This inspection took place on the 8 and 14 January 2019, the first day was unannounced.

Havelock House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 27 older people who require personal support and nursing care. At the time of the inspection there were 24 people living at the home. Some people required nursing care as they had complex health care needs, such as a stroke or Parkinson’s disease, or end of life care. Other people needed support with personal care and assistance to move around the home safely and some people were living with dementia.

The registered manager was present during 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 and associated Regulations about how the service is run.

At our last inspection in July 2016 we rated the service as Good overall but Requires Improvement in the Responsive key question. Although we had asked the provider to make improvements in relation to record keeping; including care plans, so that they reflected people’s individual care needs. Also, there was no system in place to assess and meet people’s social needs, such as activities or support to continue with their hobbies.

At this inspection we found these improvements had not been made; there was a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and additional areas for improvement were identified. The rating for Havelock House Nursing Home has changed from Good to Requires Improvement.

There was no evidence of provider oversight of the service and there was no quality assurance system to effectively monitor the services provided. The registered manager had developed and introduced audits, as part of a new quality assurance system. These reviewed some aspects of the services and facilities but, had not identified the areas we found where improvements were needed. Satisfaction questionnaires and been given out to obtain feedback and comments suggested there should be more activities, which was an area that needed additional work from the last inspection.

Care plans and supporting documentation was not up to date. For example, although risk had been identified it was not clear how people’s needs were met and there was not enough guidance for staff to follow to provide the care and support people needed. Staff said they had attended relevant training and explained how they supported people to be independent. However, not all staff followed current guidance when they assisted people to move around the home using walking aids.

Staff had attended safeguarding training and understood how to protect people from abuse. They explained what action they would take if they had any concerns and followed current guidelines.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were not fully aware of what these changes meant.

We recommend that the provider seek advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

We inspected Havelock House on the 20 July 2016.Havelock House Nursing Home provides accommodation and nursing care for up to 27 older people, who require personal support and for those that have nursing needs, including poor mobility, strokes, Parkinson’s disease, diabetes, and people who were receiving end of life care and who live with dementia. Havelock House Nursing Home also provides respite care for those people who need short term care provision. The maximum amount of people to be accommodated was 24. There were 22 people living in the home during our inspection.

Havelock House is a detached older style building with accessible gardens to the rear, suitable for wheel chair users. Accommodation is provided over two floors with communal areas on the ground floor.

Havelock House is owned by Havelock House Nursing Home. We last inspected the home in November 2014 and no concerns were identified.

There was no registered manager in post. 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. There is an acting manager who is due to submit an application to be registered with the CQC.

People commented they felt safe living at Havelock House. One person told us, “I feel comfortable and cared for.” Another person said, “I came here as I wasn’t safe at home, I’m very safe and happy here.”

Whilst care plans and risk assessments for people were in place, not all were fully reflective of peoples’ individual specific health needs. However when we spoke with the staff, they knew people very well and were knowledgeable about the people they cared for. The documentation had not impacted on safe outcomes for people at this time. A new clinical lead had been employed and they were currently reviewing the care plans and risk assessments. There was at present a lack of meaningful activities for people to engage with. There were people who told us, “Not a lot going on at present.” People who remained in their bedrooms and on continuous bed rest lacked a clear rationale for that specific decision and there was no guidance for how staff could meet their social needs on a day to day basis.

People and staff felt staffing levels were sufficient to meet the needs of the people they supported. One person told us, “Always lots of staff around.” A staff member said, “We are well staffed and a good team, I don’t feel pressured and I can do my job well.”

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them.

There was a focus on providing care and support that focused on the needs of the person whilst supporting their individuality and identity. However there was a lack of meaningful activities provided to ensure people’s social and mental well-being was being fully promoted. The acting manager The acting manager told us, “The staffing levels and the caring nature of our staff means we can give people the time they need, by staff that know them well.” We were also told, “We try to ensure that our residents are happy and comfortable.”

Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

People t

We carried out this inspection to look at the care and treatment that people living at the home received. At the last inspection on 2 July 2014 we found that there were concerns with regard to care and welfare, cleanliness and infection control, supporting workers and assessing and monitoring the quality of service provision. We carried out this inspection to follow up on these concerns. Evidence gathered at this inspection showed that the provider had achieved compliance.

The service currently has an embargo on admissions implemented by the local authority.

The home did not have a registered manager. The appointee manager was responsible for the day to day running of the home. As part of our inspection we spoke with three staff, including the appointee manager. During the inspection we spoke with four people who lived in the home.

One inspector carried out this inspection.

People told us, "It is all nice here, my family visit and they are happy too." And, "I stay in my room, my choice I feel secure and the staff look after me, it's good I am quite happy here."

