plan of how they were going to address the significant risks found during that inspection.

We undertook this focused inspection to check the service was now safe and well-led. We also checked to ensure the provider was meeting their legal requirement. 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 on our website at ¿www.cqc.org.uk

We found some actions had been taken to improve how safe and well-led the service was but improvements were still required to meet legal requirements.

The management of medicines was not always safe due to stock no longer required being held by the service. Record keeping was poor, medicines were not dated when they were opened and fridge temperatures were not being recorded.

Personal evacuations plans were not always in place and contained old and out of date information.

People at times had to wait for support and assistance from staff during meals times.

Quality assurance systems were not always in place and effective as we found shortfalls relating to personal evacuation plans and medicines management. There was no system for checking the building, health and safety, fire safety and the cleaning of equipment such as hoists. Some audits were sent following the inspection; these identified actions required. We will review the actions completed and the effectiveness of these new audits at our next inspection.

People were receiving improved care relating to their nutrition and hydration and people were putting weight on.

People were being supported with repositioning when at risk of developing pressure related although records required some improvements.

People were supported by staff who had ch

This inspection took place on 10, 11 and 14 November 2016 and was unannounced. The home was last inspected in December 2015 where we found breaches of the regulations in relation to person centred care, consent, good governance and staffing. The provider sent us an action plan outlining improvements they said they had made, or planned to make, to become compliant with the regulations.

During our inspection, we found that not only had there been no improvements made, there were more concerns and many of those were of a higher risk. For example in relation to person centred care and staffing we found that there had been further deterioration and the risks posed to people had increased. We also found further breaches of the regulations in relation to nutrition and hydration, and dignity and respect.

The home still did not have a manager registered with the Care Quality Commission. The home had been without a registered manager since 2015. Two managers had been in post since that time and one had been in the process of registering with the commission but had left the service in August. Since August 2016, the provider had placed two support managers and a support deputy manager from their other homes, in the service to assist staff and run Haven Lodge until a new manager could be recruited.

The service is required to have a registered manager and was therefore in breach of this regulation. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. We had been made aware of a number of people who had left the service and a number of staff currently within the home were working their notice to leave, this included a senior carer, unit manager and a number of care staff.

This inspection found that people's safety was being compromised in a number of areas. Care plans did not reflect people’s care needs and care delivery was not person specific or holistic. We found that care plans for people with specific health problems such as diabetes, pressure areas, and wounds were not up to date and did not have sufficient guidance in place for staff to deliver safe treatment. The delivery of care suited staff routine rather than individual choice.

During this inspection, we followed up on information of concern we had received regarding people's food and fluid intake. We found that people were not being supported or prompted to have sufficient fluid or nutrition. We reviewed the information and support available to ensure people received enough nutrition and hydration. We found that records kept to monitor people's intake of food and fluids were poorly completed, inaccurate and did not outline why people were being monitored which meant people were placed at risk.

We looked at risk assessments and saw there was little up to date comprehensive information to identify what the risks were to people. How staff protected people from risks did not always reflect recent advice from other health care providers. People were not always supported in line with their care plans. We therefore found the home was in breach of the regulation in relation to safeguarding and improper treatment.

At the last inspection in December 2015, we found there were not enough qualified skilled or experienced staff to meet the needs of the people using the service. We checked and found that the provider had still not ensured there were enough suitably trained or qualified staff deployed to meet the needs of people who used the service. We found the home was still in breach of the regulation relating to staffing. The lack of suitably qualified and experienced staff impacted on the care delivery and staff were unable to deliver care in a safe manner. Shortcuts in care delivery were iden

We undertook an inspection on 13 May 2013. We found that the provider was not meeting one of the 'Essential Standards of Quality and Safety'. The inspection identified a concern regarding supporting workers.

The provider was required to provide a report that stated what action they were going to take to achieve compliance with this essential standard. The provider submitted an action plan on 10 June 2013. The purpose of the inspection was to check that the necessary improvements had been made to ensure compliance with the essential standard.

