At the inspection of the 11, 12 and 24 April 2017 we found consistent improvements were needed in Effective, Responsive and Well Led. At this inspection we found improvements had been imbedded into practice.

This inspection was unannounced and took place on 4 July 2018.

The Haven is a ‘care home’ for 12 older people. 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.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Risks were assessed and action plans were devised on minimising the risk. Individual risks to people included mobility needs and prevention of pressure ulceration and choking. However, risk assessment for the same identified risk were repeated and for some people the information was not consistent with each other.

Members of staff were knowledgeable on how risks were managed. Where people presented with behaviours that placed others at risk of harm the staff knew how to divert and distract people. The guidance was not detailed on how staff were to manage these levels of anxiety when people became frustrated. For example, how to distract and divert people. The registered manager made some risk assessments clearer during our inspections.

Mobility risk assessments were detailed on each movement and the equipment used. For one person the risk assessment should include the colour of the hoist. The registered manager added this information to the risk assessment.

Care plans were person centred and reflected people’s physical, emotional and leisure needs. However, some care plans had been repeated and the information was not always detailed or consistent with each other.

Some people we spoke with told us they made their own decisions in relation to their health and welfare. Staff knew how to support people with the day to day decisions. People’s mental capacity was assessed and best interest decision taken where they lacked capacity to make specific decisions. Care and treatment capacity assessment must include the specific decisions. For example, staying in bed for part of the week, thickeners, administration of medicines and photographs. We recommend the registered manager seek from a reputable source the guidance on the assessments that must carried out for complex decisions made on behalf of people that lack capacity.

The arrangements for medicines were mainly safe. The introduction of Topical Medication Records (TMR) ensured staff consistently record the applications of topical creams and ointments. The directions of thickeners (used when people were at risk of choking) needed to be detailed in care plans. This information was updated by the registered manager during the inspection.

Audits were used to assess the quality of care. Where shortfalls were identified action plans were devised. However, the medicine audit had not identified that staff were not consistently signing records to show they had applied creams. The registered manager said these Medication Administration Records (MAR) had not being audited for June 2018 and this would be identified in the next audit. Person centred care was identified in the audits and staff were to attend further training. However, records were not always accurate. We made recommendations for the registered manager finds out more about developing care plans and risk assessments to ensure staff have detailed guidance on meeting people’s needs.

The people we spoke with said they felt safe and the staff made them feel safe. The staff told us they had attended safeguarding traini

We carried out this inspection over three days on the 11, 12 and 24 April 2017. The first day of the inspection was unannounced.

At the last comprehensive inspection in November 2016, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and the environment was not safe. In addition, there were not always enough staff to meet people’s needs effectively and quality auditing systems were not identifying shortfalls in the service. We issued a notice telling the provider they must take action. As a result of the concerns we had identified, the service was rated as inadequate. The service was placed into ‘Special Measures’ and the provider placed a voluntary embargo on admissions to the home.

At this inspection, we found the provider had taken the immediate action necessary to ensure people were safe. Many improvements had been made but some work was still required for people to receive a consistently good service. As a result of our findings the service was removed from ‘Special Measures’. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Haven on our website at www.cqc.org.uk.

Work had been undertaken to make the internal and exterior of the premises safe. There were clear procedures in place to ensure a clean environment and safe hygiene practices. We observed staff followed safe infection control practices in the delivery of care and support.

Medicines were administered safely and people received their medicines on time.

A chef had been employed and there was a robust food hygiene regime in place. Food was freshly cooked and people told us the food was varied, ample in portion size and nutritious. We observed people were well supported with their nutrition and hydration needs.

Activities were taking place on a regular basis and the recruitment of a chef and housekeeper freed up care staff to spend more time with people and engage them in social interaction and activities. People and families told us the staff were caring, attentive and respectful towards them. We observed this was the case throughout the inspection.

We observed that staff were available when people required support and on many occasions were spending time socialising with people. People were not hurried and care was delivered at the person’s pace.

Staff training around the Mental Capacity Act 2005 had not been fully effective as not all staff were confident in their understanding of the Act or around how best interest decisions were made. Staff were receiving mandatory and specific training, however some refresher courses had fallen behind.

Staff told us they felt very well supported through supervision with their line manager and appraisals had been set up for the year ahead. Staff took part in meetings with other staff to share information, discuss good practice and the home’s development plan.

People told us they knew how to raise a complaint but had not needed to because the provider and the registered manager were approachable and would listen to any concerns they had. People and their families had been kept informed about the improvements to the home.

The provider had improved the number and quality of the audits in place, however further improvements were required to ensure there was an overview of audits.

We carried out this inspection over four days. In November 2016 we received information of concern about unsafe recruitment practices. We carried out an unannounced inspection at the home on the 17 November 2016. Due to the concerns identified at this visit we changed to a comprehensive inspection so that we could have a detailed look at all areas of the home. We returned on the 30 November 2016 and this visit was unannounced. We continued with the inspection on 01 and 02 December 2016.

The provider had not ensured that people were protected from risk as robust employment checks had not been completed.

The home was in a significant poor state of repair and people were placed at risk because of this. Due to concerns identified in the electrical systems at the home we asked the provider to seek immediate advice from a qualified electrician to ensure the safety of people.

We contacted the environmental health officer due to the concerns we found in the safe handling of food and the poor state of cleanliness and repair of the kitchen. The Environmental health officer visited and has downgraded the food hygiene rating for this service from a level five to two. Five being the highest rating and one being the lowest. The Environmental health officer has told the provider they have to make improvements. Staff had not received the appropriate training in relation to safe food hygiene practices and infection control was poor.

