This comprehensive inspection was unannounced and took place on the 5 and 6 September 2018.

At the last inspection carried out on the 19 April 2017 three breaches of regulatory requirements were identified in relation to Regulation 12 [Safe care and treatment], Regulation 17 [Good governance], and Regulation 20 [Duty of Candour]. The service was not rated as this was a focused inspection. In line with our methodology at the time we did not award a rating or change the previous rating because we were not able to make judgements about all aspects 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.

At this inspection, we found improvements had been made and the service is rated as ‘Good’ across all domains.

Haven Lodge is a care home which provides accommodation, personal care and nursing for up to 50 older people who may also be living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 50 older people including people living with dementia in one adapted building comprising of two units. One of the units specialises in providing care to people living with dementia and mental health needs whilst the other provided for people who were physically frail and or receiving palliative, end of life care. At the time of our inspection there were 36 people living at the service.

There was 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.

People said they were safe and had no concerns about the care and treatment they received. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Risks to people’s safety had been assessed and guidance provided for staff with steps to take to mitigate the risk of harm.

Effective recruitment processes reduced the risk of unsuitable staff being employed. There were enough staff available to meet people’s needs. Training and supervision systems provided staff with the support, knowledge and skills they needed to carry out the role for which they were employed.

People's nutritional needs were met and people were supported to have enough to eat and drink. A range of external health care professionals worked with the staff team to support people to maintain their health and well-being.

People were supported to have choice and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Care plans were personalised and gave staff guidance on the care and support each person needed. People were encouraged to participate in a range of varied group and personalised activities.

People and relatives spoke positively about the management team. A number of audits and checks were used to ensure the effectiveness, safety and quality of the service.

People and their relatives were given opportunities, such as meetings and annual satisfaction surveys to give their views about the service and comment on how it could be improved.

Further information is in the detailed findings below.

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We carried out an unannounced inspection of this service on 23 August 2016. After that inspection we received concerns in relation to ineffective monitoring of healthcare needs for people who had a catheter, including identifying when a person's needs had deteriorated and taking necessary action. As a result we undertook a focused inspection to look into those concerns.

A focused inspection differs from a comprehensive because it is more targeted and focuses on areas relevant to the information received. Focused inspections do not usually look at all five key questions. We have not awarded a rating or changed the previous rating because we are not able to make judgements about all aspects of the service, which we must do in order to award an overall rating. We will return to the service to review improvements.

This report 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 Haven Lodge on our website at www.cqc.org.uk

Haven Lodge is a residential and nursing home that provides care for up to 50 people who are elderly and frail with complex needs, including dementia and/or nursing related needs. There were 43 people using the service at the time of this inspection.

There was 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.

We found that moving and handling practices were not managed safely and people were placed at potential risk of harm. Hoist slings in use to move people were not compatible with the type of hoist being used. Staff were observed using the wrong sized hoist slings which placed people at risk of discomfort or falling. Risk assessments and plans for people did not clearly specify the type of hoist and the correct type and size of sling each person required.

This was brought to the immediate attention of the registered manager. Following the inspection the registered manager informed us that action was taken to address this issue. Person-centred assessments were undertaken for each individual and plans put in place to adequately cover their moving and handling needs. We were told that each person has been provided with their own sling which is the correct size and compatible with the hoist they require, ensuring their comfort and safety.

In response to an incident where a person died, the provider had not met the requirements of Regulation 20 Duty of Candour and therefore did not promote a culture of openness and transparency. This included the actions they should have taken following the incident including investigating it, keeping the person's representatives informed of the investigation (on going or pending) and providing an explanation and/or apology including any lessons learned.

Action had been taken to ensure the wellbeing of people requiring a catheter to maintain their continence needs. Staff had received training on catheter care and maintenance to ensure people’s continence needs were supported safely. All catheter care interventions were clearly recorded. Care staff were aware of the importance of recording individuals’ fluid intake and fluid output and recording had improved. There were systems in place to check records were being completed and people’s daily fluid balance was monitored.

You can see what action we told the provider to take at the back of the full version of the report.

Haven Lodge provides accommodation and personal care for up to 50 people, some living with dementia, physical disabilities or require end of life palliative care. The service is provided over two units where people are placed dependent on their primary care needs. The first floor is Speedwell Unit providing nursing care for people with physical frailty or with palliative care needs and the ground floor is Mayflower Unit for people who require nursing dementia care.

