This inspection took place on 8 and 10 September 2015, and was in response to concerns raised by staff and relatives about the quality of care provided. The inspection was unannounced.
Haven Nursing Home is a large nursing home which provides nursing care for a maximum of 70 people in three units. People whose primary care need is dementia, are mainly supported in Birch Unit. Older people and people with more complex nursing needs are mainly supported in Oak and Elm units. At the time of our visit there were 64 people living in the home.
The service did not have 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. The registered manager left the service at the end of May 2015. Since then, two other managers had been appointed and left. The last one had worked for the provider for five weeks and left suddenly. We were concerned about the high turn-over of managers at the service, and the lack of leadership from the provider in relation to the monitoring of the quality of service provided. The provider had arranged for an interim manager from a consultancy agency to work at the home to provide management cover.
The provider of the service has a history of non-compliance with regulations and any improvements made in relation to the quality and safety of service people receive have not been sustained.
Staff were not always available at the times people needed them, and gaps in the planned staff rota were being filled with agency staff. The use of agency staff to cover staff vacancies meant people were not provided with continuity of care by staff who knew them well. There was no clear process used by the provider to determine the number of staff required. The provider did not provide sufficient staff to meet the needs of people, or take account of the size and layout of the building.
Staff were kind and tried their best to provide care. However, staff interaction with people was when supporting them with care tasks. We saw little involvement between staff and people at any other time of the day. There were limited opportunities for people to be involved in social activities, particularly for people living with dementia and who had been identified as having behaviours which challenged.
People who were independent received food and fluids which met their nutritional and hydration needs. We were concerned that people who received a pureed diet did not have the choice that other people had.
The personal care provided did not always meet people’s preferences or expectations. Most people only received a shower once a week and records showed that many were not supported to have a wash at night or their teeth cleaned. Care provided was task orientated and not tailored to the needs of each individual (person centred care).
People did not feel their concerns were listened to. We could not see an accessible policy to inform people how to complain about the care provided. The records of complaints investigations did not provide the outcome of the investigations.
Since our last visit, staff at the service had applied to the local authority for some people who required a Deprivation of Liberty Safeguard in order to ensure people’s liberty was being lawfully restricted. However, we could not be certain that applications had been submitted for everyone who had restrictions on their liberty. We were concerned that people had been restrained through the use of ‘as required’ medication and bedrails were used without consideration of whether this was in people’s best interest or the least restrictive option.
Relatives and friends were able to visit the home at any time of the day.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
You can see what action we told the provider to take at the back of the full version of the report.