Havencroft Nursing Home is registered to provide accommodation and nursing care for up to 32 people. There were 24 people living at the home at the time of our inspection.

This inspection took place on 10 January 2017and was unannounced.

A registered manager was in post but was not at work on the day 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.

People felt safe living at the home and felt safe when staff supported them. Staff were able to identify signs of abuse and knew how to reports concerns of abuse. Staff were aware of people's needs and took appropriate action to assist in reducing risks to people's safety and wellbeing were minimised. Staff were aware of action they needed to take in the event of an accident or incident and there were systems in place to prevent reoccurrence.

People’s individual needs were supported by the availability of staff to meet needs throughout the day and night. The registered manager kept staffing levels under review and made sure staff absences were filled. The provider ensured safe recruitment procedures were followed to assist in making sure prospective staff were suitable to work with people before they started work with them.

People were supported to take their medicine as prescribed and there were safe systems in place for the storage and disposal of medicine. Staff understood people's care needs and how to support them effectively. They were provided with training to ensure they had the skills and knowledge to effectively meet these needs. Staff felt they supported each other and worked well as a team in order to effectively and safely meet people's needs.

People received the care and support they wanted. Staff respected and knew people’s preferences in how they wanted their care needs met. People were involved in making decisions and giving consent to their own care. When people could not make their own decisions their rights were protected. Where decisions were made on people’s behalf these were made in their best interests.

People were treated with kindness by staff who respected people’s privacy and encouraged to remain as independent as possible and treated them with dignity and respect. Staff helped people to keep in contact with relatives and friends who were important to them.

People were supported with fun and interesting things to do. The provider had employed a dedicated activities co-ordinator available to support people with organised activities as well as individual support for people to choose what they wanted to do.

People and their relatives were confident if they had any complaints they would be listened to and acted upon. The provider had responsive systems in place to monitor and review complaints to ensure improvements were made where necessary. The registered manager had set up and developed responsive systems to monitor and review people’s experiences to ensure improvements were made where necessary.

The provider regularly visited the home to support the registered manager in driving through improvements to the standard of care provided. The registered manager used their quality checks to plan and enable improvements to be sought. As a result the quality of the service people received continued to improve.

We carried out an unannounced comprehensive inspection of this service on 21and 22 July 2014 at which breaches of legal requirements were found that had an impact on people who lived at the home. The provider did not work within the guidelines of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). People could not be confident that their rights were protected because the Mental Capacity Act 2005 Code of practice had not been followed when people were not able to make their own specific decisions about their care. We saw that restrictive practices were in place in order to keep people safe. However, measures to make sure that these restrictions were lawfully applied had not always taken place.

After our comprehensive inspection on, 21and 22 July 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to make the improvements and meet the legal requirements and when their actions would be completed by.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements and how people experienced lunchtime as this required improving to effectively meet people’s nutritional needs. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Havencroft Nursing Home on our website at www.cqc.org.uk.

Havencroft Nursing Home is a care home that provides personal and nursing care for up to 32 people. Care and support is provided to older people with dementia, nursing and personal care needs. At the time of our inspection 20 people lived at the home.

At the time of this inspection the provider did not have a registered manager in post, as the person undertaking this role at the previous inspection had left. The provider had recruited a deputy manager and the provider is taking action to recruit 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 were encouraged and supported to make their own decisions and choices about their care and treatment which were respected by staff. Staff made sure people’s right to consent was upheld as they assisted and supported people. This was achieved by staff checking and making sure people understood what was said to them and alternative ways to communicate were used to make sure people were not disadvantaged if they did not understand.

Where people were unable to give their consent and make specific decisions either verbally or in writing about their care and treatment, actions had been taken in people’s best interests. This was with the involvement of people who had the authority to do so and knew people well in order to protect people’s rights as outlined in the Mental Capacity Act 2005. Some further improvements were needed to be made to ensure best interest decisions could be easily accessed in people’s records so that there was not a risk these could be overlooked.

The required standards of the law related to the Deprivation of Liberty Safeguards (DoLS) were being met. This was because the DoLS was now consistently applied so that people were not potentially deprived of their liberty. Permission of people who had suitable authority to do so was sought. The deputy manager had knowledge about the DoLS and the people whose liberty was potentially restricted. Applications had now been submitted to the supervisory bodies for authorisation purposes.

Staff were knowledgeable about the MCA and DoLS. This enabled people to receive care and support in the least restrictive way and reducing risks to people’s health and safety.

People enjoyed the food they received and felt able to share where meals could be improved upon. Lunchtime was seen to be a more pleasurable experience for people where their choices and independence were promoted. Where people did need some support to eat their meals this was provided in a relaxed and dignified manner making sure people had enough to eat to keep them healthy and well.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made and planned, continue to be implemented and have been embedded into practice.

At the previous inspection on 14 May 2013 we identified areas of concern with medicine management in the service, which resulted in the service receiving a warning notice. This inspection visit was made in order to follow up on the warning notice.

On arrival we observed two nurses administering the morning medicines to people with patience and care. The time of completing the morning medicine administration was 10.30am. The manager told us that ‘’improvements had been made with two nurses administering medicines in the morning’’.

We spoke with one person who lived in the home. They told us that ‘’things are much better now that I look after my medicines. I am much happier with this’’.

We found that the provider had made improvements in order to manage the risks associated with the unsafe use and management of medicines.

When we carried out this inspection 27 people were using the service.

A compliance inspector and a pharmacist inspector from the Care Quality Commission carried out this inspection. We spoke with the manager, the provider’s, one nurse as well as care workers. We spoke with seven people who used the service and two visitors. One person commented: “It’s wonderful, I can’t fault it”. A visitor told us they had: “No cause for compliant”.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. This was confirmed by people who were using the service.