There were 37 people living in the service when we inspected on 23 August 2016. This was an unannounced inspection.

There was a registered manager in post, who was also a provider. 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 there was sufficient staff to meet people’s needs. However some people, relatives and staff raised concerns about the staffing levels in the service. We have recommended the service reviews their staffing arrangements including the assessment and deployment to ensure that people were provided with their personal care needs when they needed it.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments provided guidance to staff on how risks to people were minimised. There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely.

The recruitment of staff was done to make sure that they were suitable to work in the service and people were safe. Staff were trained and supported to meet the needs of the people who used the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner. People and/or their representatives were involved in making decisions about their care and support.

People were provided with personalised care and support which was planned to meet their individual needs. People were provided with the opportunity to participate in activities which interested them. A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open and empowering culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

Prior to our inspection we had been told about safeguarding issues by the service and the local authority safeguarding team, who are responsible for investigation such concerns. At the time of our inspection some of these issues were still being investigated. Once we have received the outcomes to these we will consider our regulatory response. We carried out this inspection to check that the people who used the service were provided with safe and effective care.

We spoke with nine of the 47 people who used the service. We also spoke with the registered manager, the deputy manager and three staff members. We undertook a short observation inspection (SOFI) on the ground floor of the service where people who were living with dementia were accommodated. This assisted us to observe people's wellbeing and staff interaction. We looked at five people's care records. Other records viewed included staff training records, meeting minutes and satisfaction questionnaires completed by the people who used the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the deputy manager looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant staff have been trained to understand when an application should be made, and how to submit one. The service were aware of the recent changes to DoLS following a supreme court ruling in March 2014. They were able to demonstrate the actions that they were taking as a result of this.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw the staff rota which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "It is very good." Another person said, "It is very nice here, very nice indeed."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "They (staff) are all kind."

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and dietician.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Following recent concerns and safeguarding we saw that the service had taken action to reduce the risks of similar incidents happening again.

We spoke with nine people who used the service about their experiences of the care and support they were provided with. People told us that they were happy living in the service. One person said, “I am happy, it is lovely.” Another person said, “I am looked after very well.” Another said, “I have no complaints, it is very nice.”

We spoke with four visitors to the service who told us that they were happy with the care and support their relatives or friends were provided with. One person's relative said, "I would fully recommend it to anyone. (Person) is looked after, I would not want (person) to live anywhere else."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We found that people were provided with a balanced and varied diet to meet their nutritional needs.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service. Checks were made on staff before they started work to ensure that they were able to work with vulnerable people.

We found that people were provided with a clean and well-maintained environment to live in. Checks were undertaken on equipment in the service, such as lifting equipment, to ensure they were safe and fit for purpose.

People's complaints and comments were listened to and acted upon.

We spoke with six people who used the service. They told us that they were happy with the care they were provided with, that the staff treated them with respect and listened to them and acted on what they said. One person said, "I get everything I need, I could not ask for more." We asked another person if the staff treated them with respect and they answered, "Oh definitely." Another person said, "I can do most things myself." We asked them if they felt that the staff respected their independence and they answered, "Yes they do." Another person said, "I have no complaints."

We saw that staff were attentive to people's needs. Staff interacted with people in a respectful manner.

We looked at the care records of three people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Relatives who completed surveys as part of the home’s own quality monitoring process made positive comments about the food, staffing, how staff care for people, the environment and cleanliness.

These comments included:

“X never leaves anything on [their] plate. Food is excellent”, “I don’t see my [relative] as often I would like, but I am there at meal times and the food looks good” and “The food is great. My [relative] loves all of it especially the home made cakes”.

“My family and I have every admiration for staff and cannot fault anything”, “Staff always friendly” and “All the staff are very welcoming”.

“Although my [relative] can not communicate, the staff are aware of [their] preferences and know how [they feel]”, “My [relative] doesn’t speak very much and wouldn’t ask for anything so awareness of staff is essential” and “I attend a meeting once a month”.

“Excellent. The cleaners are all very hard working and friendly” and “Many improvements recently, i.e. decoration, visual aids and pictures etc”.

During our visit on 22 March 2011 we observed that people were being cared for in a respectful and manner. We saw that staff were attentive to people’s needs and interactions were appropriate. We also saw that people were enjoying their lunch and people with whom we spoke said that the food was good.

People also told us they are well looked after at Haven Lodge and they are treated well.