Archived: New Haven Care Home

Updated 6 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

New Haven Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. New Haven Care Home is a care home with nursing care however they do not currently provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were 2 registered managers in post. During the inspection, 1 of the registered managers cancelled their registration with us.

Notice of inspection

This inspection was unannounced on the first visit and announced on the second visit.

What we did before the inspection

We reviewed all the information we had received about this service since its last inspection in 2020. We requested feedback from stakeholders, including local safeguarding, infection control and commissioning teams. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity which took place on 14 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and 4 relatives about their experience of care provided. We gathered feedback from 21 staff members including 2 registered managers, the deputy manager, the provider, the nominated individual and care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked around the building and observed people being supported.

We reviewed a range of records including 8 people’s care plans and risk assessments. We reviewed 16 medicines records. We looked at 3 staff files in relation to recruitment. We reviewed a variety of records relating to the management of the service, including policies, action plans, compliance reports and quality assurance records.

We had a meeting with the registered manager, nominated individual and provider during the inspection to discuss concerns in relation to safe care, consent, staffing and governance. We made a second site visit following this meeting to review further information. We shared our concerns with the local safeguarding, infection and prevention control and commissioners of care teams.

Updated 6 January 2023

About the service

New Haven Care Home is a residential care home providing accommodation for up to 50 people, who require personal care. The service provides support to people who have physical health needs and conditions such as dementia. At the time of our inspection there were 37 people using the service, this increased to 39 by the end of the inspection.

The home is set out across 3 floors, one floor was dedicated to providing care for people living with dementia. Two floors contain communal areas and each bedroom has an en-suite. There is also a hairdressers and beauty space available for people.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found people being deprived of their liberty without the principles of the Mental Capacity Act being followed. This practice was addressed by the registered manager during our inspection.

We found people were at risk of harm as medicines and risks associated with people’s care were not safely managed. Risk assessments and care records for people were either not in place or not reflective of people’s needs. We found staff and the management team were not always assessing risks and reporting incidents appropriately.

The provider was not actively involved in the running of the service and we found no evidence of provider audits. The provider hired a consultancy firm to complete periodic reviews and provide support at the service, however the provider had not acted on concerns raised by the consultancy. The head of the consultancy firm was the nominated individual of the service and was not completing audits on behalf of the provider.

The shortfalls from previous inspections had not been adequately addressed. There was a new registered manager in post at the service who had identified multiple concerns with poor care and was actively working to improve people’s experience. The governance processes in place had been implemented by the new registered manager but needed embedding in practice.

We found staff were not knowledgeable about mental capacity, consent and dementia care. The consultancy firm confirmed they would provide additional training after the inspection.

We found staff were not always reporting safeguarding concerns to the management team and potential safeguarding concerns were not always appropriately reviewed by the management team.

People, relatives and staff raised concerns about staffing levels. We saw some positive interactions between staff and people; however, people were not always supported in a timely manner and staffing was not calculated in line with people’s needs. The registered manager was actively working to improve the dining experience for people.

Feedback from staff was mostly negative about the culture of the service and the support they received.

People and their relatives told us they felt people were safe. Recruitment was managed safely. Staff were trained in safeguarding and some staff could give examples of different types of abuse. The service was well maintained providing a spacious and hygienic environment. People and relatives spoke positively about the care provided by care staff. We saw evidence of and gained positive feedback from visiting professionals around good partnership working to meet the needs of people living at the service.

The registered manager and consultancy firm were responsive to our inspection findings and responded during the inspection. We received updates about what actions they were taking to address concerns.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 March 2020) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations and found new breaches of regulation. This service has been rated requires improvement for the last 2 consecutive inspections and is now rated inadequate.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received in relation to the management team at the service. As a result, we undertook a focused inspection to review the key questions safe, effective and well-led. The provider has taken action to mitigate some of the risk identified at this inspection. Please see the safe, effective and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Haven Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent, staffing and good governance. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.