About the service: The Haven Care Home is a residential care home that was providing personal care to 26 older people, some whom were living with dementia.

People’s experience of using this service:

¿ Some records were not detailed to determine how the service was meeting the person’s nutrition and hydration needs. Each person had been individually assessed and advice was sought when concerns were identified.

¿ People had not consistently consented to having a sensor mat to alert staff when the person got out of bed. We have made a recommendation about this. People were asked for their consent prior to any care or support tasks.

¿ People’s needs were assessed prior to staying at the service for a period of respite or a permanent admission. Care plans were then developed with people and their relatives; this were regularly reviewed to ensure they met people’s needs.

¿ People felt safe and were protected from the risk of harm and abuse. Staff understood their responsibilities and knew the action to take if they had any suspicions about abuse.

¿ Staff followed guidance to mitigate potential risks that had been identified.

¿ People lived in a building adapted to meet their needs and was maintained to make sure people were safe.

¿ People received their medicines safely from staff that had been trained and had their competency assessed.

¿ People were supported to remain healthy with support from health care professionals.

¿ Staff knew people well, understanding their needs and personal histories. People were treated with kindness by staff that understood the importance of maintaining people’s privacy and dignity.

¿ People were offered the opportunity to participate in a range of activities which met their needs and interests.

¿ People’s feedback was sought and acted on.

¿ Systems were in place to monitor the quality of the service people received.

¿ The provider was in the process of redecorating and upgrading items of furniture within the service.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (report published 20 July 2018). At this inspection we found the service had improved to Good.

Why we inspected: This was a comprehensive planned inspection. We brought this inspection forward due to information of concern regarding people being at risk of harm and abuse. We did not find anything during our inspection which raised any concerns.

Follow up: We will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was carried out on the 15 and 16 May 2018. The inspection was unannounced.

The Haven Care 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.

The Haven Care Home provides accommodation and personal care for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 27 people living in the service when we inspected.

At our previous inspection on 18 April 2017 we found a breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions effective and well-led to at least good. Improvements were required in relation to ensuring staff had the skills, knowledge and competence to meet people’s needs, and to implement effective governance systems to monitor the quality of the service. The registered manager submitted an action plan stating they would meet the regulation by 31 July 2017. At this inspection we found that some improvements had been made to meet the relevant requirements relating to regulation 12. However, we found a continuing breach of Regulation 17, a new breach of Regulation 12, Regulation 13 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

There was a registered manager in post who managed the service who had worked at the service for a number of years. 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, the registered manager was not aware of all of their responsibilities to ensure compliance with fundamental standards and regulations. They had failed to notify CQC of a notifiable event in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People were not always protected from the potential risk of harm and abuse. Potential safeguarding concerns where unexplained bruising had been found on a person had not been reported to the local authority safeguarding team. Staff had been trained in safeguarding adults and were aware of the signs of potential abuse.

Medicines were not always managed safely. Guidance was not consistently in place for people that had been prescribed ‘as and when required’ medicines. Procedures relating to ‘controlled drugs’ had not been consistently followed. Systems were in place for the ordering, obtaining, storage and disposal of people’s medicines. Staff were trained in the administration of people’s prescribed medicines.

Governance systems that were in place to monitor the quality of the service were not always effective. The audit that had been completed by the registered manager and the senior manager had failed to identify the concerns that were found during this inspection.

Potential risks to people, staff and visitors had been assessed with procedures put into place to reduce these risks. The environment and equipment had been maintained and serviced to reduce the risk to people. Accidents and incidents involving people had been monitored and recorded.

Staff had been recruited safely. Staffing levels were monitored to ensure there were enough staff to meet people’s assessed needs.

Staff received support and guidance from the management team. Staff had completed the provider’s mandatory training. However, staff had not always been trained to meet peop

We inspected The Haven Care Home on the 18 April 2017. The inspection was unannounced.

The Haven provides accommodation and personal care for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 28 people living in the service when we inspected

At our previous inspection on 15 January 2016 we found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We required the provider to make improvements in relation to assessing people’s capacity to consent. The registered manager submitted an action plan stating they would meet the regulation by 01 June 2016. At this inspection we found that improvements had been made to meet the relevant requirements. However, we found additional breaches of regulations.

There was a registered manager in place who had worked at the service for a number of years. 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. The registered manager was supported by a number of senior care staff who managed the care staff.

Staff had not always received the training they required to meet people’s specialist needs. Staff were supported in their role by the registered manager. New staff completed an induction prior to working within the service. There was an open culture where staff were kept informed about any changes within the service or people’s care needs.

People were not always protected from potential abuse or harm by staff who understood the signs and the action to take if they suspected abuse. Potential risks to people had not always been recorded within the care file, to ensure staff were following the most up to date guidance. We have made a recommendation about these areas.

