This comprehensive inspection took place on 21 October 2018 and was unannounced. The last time we inspected this service on 18 and 26 October 2017 we completed a focussed inspection, looking at the Safe, Effective and Well-Led key questions. After that focussed inspection we rated the service ‘Good’ overall but ‘Requires Improvement’ in the Safe key question. During that inspection we had identified that safety concerns were not always being reported as required and medicines not always being properly managed. During this inspection in October 2018 we found that sufficient action had been taken to improve on these areas. We identified some concerns with regards to the environment which meant Safe was rated ‘Requires Improvement’ once more. All other key questions were rated ‘Good’ which meant the home was rated ‘Good’ overall.

Rest Haven Charitable Home (referred to in this report as Rest Haven) 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. Rest Haven accommodates up to 34 people in one adapted building. At the time of our inspection there were 30 people living in the home.

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 2008 and associated Regulations about how the service is run.

During the inspection we identified two unrestricted windows which could pose harm to people. We raised this with the registered manager and they confirmed those had been secured immediately following our inspection. We also raised concerns about some uneven flooring which could potentially be a risk to people. The registered manager took immediate action following our inspection to add signage to draw attention to it and reduce the risks.

People praised the staff and management of Rest Haven and told us they received high quality care. Comments included, “I wouldn’t go anywhere else”, “They’ve got very good staff. The staff really know what they’re doing”, “They will do everything they can oblige. We can do what we want” and “I would like to stay here for the rest of my life.” People were held in high regard and had a good quality of life. People had freedom to make choices and were supported to be independent. Staff treated people with respect and kindness.

People who lived in Rest Haven were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

Action had been taken to ensure staff understood the Mental Capacity Act 2005, the principles of the Act and how to apply these. We found people were involved in all aspects of their care and their consent had been sought prior to any care being delivered. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

Recruitment procedures were in place to help ensure only people of good character were employed by the

This focussed inspection took place on 18 and 26 October 2017 and was unannounced on the first day. We had previously carried out an unannounced comprehensive inspection of this service on March 2016 and rated the service as Good overall, although the service was rated as requiring improvement in terms of effectiveness. At that inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities (Regulations 2014. This was because the service was not following all the requirements of the Mental Capacity Act (2005). We carried out a focussed inspection in April 2017 to look at the effectiveness of the service and to see whether the service was now meeting the requirements of the regulation. We found that they were now compliant with this regulation. However, we found that staff were not fully up to date with all their training and had not received supervision from a senior member of staff. We therefore continued to rate the home as requiring improvement in effectiveness.

After that inspection we received concerns in relation to an incident where a person had fallen, and subsequently died. As a result we undertook this focused inspection to look into whether the service was safe, effective and well-led. This report only covers our findings in relation to these areas. You can read the reports from our last comprehensive inspection and focussed inspection, by selecting the 'all reports' link for Rest haven Charitable Home on our website at www.cqc.org.uk

Rest Haven Charitable Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rest Haven is owned by a charity andhas a board of trustees who oversee the work of the home. Trustees serve on a voluntary basis.

The care home accommodates 34 people in one adapted building. At the time of the inspection, 29 people were living at Rest Haven. Some people had been resident for a number of years. Some people had physical disabilities and a small number of people living at the home had dementia.

The home 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 2008 and associated Regulations about how the service is run.

People, relatives, staff and visiting professionals all said that the home was well managed. They said they knew who the registered manager and her deputy were and they were available to talk to whenever needed. The registered manager worked with the board of trustees of the home to ensure they monitored and improved the safety and quality of the care provided. There was evidence that where incidents and accidents occurred, it was reviewed to see whether changes to systems were needed.

People, their families and visitors to the home including health and social care professionals were very positive about the care and support people were given. Comments from people included “I feel safe; staff look after me well”; “Very nice. They look after me very well, really can’t fault anything.” A visitor commented “Absolutely amazing place caring for physical and spiritual needs.” A health professional commented “It’s one of our better homes; I have no concerns at all.” There were systems in place for feedback including resident meetings and surveys. Staff meetings were held regularly to ensure staff were able to voice concerns and suggest improvements

People received support from staff who knew them well. Throughout the inspection there were positive interactions between people and staff who worked in a calm and unrushed manner. Staffing levels were monitored to ensure they met

This focused follow up inspection took place on 6 April 2017 and was unannounced.

