About the service:

Haven Lodge is a residential care home that was providing personal care to 28 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People told us they felt safe and staff were able to recognise and knew how to report signs of possible abuse. Risk was safely managed with personalised assessments and detailed guidance for staff to follow.

Staffing levels were sufficient to ensure people’s needs were met promptly. Staff were caring and kind in their approach, and clearly knew people well. They told us, and we saw, records of regular training to ensure they were adhering to current best practice models. Staff worked well as a team.

Medicines were managed safely and infection control measures were robust.

People were supported and encouraged to eat and drink regularly and accessed external support services as needed. There had been a significant improvement to the building and this was part of a wider refurbishment programme which people told us had improved the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Privacy and dignity were promoted and respected at all times.

Although structured activities were limited, people said they had enough to do and appreciated when events did take place. Care records were personalised and provided current information about support offered to people.

The registered manager provided robust and sound leadership, which was supported with a comprehensive quality assurance system. People and staff were happy to live and work at Haven Lodge. All of the changes which had begun at the previous inspection were now fully implemented and embedded in service delivery.

Rating at last inspection: Requires Improvement (report published April 2018)

Why we inspected: This was a planned inspection based on the rating at the previous inspection. The service had previously been in breach of one regulation but at this inspection we found improvements had been made.

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

The inspection of Haven Lodge took place on 5 and 7 February 2018 and was unannounced. The previous inspection in July 2017 had rated the home as inadequate and it was placed in special measures. Six breaches of regulation were found, three of which resulted in warning notices for safe care and treatment, governance and staffing. The other three breaches were in relation to consent, nutrition and equipment and resulted in requirement notices. The provider completed an action plan to show they were going to address the concerns raised and during this inspection we looked to see if these improvements had been made.

Haven Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Haven Lodge accommodates 32 people in one adapted building, in single rooms. During this inspection 27 people were living in Haven Lodge.

There was a new manager in post who was in the process of registering with the Care Quality Commission. 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 and their relatives were keen to tell us about the improvements made since the previous inspection. The appointment of a new manager was a significant part of this as they were visible and open to addressing any issues. The atmosphere in the home was positive and staff, for the most part, were calm and supportive in their approach.

People told us they felt safe and staff knew how to report concerns to the manager; confident they would be addressed and monitored. Learning from concerns was shared with all staff. Although there were still areas which needed further development, it was clear the groundwork had been laid to establish better outcomes for people.

Risks were more constructively managed, although some documentation needed further cross referencing with people’s care needs. Moving and handling practice had improved and staff appeared confident in the techniques required. All staff had received further training in this area.

Staffing levels were more appropriate to meet people’s needs and further recruitment checks were in the process of being made to ensure all were in place as required.

Medication administration practice had improved although there were some minor issues. These were addressed promptly by the manager who was keen to ensure best practice. Infection control was also subject to further improvement and staff had received additional support in this area.

The manager was aware of guidance and how to follow it. They were in the process of ensuring compliance with the requirements of the Mental Capacity Act and showed what work they had undertaken so far. There was more to be completed, but it showed an understanding of the process and requirements. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Nutritional and hydration needs were better met for people with clearer documentation in place. Staff had access to food and fluid charts which were completed in detail and a system had been developed which ensured any risks were flagged up on a daily basis. However, not all staff were aware who was at nutritional risk. We saw action where concerns were raised was both prompt and appropriate, with referrals made to other health and social care services as necessary.

Staff were compassionate, caring and kind in their approach, and apart from one instance which was immediately dealt with, respected people’s privacy and dignity. Relatives were invited to sh

The inspection of Haven Lodge took place on 11 and 13 July 2017 and was unannounced. The home had previously been inspected in January 2016 and was rated good.

Haven Lodge provides accommodation and personal care for up to 32 people in single room accommodation. The home is located in the village of Normanton on the outskirts of Wakefield. The home has accommodation over two floors, accessible by stair lifts. Communal lounges, a dining room and bathing facilities are all provided. There is a small garden to the rear of the building. There were 32 people resident in Haven Lodge on the days we inspected.

There was a registered manager in post and they were available on both days of the 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.

People and their relatives told us they felt safe and staff knew how to support them safely.

We found serious issues with the assessment and management of risk, as documentation did not provide sufficient guidance for staff in how to minimise the likelihood of harm. Not all staff appeared confident in moving and transferring people safely and we observed some poor practice.

Staff were stretched as on the first day one care worker was off sick and the registered manager spent part of the day shopping for groceries for the home. People displayed high dependency needs and many needed the assistance of two staff to transfer safely, but this was not reflected in staffing levels.

There were numerous issues with medication including administration, storage and record keeping. Where issues had been noted, it was not evident they had been addressed and audits proved inaccurate tools to assess competence.

Supervision and training was available to staff although some of this had been acquired with previous employers. Recruitment checks also raised issues as these were not followed up appropriately.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

There were issues in the home for the support of people with nutritional needs as staff were not aware of how to support effectively, and guidance from dieticians was not always followed.

People were able to access external health and social care support as required.

Staff were caring, kind and compassionate despite being under considerable pressure. They acknowledged people and spoke fondly to them, engaging in conversations where time allowed.

People and relatives felt included in decisions about their care although the written evidence was not always evident.

Activities were non-existent as staff were unable to offer extra support as they were too busy providing care support. People and relatives did speak positively of options usually available.