Systems in place to monitor the quality of the service were not effective. The overall governance by the registered provider had failed to identify the shortfalls that were found during this inspection. People were encouraged to raise any concerns or complaints they had. People’s feedback about the service they received was sought and acted upon.

There were enough staff on duty to meet people’s assessed needs. People were treated with kindness by staff who respected their privacy and dignity. People’s likes, dislikes and personal interests had been recorded within their care files. Safe recruitment practices were not always followed to ensure staff were safe to work with people who needed care and support. We have made a recommendation about this in our report.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, applications had been made to deprive people of their liberty. The registered manager understood their responsibilities under the Mental Capacity Act 2005 (MCA). Mental capacity assessments and decisions made in people’s best interest were recorded. People were actively encouraged and supported to make decisions relating to their lives. Staff’s knowledge varied in their understanding of the MCA. We have made a recommendation about this in our report.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and their relatives and reviewed to ensure people continued to have the support they needed. Records showed that some people’s needs had not changed over a period of 18 months. We have made a recommendation about this in our report.

People were encouraged and supported to maintain as much independence as possible. People were supported to participate in a range of activities w

The inspection was carried out on 15 January 2016 and was unannounced.

The service provides accommodation and support for up to 30 older people. All rooms have en-suite facilities. Accommodation is arranged over two floors and there is a shaft lift so that all rooms can be easily accessed. There were 29 people living in the service when we inspected.

A registered manager was in post and was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the registered manager had applied for DoLS authorisations for some people living at the service, with the support and advice of the local authority DoLS team. The registered manager understood their responsibilities under the Mental Capacity Act 2005. However, people’s capacity to consent had not always been assessed prior to applications being made to deprive people of their liberty.

Not all activities were specific to meet people’s needs interests or preferences.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure people’s safety. People’s safety in the event of an emergency such as a fire had not been assessed or recorded. We have made a recommendation about this.

Recruitment checks had taken place prior to staff starting work at the service, however gaps in people’s employment history had not always been explored. We have made a recommendation about this. Staff felt supported in their role and received regular supervision. Staff told us the registered manager was approachable and there was an open culture within the service. The registered manager provided leadership and guidance to the staff team with the support from senior staff.

There were enough trained staff on duty to meet people’s needs. Staff told us they had received the training and support required to fulfil their role. However, staff had not always received the refresher training they required in a timely manner. We have made a recommendation about this.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded. People were asked for feedback on their food and action was taken if required.

People were supported to maintain good health. Staff had up to date information to support people to remain as healthy as possible. People were supported to stay in touch with people that mattered to them.

Processes were in place to monitor the quality of the service being provided to people. Records were up to date and stored appropriately. A complaints policy and procedure was in place

At the inspection conducted on 17 April 2013 we had concerns regarding the management of medication. The manager wrote to us following our inspection to tell us how the management of medication was going to be made safe. We visited the service and found that the manager had completed the action plan and that processes for managing medication safely were in place.

People told us that generally they were happy living at The Haven Care Home. They told us that they were well cared for and that staff understood their individual needs. People said they enjoyed the activities on offer and had formed friendships with the staff.

People told us that the food was very good and that there was always a choice at every meal time. We saw that people needing help with eating and drinking were encouraged and assisted discreetly.

It could not be assured that people received their medication at the times they needed them, as there were some areas in administration records, this was because some staff had not signed the medication administration records to confirm that medicines had been given. A photograph of each person who lived in the home was not available for staff. Therefore, staff could not complete all the identity checks as detailed in the homes policy for the safe administration of medicines, to ensure that they were giving the right medicines to the right person.

People’s safety was protected because effective recruitment procedures were in place.

There was a complaints policy in place and staff were aware of their responsibilities in relation to reporting and recording complaints. People living at the service had confidence in the manager and said they felt sure if they made a complaint it would be dealt with.

We spoke with three people living at the home as well as to staff and the manager. People told us that the staff were kind and helpful, and that the food was very good. People said that there was a good range of activities they could take part in. People said that the staff knew them and understood their individual needs and preferences and respected their wishes.

People told us that they were offered choices in their daily lives and that they felt listened too.

This inspection was carried out to assess if action had been taken in regards to concerns which had been highlighted at the last visit on 24th October 2011.

We visited the service to look at records and speak to the manager and staff. We did not speak with people living at the home to assess the outcomes on this occasion as it was not needful for our assessments. However, during our visit we saw that people were being supported around the home by staff in a kind and sensitive manner, in a way that promoted individual independence.

We spoke with three people who lived in the home during our visit. People told us they were happy with the care they received at the Haven. They told us their privacy and dignity was respected and staff always knocked on their bedroom doors. People said they felt safe at the home. They told us they were able to do the activities when they wanted to and staff were kind and helpful.