Prior to the inspection we were made aware of one person who had developed pressure ulceration (sometimes called pressure sores) as a result of equipment not working. The provider did not notify us of this. The local authority that is responsible for investigating safeguarding concerns, substantiated the safeguarding concerns raised.

There was not sufficient staff employed. Care staff had taken on additional roles such as cooking, cleaning, laundry. This impacted on the time that care staff had to spend with people either delivering care or providing meaningful activities. During the inspection the manager told us they had recently offered two people the position of cook and cleaner pending successful references.

Not all staff showed a caring approach to people. There was limited interaction and staff did not have the appropriate skills to support and engage with people who were not able to verbalise. Staff did not maintain people’s dignity and self-esteem.

When assisting people to eat, staff did not explain the food content or make conversation to enable a more pleasant experience. Some people were not supported to eat and drink sufficient amounts. People who were in the lounge during the day time were not offered drinks apart from set times. Medicines were not always administered safely.

Care plans were not person centred and were task focused. Records did not demonstrate a clear understanding of the Mental Capacity Act 2005. Not all people were properly assessed or monitored in terms of the risks to their safety and wellbeing.

Staff told us they received training however during the inspection staff did not demonstrate the necessary skills when communicating with people, infection control and the MCA 2005.

Staff had not received regular supervision with their line manager to discuss their performance or personal development. The manager told us they were in the process of implementing a new schedule of supervision dates. Staff told us they felt well supported by each other and the manager.

Quality assurance systems, governance and the audits in place had not identified shortfalls in the provision of the service and there was a lack of effective monitoring of the environment to ensure people were safe. There was no analysis of accidents and incidents to identify possible trends or triggers, to minimise further occurrences.

There was not a Registered Manager in post. The Registered manager had recently left the service and the deputy manager was “acting up” in the interim. Following t

We carried out a comprehensive inspection of this service on 14 November 2014. At which we found two breaches of the legal requirements of the safe and well led questions. This was because the provider had; failed to ensure that people who use the service and others were protected against the risks associated with the unsafe use and management of medicines. Some of the medicine records held were inaccurate.  In addition, the provider had failed to ensure that staff were suitable to work at The Haven. There were gaps in the employment history of staff, therefore the provider could not be assured they had full and accurate information upon which to base a decision to employ the person.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook a focused inspection on the 22 May 2015 to check that they had met their action plan for improvements.

At this inspection  we found a breach relating to the suitability of the current fire warning and detection system. We had also received information of concern relating to the care and wellbeing of people who live at The Haven.

This report only covers our findings in relation to the above topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Haven’ on our website at www.cqc.org.uk’

The Haven is a residential care home providing accommodation for up to 12 people, some of whom may have dementia. At the time of our inspection on 22 May 2015 there were ten people living at the home. The home is in a rural setting and set over two floors.

The home had a registered manager in place. 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.

The Haven is a care home which provides accommodation and personal care for up to 12 older people, some of whom have dementia. At the time of our inspection eight people were resident at The Haven.

This inspection took place on 14 November 2014 and was unannounced.

There was a registered manager in post at the service. 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.

The service did not have an accurate record of medicines they held for people and some medicines were not securely stored. This increased the risk that people’s medicines, including controlled drugs, may be misused.

The service did not have detailed information about the employment history of staff. This meant the provider did not have a history of where staff had been working, the reasons why they had left jobs in the health and social care sector or an explanation for any gaps in employment. 

Although the service carried out checks on how the home was operating, these were not always accurate. We found that shortfalls we identified during the inspection had not been picked up by checks the provider completed.  We recommended that the provider completed robust audits of the service provided, which identified any risks and planned improvements that were needed.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments included, “They treat us very well”; “The staff are lovely, they provide any help that I need” and; “We are very happy with the care provided, they couldn’t do things any better”.

Relatives told us they felt people were safe when receiving care and said they were consulted about people’s care needs. Systems were in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting. We saw that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received an induction when they started work at the service. Staff demonstrated a good understanding of their roles and responsibilities, as well as the values of the service. The staff had completed training to ensure they had the skills and knowledge to meet people’s needs.

The service was responsive to people’s needs and wishes. We saw that people’s needs were set out in clear care plans. These were developed with input from the person and people who knew them well. Relatives were confident that they could raise and concerns or complaints and they would be listened to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We found that the people who lived at The Haven were not all able to comment on the care they received due to their level of dementia, however as far as possible they were being consulted and supported in how they wished to lead their lives.

We saw that people's health and welfare needs were being met and the support they received was appropriate to their needs.

We found that people were being well treated and there were systems in place to protect them from possible abuse.

We found that staff received appropriate training and support to be able to meet the needs of people living in the home.

The home was clean, safe and well maintained and further improvements were being carried out.

We found that the quality of the service was being monitored and systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

We saw the Haven had a relaxed family atmosphere and people could choose how they spent their day. Staff were polite to people at all times, treating them with respect.

People said they liked living in the home and their needs were met. One person told us the home was “very nice” and a person who had recently been admitted told us “what I’ve had here is very good”. We saw staff supported people with dementia and who were frail in an appropriate manner.

The home was clean and staff followed safe practice in infection control. The provider had plans in place to further improve facilities for infection control.

The provider was recruiting more staff, to ensure people had the numbers of staff they needed to meet their needs.

People said they liked the home environment. One person told us “it looks nice”. The provider had an action plan to make improvements in the service, this involved consultation with people, their supporters and staff.