Rest Haven Charitable Home is located in a quiet road near to the centre of the seaside town of Exmouth. It consists of a main house with an extension which provides additional bedrooms and sitting areas. Everyone living at Rest Haven had their own bedroom, some of which were en-suite. There was a main dining room and three sitting rooms. There was also a chapel where daily services were conducted and a further seating area in the large entrance hall. Externally there was a garden laid mainly to lawn, as well as off street parking.

Rest Haven is owned by a charity, which was set up in 1925. It has a board of trustees who oversee the work of the home, serving on a voluntary basis. The location is registered to provide care for up to 34 people. At the time of the inspection, 29 people were living at Rest Haven including one person who was receiving respite care. Some people had been resident for a number of years. Most people living at Rest Haven were elderly and frail; some people had physical disabilities and a small number of people living at the home had dementia.

The home 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 2008 and associated Regulations about how the service is run. On the day of our inspection, the registered manager was on leave. Her deputy was therefore in charge of the home.

Previously we had carried out an unannounced comprehensive inspection of this service on 1 and 4 March 2016. At that inspection we found a breach of regulations. This was in relation to the Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 as the home was not complying with the requirements of the Mental Capacity Act (2005). The provider submitted an action plan to show the actions they would take to achieve compliance and ensure that people were receiving effective care.

At this inspection we found that the service was meeting the requirements of Regulation 11. Staff understood their responsibilities in terms of working within the requirements of the Mental Capacity Act 2005. Where people did not have capacity to make a decision, best interest decisions were recorded. Applications for Deprivation of Liberty Safeguards authorisations for people who were assessed as not being safe to go out alone had been submitted to the local authority.

The home was well maintained and suitable to meet the needs of people living there. There were several communal areas including the dining room and four lounges. Improvements had been made to the gardens. Some bedrooms had also recently benefitted from being fitted with an en-suite toilet.

We found people were cared for by staff who knew them well and were able to meet their needs. Although staff had undertaken some training, they were not all fully up to date with refresher training. Staff said they felt supported by the registered manager and her deputy. At the time of inspection, we found that supervision and appraisal of staff had not been regularly carried out. However after the inspection, we received information which showed that staff had received supervision and were in the process of updating their training.

People were provided a varied and healthy diet. Menus offered a choice of dishes which people said were well prepared and tasty. Where people were at risk of choking or malnutrition, specialist advice was sought.

People had access to health professionals and were supported to attend appointments. Where staff had a concern about a person, they contacted relevant health professionals for advice and support.

Please note that the summary section will be used to populate the CQ

The inspection took place on 1 and 4 March 2016 and was unannounced. The service was last inspected in January 2014 and had met with all the regulations inspected.

Rest Haven Charitable Home is located in a quiet road near to the centre of the seaside town of Exmouth. It consists of a main house with an extension which provides additional bedrooms and sitting areas. Everyone living at Rest Haven had their own bedroom, some of which were en-suite. There was a main dining room and three sitting rooms. There was also a chapel where daily services were conducted and a further seating area in the large entrance hall. Externally there was a garden laid mainly to lawn, as well as off street parking.

Rest Haven is owned by a charity, which was set up in 1925. It has a board of trustees who oversee the work of the home, served on a voluntary basis. The location is registered to provide care for up to 34 people. At the time of the inspection, 33 people were living at Rest Haven including one person who was receiving respite care. Some people had been resident for a number of years. Most people living at Rest Haven were elderly and frail; some people had physical disabilities and a small number of the people living at the home had dementia.

There were sufficient staff to meet people’s needs. People were treated with kindness and compassion by staff who were committed to providing good quality care, which reflected the values of the provider. People and their families were very positive about the home, the staff and the care they received. Comments included “It’s all good here; staff care for you.”; “The home is really good.” and “Feels very safe and secure.”