We found that the provider had introduced a system which ensured that staff members were supported to enable them to deliver care and treatment to an appropriate standard.

People we spoke with told us how they had been involved in discussions about their care needs. One person told us they had been part of a review meeting that had been held to discuss their care arrangements. They told us, "I can always say if I need help and staff are always available if I need them". Another person told us they had received care over a period when they had been unwell and that, "staff were all very good giving me the help I needed at the time I needed it".

Records showed that people living in the home had an opportunity to discuss their care and family or representatives were consulted where this was needed for example where a person had dementia and was unable to express their view.

People we spoke with told us that they were happy with the care they received and that staff were helpful and kind. One person told us, "I always get the care I need". Records showed detailed information about the health and social care needs of the individual.

We found that the provider had taken reasonable steps to protect people using the service from abuse. We found that staff had received the necessary training so that they had the knowledge and skills to respond professionally to any concerns about possible abuse. We found that staff were trained to provide appropriate care and that they received regular supervision. People told us that staff were caring and supportive with one person telling us that staff were able to give them the care and support they needed.

We inspected this home on 3 and 4 December 2015. This was an unannounced inspection. The home was registered to provide residential care and accommodation for up to 108 older people over four floors. At the time of our inspection 66 people were living at the home. The home was split into three units on three of the four floors, Cherry, the third floor, of the building providing accommodation for people with nursing needs, the second floor, Sycamore, providing care for people with nursing care who are living with dementia and Willow on the ground floor of the building accommodated people living with dementia.

A new manager was in place at the service. The new manager confirmed that they had begun the process to become the 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.

People we spoke with told us that they felt safe living at the home and relatives we spoke with confirmed this. We found that staff knew how to recognise when people might be at risk of harm and were aware of the registered provider’s procedures for reporting any concerns.

At the time of our inspection we were told that there were adequate staffing levels to meet people’s individual needs but people, relatives and staff told us this was not the case and the manager stated they needed to improve levels. It was identified that at times more staff were needed to ensure staff responded to people’s needs in a timely manner. Call bells were not answered promptly at times and relatives told us that they thought more staff were needed to support their loved ones to ensure their needs were met.

People’s rights were not fully protected because the correct procedures were not being followed where people lacked capacity to make decisions for themselves. The home was not consistently undertaking mental capacity assessments in accordance to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had not been submitted to the Local Authority for people who lacked mental capacity. However, staff did seek people’s consent before providing support or care.

People were supported by staff that had received training and had been supported to obtain qualifications. This ensured that the care provided was safe and followed best practice guidelines. References were requested to ensure new staff were suitable to work with people who needed support. However, in all the staff files we reviewed, DBS (Disclosure and Barring Service) evidence was missing. The manager provided this information following the inspection. Staff had not received regular supervisions or yearly appraisals

People were supported to receive their medicines in a timely manner and medicines were stored securely and at the correct temperature however there were inconsistencies in recording on one floor.

There was caring and compassionate practice and staff demonstrated a positive regard for the people they were supporting.

People’s needs had been assessed but care plans were not always person centred and they had not been developed to inform staff how to support people in the way they preferred. Measures had been put into place to ensure risks were managed appropriately.

People’s nutritional and dietary needs had been assessed and people were supported to eat and drink sufficient amounts to maintain good health. People were supported to have access to a wide range of health care professionals.

People were asked to join in a range of activities but they were not always person centred and suitable to meet people’s individual choices. There was little evidence to support people had been able to maintain interests that they had before moving to the home. People who were confined to their rooms were at risk from social isolation.

There was a complaints process that people and relatives knew about. There were inconsistencies experienced by relatives as to the effectiveness of the complaints process. Systems were not in place to help the provider learn and develop the service from feedback and outcomes of complaints.

The service was in the process of a lot of changes due to the change in manager and the systems in place to monitor and improve the quality of the service were not yet embedded. The manager and provider had identified many improvements that were needed and had plans in place to improve the quality of the service.

We found 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 this report.