We carried out an unannounced comprehensive inspection of Haven Court on 25, 27 and 28 June 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.At the last comprehensive inspection of the service on 14, 16 and 22 March 2017 and the home was rated as ‘Requires Improvement’ overall. We identified breaches of regulation 12, safe care and treatment, and regulation 17, good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the key questions of safe, effective, responsive and well led as ‘requires improvement’. The provider did not have safe and effective systems in place in relation to people’s medicines. The provider also failed to ensure that there was an effective system in place to monitor the quality and safety of the service.
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 of safe, effective, responsive and well led to at least good. At this inspection we found sufficient improvements had been made to address the key question of effective and responsive but the home continued not to meet all the fundamental standards we inspected against for the key questions of safe and well-led. This is the second time the service has been rated requires improvement.
Haven Court is a 'care home' located in South Shields. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate 80 people in one adapted building and on the date of this inspection there were 54 people living at the home.
During this inspection we found a breach of regulation 12 (Safe care and treatment), 15 (Premises and equipment), 17 (Good governance) and 20A (Requirement as to display of performance assessments) of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents. This was because the provider had not adequately assessed the risks to the health and safety of people using the service, the premises were not safe, there was no robust overarching governance framework in place, renewal applications for the Deprivation of Liberty Safeguards (DoLS), safeguarding incidents and serious injuries were not notified to the Commission,
You can see the action that we have asked the provider to take at the back of the full version of this report.
At the time of the inspection was no registered manager in post and we were supported by the home’s quality and patient safety coach. A registered manager is a person who has registered with the CQC 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 told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The management team continued to provide on-going training for staff and monitored when refresher training was required. Staff had received training in end of life care and the service worked closely with partnership agencies to deliver this when required.
Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. We observed that there were enough staff on duty to support people appropriately in line with their assessed needs.
During our inspection we found that the premises were not safe for people living at the home. We found windows on the ground and first floor did not have restrictors in place or were locked closed. Fire doors stating “keep locked” were open, the laundry room was open for people to access, the clinical waste bin was open, kettles containing boiling water were left unattended in communal areas, pull cords were propped out of reach, sharp items in communal areas, substances that may have caused damage to people’s health were not securely stored.
Infection control measures were in place and the service was clean. We saw domestic staff cleaning the home regularly during inspection.
The home provided safe medicine management. Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. There were records regarding other professionals involved in people's care. People’s medicine care plans completely documented all the information needed to fully support people.
People were supported to maintain a balanced diet and we saw people had access to a range of foods and fluids throughout the day. Relatives and people told us that they were pleased with the range of food provided. We observed that at times people waited for long periods of time for their meals to be served. Food and fluids were easily accessible to people who were at risk of aspiration and choking or who had special dietary requirements.
The premises were not always 'dementia friendly '. There was some pictorial signage to help people orientate themselves. Bedrooms did not have personalisation.
The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. Staff demonstrated their understanding of the MCA.
We saw staff asking people for consent when supporting and asking for people's choices for meals and drinks. Staff treated people with dignity and respect. They showed kind and caring attitudes and people told us the staff spoke nicely to them. We observed people enjoyed positive relationships with staff and it was apparent they knew each other well. People and relatives knew how to raise a complaint or concern. There was information on how to make a complaint displayed within the service and this was accessible to everyone. Feedback was sought from people, relatives, staff and visitors to help continuously improve the service.
People had person-centred care plans and risk assessments in place to keep them safe. People, relatives and external health professionals were all involved in best interest decisions and mental capacity assessments. People's care records were accurate and up-to-date.
The management team had a clear vision to care for people living at the home. Staff told us that they could approach the quality and patient safety coach or deputy manager if they needed support or guidance. Relatives said that they were always welcome at the service. The quality and patient safety coach and deputy manager carried out checks and audits of the service but these were not always documented. The provider did not have a thorough governance framework in place to monitor the quality and assurance of the home.
People had access to a variety of meaningful activities and were able to enjoy social activities within the service. There was a large garden area and a coffee shop for people, relatives and visitors to access.
People’s privacy and dignity was respected by staff. During the inspection we observed staff asking people discretely if they could carry out personal care and if they required support. The service promoted advocacy and there was accessible information available detailing what support people could access to help make choices about their individual lives.