People and their family members, where appropriate, were included in discussions, plans and decisions about their care. Records were well maintained and provided detailed information so staff could deliver the care planned.

The home was well-maintained, clean and odour free. Some areas had been newly decorated and there were plans to make further internal improvements.. There were also improvements which had been carried out to make the outside area more accessible and provide people with an opportunity to sit outside in comfort and safety.

Staff were recruited safely with checks being carried out to ensure they were fit and proper persons before they started working at the home. Staff received an induction and training when they first joined the home. Training was regularly updated. Staff were also supported through regular supervision and appraisal of their work. Staff knew how to safeguard vulnerable people and what to do if they had a concern. Staff had had Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training and were able to describe what was meant by capacity. However , senior staff took action to organise further training on the MCA and DoLS during the inspection.

People’s medicines, including ointments and creams were administered, recorded and stored safely. Staff who administered medicines had been trained in this.

People were supported to have enough to eat and drink. Specialist dietary needs such as gluten-free and dairy-free were also catered for. People said the food was good. One person commented “You can’t complain about the food, it’s what makes this home worth staying in!” People enjoyed the meals and were offered alternatives, where they did not want the meal on offer. People were served meals either in the dining room or their bedrooms if they preferred.

Family and friends were welcomed into the home and were supported to be involved in their relative’s care, where appropriate. A relative described how Rest Haven had “Given me mum back. Like a family here, you are part of the family.”

Although people were supported by staff who knew them well, their capacity to make informed decisions was not always documented. There had been no consideration of whether an application for a D

When we visited Rest Haven in September 2013 we found that some improvements were needed to the home’s medication systems. At this visit in January 2014 we looked to see if the improvements needed had been made.

At our last inspection in September 2013 we found that improvements were needed to the way in which medication was administered. We also found that there was not a list of care workers’ signatures that would have enabled the manager to see who had administered each dose of medication. There was no homely remedies policy and list, detailing over the counter medication that could be given to people without a prescription. This included mild indigestion remedies or simple linctus.

At this inspection in January 2014 we spoke with one care worker who was administering medication, the manager of the home and two visiting pharmacy advisors. We saw that all improvements that were needed had been addressed.

We, the Care Quality Commission (CQC) last visited Rest Haven on 02 January 2013. At that visit we found improvements were needed to records being kept at the home. At this visit in September 2013 we found that improvements had been made.

People that we spoke with told us that staff were “very helpful”.

We found that where possible people’s consent had been obtained for any care and treatment provided to them. We heard examples of care workers asking people for their consent to undertake a task or activity. For example, we heard people being asked if it was OK with them to be moved when necessary.

We looked at the care records for three of the people who lived in the home to find out how the home had assessed their health and personal care needs, and how they planned to meet those needs. The records showed that people's needs and risks had been identified and well planned for. A range of risk assessments had been completed including those for pressure areas, nutrition and moving and handling.

We saw that medication was being stored safely, in a locked room in locked cupboards or a locked trolley. However, we saw that improvements were needed in the way medication was administered.

Care workers’ files showed there were effective recruitment procedures in place. For example, Disclosure and Barring Service (DBS) (criminal records) checks had been performed.

The home had a robust system in place which ensured records were secure up to date and accurate.

People we spoke with told us they felt involved in their care and that said that staff listened to their preferences and the way they liked things done.

People were complimentary about the staff and the care they received. They said they felt safe living at the home and thought there were enough staff on duty. People were asked their views on the care and service they received. They knew how to complain and felt satisfied complaints would be dealt with appropriately.

We spent fifteen minutes observing life in the dining room and fifteen minutes observing life in the lounge. We call this a short observation framework tool (SOFI). During this time we observed staff being polite, respectful and kind. We heard friendly banter and affection being mutually shared. We did not see any negative interactions during our inspection.

People told us they enjoyed the range of activities offered and were included in the planning of these. People appreciated the services staff had arranged including visiting choirs, the in house shop, hairdressers and musicians.

Records were not maintained well at the home and did not reflect the actual care, support or staff training that had been given.

Systems were in place to monitor the quality of the service, although systems did not always include monitoring the standard of record keeping at the home.