From our observations we saw that people were provided care to met their individual care needs. We became aware of some conflicting information and breakdown in communication between staff

We found that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

People were supported by experienced staff. The manager was aware of gaps in the training undertaken by members of staff.

We saw that the manager had developed some systems for monitoring the quality of the service. These were not fully sufficient to ensure that areas for improvement were recognised and acted upon. We found that management arrangements were not consistently maintained due to a lack of registered manager.

This inspection was unannounced which meant that no one living at or working at Havencroft Nursing Home knew that we were coming. There were 27 people who used the service at the time of our inspection. Since our previous inspection a new interim manager had been appointed as the previous manager had accepted a job elsewhere. One of the providers was available in the home throughout our visit.

During our inspection we spent time observing people who used the service while they were in the dining room area as well as in the lounges. We spent time speaking with these people as well as members of staff and some people who were visiting.

While at Havencroft Nursing Home we saw that care workers were being courteous and respectful towards people who used the service ensuring that people’s dignity was upheld.

Care plans, risk assessment and other records were not always in place to give staff guidance and direction about the level of care required to meet individual needs.

Staff had an awareness of their responsibilities to report allegation of abuse.

People using the service did not always receive their medication as prescribed and further improvements were needed.

The use of agency staff had reduced to ensure that staffing was consistent.

Systems were in place to assess and monitor the quality of care provided and as a means to identify any improvements needed.

As part of this review we spoke with people using the service as well as staff and visiting professionals. Staff were seen to be kind to people living at the home and in most situations respected their privacy and dignity. Staff were seen using hoisting equipment to transfer people, and generally this task was carried out appropriately.

Staff interactions were limited to when people were receiving drinks or while receiving assistance with their dietary needs.

Since our last report the person in charge of the day to day running of the home has changed a number of times. The person in charge at the end of this review commenced duties during January 2012. Since becoming manager at Havencroft the new manager had introduced new care plans and risk assessments. The volume of paperwork within individuals care files had reduced.

Three of the new care plans and risk assessments were viewed. They were not fully reflective of people’s current needs although an improvement on those seen during previous visits. Information within them was either conflicting or not there for staff to work to. We found that staff at times had different accounts of people’s current needs.

We spoke to a professional who believed pressure care at Havencroft had improved. One person living at the home told us that their wound had healed. Records regarding wound care were insufficient and we were unable to tell when dressings were last changed and what the plan of action was for people.

Although we found some improvement during the course of this review the management fluids remains non compliant with the regulations.

Improvements had taken place regarding infection control. Although the home was generally clean improvements are necessary to ensure the Department of Health’s guidelines are met.

The management of medication systems remains insufficient which could potentially leave people at risk. We saw gaps in medication records and we were unable to determine what household remedy’s had been administered.

As a result of recent recruitment agency staffing levels had reduced therefore having a more consistent care team available to people living at the home.

Throughout this report we have identified areas of concern which should have been noted and managed by Regal Care Limited. Although some audits had taken place quality assurance systems need to be developed to assistant in improvement of service delivery.

When we visited the service we met people who lived there. We also spoke to a visiting professional who told us that the home is pro active in the use of creams to prevent pressure damage. We were told that staff at the service had followed recommendations made, that they were both approachable and aware of the needs of people living there.

Many of the people residing at Havencroft were not able to tell us about their experience at the home due to their condition. We observed staff throughout the time we were at the home and found them to be kind and caring.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This inspection was unannounced, which meant the provider and staff did not know we were coming. At our last inspection in May 2013 the provider was not meeting the essential standards of quality and safety. This is because the provider did not have systems in place to ensure that people were not at risk of receiving inappropriate care and support. At this inspection the registered manager had made improvements so that checks were undertaken to assess the quality of the service people received.

Havencroft Nursing Home is a care home that provides personal and nursing care for up to 32 people. Care and support is provided to older people with dementia, nursing and personal care needs.  At the time of our inspection 25 people lived at the home.

There was a registered manager in post at the time of our inspection and staff who we spoke with told us that they were approachable at any time to support staff with any concerns they had. It was important to staff that there was management stability as this had been lacking in the past. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People who lived at the home told us that they received good care from staff and staff were there when they needed assistance. However, staff practices did not always promote people’s rights to make informed choices about their care or that staff would respond to their individual needs in the right way and at the right time.

We found the provider needed to make improvements to ensure people’s needs were met and their human rights protected. There was an inconsistent approach in applying the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) in order to support people’s rights by staff who had limited knowledge about the law. Providers are required under DoLS to submit applications to a supervisory body for authority so that decisions about depriving people of their liberty are assessed and decisions are made. This ensures people receive care in the least restrictive way. The registered manager had knowledge about the DoLS and the people whose liberty was potentially restricted but they had not submitted applications to the supervisory body. This meant the required standards of the law related to the MCA and DoLS were not being met as some people’s movements were potentially unlawfully having their movements restricted. You can see what action we told the provider to take at the back of the full version of the report.

Staff had the knowledge and skills to know how to identify and report any incidents of abuse or poor practices so that people were protected from harm.

Risks to people’s health and wellbeing were well managed. People’s nutritional needs and risks were monitored and professional advice was sought. However, improvements were needed at meal times so that people’s individual nutritional needs were effectively managed and met.

The views of people who lived at the home and their relatives were looked at regularly by the registered manager to look at any areas for improvement.

The registered manager had improved the arrangements in place that checked people received good quality care and that people were safe. During our inspection the registered manager listened and responded when people did not always have interesting and fun things to do so that people’s wellbeing was further promoted.