We saw staff speaking to people and providing care and support. Staff spoken with were able to tell us about people and their individual needs. There were systems in place to report and audit accidents, incidents and falls effectively.

The home asked people who used the service for their feedback, This was in the form of a satisfaction survey which had been completed by people living at Havelock House and a further survey by their relatives. We saw that comments had been followed up and actioned. Therefore evidence was seen to show the results of these surveys had been used to improve the service.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our inspection there were 24 people living at Havelock house. Not everyone who lived at the service could tell us about their experiences, those who could told us they were happy with the care provided. We were told, “I have been here about a year, it’s like a second home.” And, “They look after you.” We also spoke with relatives and visitors to gain feedback from people who could not tell us about their experiences of living in the home.

We reviewed records about the assessment and monitoring of the quality of the service, policies, information around supporting and training staff, care plans and associated documentation.

Below is a summary of what we found.

Is the service safe?

We saw that care plans and risk assessments were in place. These had been written and reviewed regularly to ensure that information provided to staff was up to date and relevant.

The staff we spoke with demonstrated an appropriate level of understanding around how to recognise and report abuse. However not all staff had received all the mandatory training. No staff had received training in dementia care since commencing employment at the service.

Is the service effective?

Staff spoken with knew people and were able to tell us about their needs. People we spoke with who lived at Havelock House and relatives of people told us that the staff were supportive and provided good care. One relative told us, “I visit almost every day, staff are on the ball.”

Is the service caring?

We observed staff talking to and supporting people in a kind caring manner. Relatives and visitors spoken with told us they found staff to be kind and caring at all times. We were told, “Staff are lovely, they pick up on X’s mood, they know them and tell me how they've been when I come in.”

Is the service responsive?

We saw that referrals had been made to outside agencies and other professionals including GP’s and Tissue Viability Nurses (TVN). We saw that one person living in the home required increased levels of care and supervision. It was unclear what assessments had taken place to ensure that the service was able to meet this person's needs.

Is the service well-led?

The service had a registered manager. There was no deputy manager, however the manager told us that they were supported in their role by the activities co-ordinator who covered when the registered manager was unavailable. Staff and visitors told us if they had any concerns they raised these with the activities co-ordinator who we were told was very approachable and readily available around the home when they visited. If the co-ordinator was unavailable they would happily speak to the manager.

Staff meetings had only taken place once in the last year. A residents meeting had taken place in June 2013. Staff supervision and appraisals had not been completed in the last 12 months. The activities co-ordinator had started to gain feedback in resident satisfaction questionnaires. We saw that two of these had been completed, one in May and one in June 2014. Relative’s feedback forms were last completed in 2011.

During our inspection we spoke with four people who lived at the home and with five members of staff. These included the owner, the manager, the chef, the activities co-ordinator and a care worker. We reviewed a range of information from other sources to help us understand the views of people who were using the service. This included minutes of meetings and individual care records.

We observed that people and relatives had positive relationships with care staff, were being treated well, receiving good care and supported in a sensitive and professional manner. People told us that their nutritional needs were being fully met. Staff reported that they felt valued, trained and supported and demonstrated a good understanding of people’s individual care needs. One member of staff told us “We try hard to provide the best service to the people who live here; this is their home”.

The provider had a range of systems embedded into practice to address security and maintenance issues and to monitor the quality of service. People described the home as ''a happy home”, told us that it was a ''good place to live'' and that they could speak with the manager at any time if they had any concerns.

We found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Some of the residents at Havelock House had complex needs which meant they were not all able to communicate to us their views on the service. Therefore, we used a number of different methods to help us understand the experiences and views of these people. This included looking at supporting care documentation, speaking with a relative, observing how care was delivered, talking with staff and reviewing the provider’s feedback mechanisms.

During our inspection we took the opportunity to talk to a relative who told us that she visited most days. She described to us how she was involved in all aspects of her mother’s care which she found to be excellent. She told us “I know the décor is not tip top but the care is very special”.

People who were living at Havelock House told us that they “felt safe and were well cared for”. They said they were treated with respect and dignity and given choices about their daily life and were involved in how they would like their care to be delivered. People described the home as ''a happy home'' and told us that it was a ''good place to live'' and that they could speak with the manager at any time if they had any concerns”.

We spoke with the provider, registered manager and care workers. They all told us that they were happy working in the service, the team worked well together and that they had received the training and support they needed to meet individual people’s care needs.

Some people we spoke with were able to tell us that they enjoyed living at Havelock House, and were happy. We were told by one person “everyone is nice”, “I am lucky” and “the food is good”.