Havelock Court 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.

Havelock Court Care Home provides care and support to up to 58 people, many of whom have physical disabilities, HIV (human immunodeficiency virus), mental health needs and are living with dementia. On the day of our visit there were 58 people using the service.

At the last inspection, carried out on 15 and 19 June 2017, the service was rated GOOD.

This inspection was brought forward due to a number of safeguarding concerns raised in relation to medicines management at the service. This unannounced inspection was carried out on 22 January 2019 and we rated the service requires improvement overall. Their previous rating for the key questions, Is the service effective? and Is the service well-led? Has however deteriorated from good to requires improvement at this inspection.

The service had a registered manager 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.

During the inspection we found that the quality assurance processes in place were not always effective and the concerns we identified were not found during the auditing processes, including issues related to people's medicines, mental capacity assessments and DoLS notifications not being sent to CQC as required by law. We made a recommendation about this.

Staff were aware of potential risks to people and took actions to protect people from risk of abuse and incidents and accident taking place. The service followed appropriate staff recruitment processes to employ suitable staff to take care of people. However, during the inspection we identified some errors related to medicines management practices.

Staff had support to up-date knowledge and skills to ensure they carried out their duties in line with their role requirements. People’s nutritional needs were identified and met as necessary. Staff supported people to make everyday choices and they worked in partnership with the local authority to assist people in the decision-making process if they required help. However, the mental capacity assessments carried out by the staff team were not accurate and contradicted the principles of the Mental Capacity Act 2005 (MCA). Records also showed that call bells were not answered within the time frame that the provider considered appropriate.

People and their family members described staff as kind, friendly and caring. People had their religious and cultural needs identified and met by the staff that supported them. Staff knew people’s preferences and had time to have conversations with people which ensured that people were listened to. People were encouraged to carry out activities when they wanted to.

Care records included relevant information about people, including their social care needs. People and their relatives were involved in care planning and provided regular feedback about the service delivery. Regular group meetings were facilitated to gather people’s views about the changes they wanted to make. Although we saw people being encouraged to engage in conversations and use their preferred ways of communication, people did not always receive appropriate support to make food choices.

People, their relatives and the healthcare professionals told us there was good leadership at the service which ensured that actions were taken to improve where necessary. The service was led by a registered manager who we found transparent and caring about people’s wellbeing. The staff team were encouraged to develop and kne

We carried out a comprehensive inspection on 23 and 24 March 2016, were we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Havelock Court Care Home’ on our website at www.cqc.org.uk.

We undertook a focused inspection on 7 July 2016, where we found that the registered manager and provider had followed their action plan in respect of the breaches identified during our comprehensive inspection of March 2016. Despite meeting the legal requirements in relation to staffing and management support to staff we did not revise the rating for the key questions ‘Is the service safe?’ and ‘Is the service well-led?’ because to do so required a record of consistent good practice over time.

We undertook this unannounced comprehensive inspection on 15 and 19 June 2017 and found the provider had sustained the improvements put in place after our previous inspections of March and July 2016.

Havelock Court Care Home provides care and support to up to 60 people with mental health needs. The first floor caters for younger adults who are physically mobile. The second floor caters for older adults or those that are physically frail or have limited mobility. At the time of our inspection, 54 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [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 were safe at the service. Staff knew how to identify and report abuse because they had received training on how to protect people from harm. Appropriate safeguarding procedures were in place and were followed to keep people safe. Staff understood their responsibilities in relation to safeguarding and reporting concerns.

Risks to people were identified and managed. Staff had sufficient information about how to mitigate risks to people’s health and well-being. Positive risk taking was encouraged to support people to live an independent life as far as practically possible.

People were supported to take their medicines safely by staff trained and assessed as competent to do so. Staff followed the provider’s procedures and current practice when managing people’s medicines.

People received effective care from trained staff who were supported in their role. Staff had supervisions and appraisals to reflect on their performance. Personal development plans were put in place to address any knowledge gaps and skills.

People’s care was delivered in line with the requirements of the Mental Capacity Act 2005. People were asked for their consent before care was provided and staff respected their decisions. Relatives and healthcare professionals were involved in best interests meetings to support people who were unable to make decisions about their care. People enjoyed their freedom in adherence with the restrictions placed on them by the Deprivation of Liberty Safeguards.

People enjoyed the food provided at the service and their nutritional and dietary needs were met. Refreshments, fruits and snacks were available. Staff supported people to access healthcare services and to maintain good health.

People’s needs were assessed with their involvement and that of their relatives and healthcare professionals when appropriate. Care plans reflected people’s individual needs and preferences. People received individualised care in a manner they preferred. Staff respected people privacy and promoted their dignity.

People were encouraged to pursue their interests and supported to access the community. People knew how to make a complaint. Complaints were resolved in line with the provider’s p

We carried out an unannounced comprehensive inspection of Havelock Court Care Home on 23 and 24 March 2016 at which we found a breach of regulation. At this inspection, we found that people had not always received safe and appropriate care. The service did not always have sufficient staff on duty to meet people’s needs safely. The procedures for the service to follow in an emergency to ensure there were sufficient and suitable staff deployed to cover both emergency and the routine work of the service were not robust.

Due to our concerns and the breach of regulation we issued a warning notice which the provider and the registered manager were required to comply with by 30 June 2016.

We undertook a focused inspection on 7 July 2016 to check that the service now met the legal requirement. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Havelock Court Care Home’ on our website at www.cqc.org.uk.

Havelock Court Care Home is a care home with nursing. The service provides personal care and nursing care to older people, those living with dementia and mental ill health. The service can accommodate up to 60 adults. 58 people were using the service at our inspection on 7 July 2016.