Care records provided contradictory information or in some cases, not enough to minimise risks to people. Evaluation records, although completed, did not always reflect changes in people’s needs.

Complaints were handled well.

The home had a pleasant and friendly atmosphere which was evidenced in the positive interactions between people and the staff.

The registered manager was new to their role and appeared to lack experience. Due to the number of concerns we identified we found the overall management and leadership lacking as staff needed support but did not receive it and the quality assurance processes were not effective as issues were not addressed or actioned.

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

The inspection took place on 12 January 2016 and was unannounced. We returned again on 20 January 2016 and this was announced. The service had previously been inspected in June 2015 and this had identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) regulations at that time. We found at this inspection the provider had taken all necessary actions to improve the quality of care.

Haven Lodge is registered to provide accommodation and personal care for up to 32 people. There were 32 people living at Haven Lodge at the time of our inspection.

Accommodation at the home is provided over two floors, which can be accessed via stairs or a stair lift.

At the time of our inspection 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The home provided a friendly, welcoming environment for people. Some parts of the home were in need of maintenance, such as the ceiling in the lounge that was damaged in recent weather, and bedroom furniture that was worn. The registered manager was aware of the improvements that were required.

People told us they felt safe and staff demonstrated safe practice. Staff understood how to ensure people were safeguarded against the risks of abuse.

People who needed assistance to mobilise were supported safely, although their moving and handling plans were not always sufficiently detailed.

Medicines were managed safely and people received their medicines on time.

The home was clean and there were no malodours. Staff understood how to prevent the spread of infection, although procedures for emptying and disinfecting commodes were not always suitable.

Staff were well supported to carry out their roles and had suitable opportunities to update their skills and professional development.

Staff had a secure understanding of the impact of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People enjoyed the meals, snacks and drinks. People’s dietary needs were catered for appropriately, although some people said they were not always offered a drink upon waking first thing and had to wait for breakfast.

People’s dignity and rights were promoted well and they were treated respectfully. There were good relationships between staff and people living in the home and staff were kind and patient in their approach.

People said they felt included and involved and there was evidence of person centred care; people said their care was how they wanted it to be.

Care records were up to date, although where people’s needs had changed it was not always evident they had been referred to other professionals, such as for specialist seating assessments.

People and relatives we spoke with understood the complaints procedure and said staff and managers were approachable for them to raise any matters for discussion. Complaints had been responded to appropriately.

There was evidence of effective teamwork and everyone we spoke with said they felt the home was well run. Communication was clear so all staff understood people’s needs. Systems and processes to underpin the safe running of the home were in place. Areas in need of improvement were identified, such as premises/equipment refurbishment, and there were action plans in place.

At the time of our inspection there were 18 people residing at Haven Lodge.

We spoke to two residents and two relatives to gain their views of the service. One resident told us “I’m never bored, I like everybody and I’m happy here.”

The relatives we spoke with told us they were happy with the care provided at the home and one relative told us “they take care of people rather than sit them in a chair in front the TV.”

Residents spoken to were happy with the cleanliness of the home and one resident told us “Yes, it’s always clean and tidy.”

We spoke with two staff members who were both confident that they could raise any issues or concerns with management. One staff member said “there have been a lot of positive changes.”

One person said they like living in the home, they like their rooms and the people looking after them. Another said the staff are very good and they listen to what the have to say. One person said the meals are very good and they have a choice and get enough to eat and drink. One visiting relative said they are generally pleased with the care the home provides. One person complained that they could not sit where they usually sit because the main lounge is been decorated as the roof has had a leak.

People say they like living in the home. One person said they are well looked after and ‘the girls are wonderful’. Another said they have lived in the home for a number of years and never had any problems.

People say they like the people caring for them. One person said the carers are very good and very caring. Another says ‘there is always someone there when you need them.

People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them. One person said the staff are very good and listen to what they say.

People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them.

This inspection took place on 1 & 4 June 2015 and was unannounced. At the last inspection in May 2013 we found the provider was meeting the regulations we looked at.

Haven Lodge is a care home registered to provide personal care and accommodation for up to 32 older people. The service had 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.

At this inspection we found people were generally happy with the care they received. People felt staff were caring. We saw people received good support during the inspection and enjoyed the company of staff.

People told us they felt safe and didn’t have any concerns about the care they received. However, there was a risk to people’s safety because safeguarding procedures were not always followed.

Some incidents between people who used the service had not been reported to the appropriate agencies. Other safeguarding incidents were reported and staff had a good understanding of safeguarding processes that were relevant to them. Medicines were not always managed consistently and safely.

People made day to day decisions such as choosing when to get up and go to bed. However, the provider did not always meet legal requirements because they were not robustly checking people were consenting to care and treatment. People’s care was not always planned to meet their individual needs and preferences. Care records did not sufficiently guide staff on people’s care.

People enjoyed a range of social activities and had good experiences at mealtimes. People’s health needs were met.

The provider had increased staffing numbers to help ensure there were enough staff to keep people safe. In the main, robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff felt supported but the arrangements for supervising and appraising staff required improvement to ensure staff development was reviewed and training needs were identified.

Systems for checking that people received safe quality care were not always effective. People told us they would feel comfortable raising concerns or complaints. People provided positive feedback about the registered manager.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.