At our focused inspection on 7 July 2016, we found the registered manager and provider had followed their plan and met the legal requirements in relation to staffing. We saw staffing levels had been reviewed and increased. The registered manager ensured there were sufficient staff to meet people’s needs safely. Staff responded to call bells and people’s requests promptly and spent time engaging people in conversation and activities. There were enough staff to enable them to complete their duties in an unhurried manner.

At our previous comprehensive inspection on 23 and 24 March 2016, we found some staff felt unable to approach the registered manager and felt unsupported in their role. The staff told us they felt their concerns were not taken seriously. At this inspection of 7 July 2016, we found the provider and the registered manager had increased their engagement with staff. Staff told us they felt their relationship with the registered manager and management continued to improve and said their concerns were being addressed.

This unannounced inspection took place on 23 and 24 March 2016. Havelock Court Nursing Centre is a care home with nursing. The service provides personal care and nursing care to older people, those living with dementia and mental ill health. The service can accommodate up to 60 adults. 58 people were using the service at the time of our inspection.

A registered manager was in post at the time of our inspection. 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 previous inspection of the service took place on 3 January 2014. The service met all the regulations we checked at that time.

We identified that the provider was not meeting regulatory requirements and was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, we found that people had not always received safe and appropriate care. There were not always sufficient staff on duty to meet people’s needs safely. The provider used a robust process to recruit staff suitable to support people at the service. Staff assessed and reviewed people’s needs and put plans in place to support them. Staff had identified risks to people’s health and had sufficient guidance on how to manage those risks safely.

Staff knew how to protect people from abuse and neglect. People told us staff were kind and caring. Staff upheld people’s dignity and respected their privacy. Staff knew people well, understood their communication needs, and provided them with the support they required. Staff promoted people’s health and provided them with support that reflected their choices and preferences. People received the support they required to take their medicines safely. Medicines were securely stored and administered in line with people’s prescriptions.

Staff involved people and their relatives where appropriate in the planning and delivery of their care. Staff understood their role in line with the requirements of the Mental Capacity Act 2005 (MCA) and ensured people consented to the care and support they received. The registered manager ensured decisions were made in people’s ‘best interests’ if they were unable to do so. Staff upheld people’s rights and appropriately supported those whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards (DoLS).

The provider supported staff to develop their skills and knowledge to meet people’s needs. Staff received relevant training in caring for people and received clinical supervision. Staff discussed their learning and development needs in regular one to one meetings and action was taken to address any knowledge gaps. Staff received the support they required to develop their knowledge and skills by attending in-house and external training organised by the provider. The service held regular staff meetings.

People took part in individual and group activities that they enjoyed at the service and in the community. The service worked in partnership with healthcare professionals to ensure people receive appropriate care and treatment. People enjoyed the food provided at the service.

The service valued people’s and their relatives’ views and opinions about the service and acted on their feedback to develop their support and care. People knew how to make a complaint and felt confident to raise a concern with the registered manager or staff.

The provider was in the process of recruiting more nursing and care staff. Staff morale varied at the service and the spirit of good teamwork was not shared by all. Some staff felt management did not listen to their concerns and were not confident the provider took note of their issues seriously. There was an atmosphere of distrust

The majority of people we spoke with told us they enjoyed staying at the service and appreciated the support and care they received from the staff.

People received care and support that was tailored to their individual needs. Assessments were undertaken and care was planned to ensure the safety and welfare of people using the service.

A choice of nutritious meals was available and people were able to request meals to be added to the menu. The service was able to cater for people’s cultural preferences.

The provider worked with other health and social care professionals to ensure people’s needs were met. There was regular input from a GP, dentist, and chiropodist. Specialist advice was available through referral to dieticians, occupational therapy and tissue viability services.

People told us they felt safe at the service. Staff were knowledgeable in recognising signs of potential abuse and were aware of the safeguarding vulnerable adults reporting processes.

There were processes in place to monitor and assess the quality of service provision. There were a number of audits and meetings in place to review service delivery.

During our inspection we spoke with six people who use the service and their representatives, and five staff members. We reviewed four care plans.

People who use the service told us, “I like being here“ and the staff were “helpful and happy people.” Another person told us, “No matter how busy the staff are they will come and help you.”

People’s diversity, values and human rights were respected. One staff member told us when they started they were introduced to people using the service and told about their likes and dislikes, what they can do for themselves and what support they need.

Care and treatment was planned and delivered in-line with individual needs. The provider had started to work towards the Gold Standards Framework in order to further strengthen their end of life care.

Training programmes, supervision and appraisal systems were in place to support workers, and to enable them to maintain skills and increase their knowledge to support people using the service. Staff told us, “The training is so good. You get lots of training.”

An effective quality checking process was in place with regular auditing of key elements of service provision. The electronic system allows for analysis of incidents and complaints.

Some of the people spoken with were cognitively impaired or restricted by short term memory loss. Those unable to talk indicated by gesturing and through body language that they were comfortabe in the home. All those living at Havelock Court appeared well cared for, and showed an interest in their appearance.

People were at ease when talking to staff and told us that they were happy with the care and support provided at the home.

People spoken with were complimentary about the home, the following remarks were a sample of those received, " I spent most of my life in hospitals so far and was often unhappy, my life here is so much better and I feel appreciated by the staff", " I feel supported here and staff are great, they understand why my memory is poor and that I repeat myself", "There are many actiivities for me to enjoy and it is homely place to live".

Staff morale was good, staff said that the training and direction given by the management team gave them enthusiasm for the work.

External health professionals told us that staff were demonstrating in practice the guidance and recommendations made by professionals.