The inspection of Havenfield Lodge took place on 7 November 2018 and was unannounced. At the previous inspection in July 2017 we found issues with medication, consent, staff training and good governance. As this included four breaches of the Health and Social Care Act regulations, the home was rated overall as requires improvement. 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; in safe, effective and well led; to at least good. On this inspection we found some improvements had been made. However, the overall rating is still requires improvement.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability, and/or autistic spectrum disorder and/or physical disability. There is a separate flat within the home shared by three people with its own staff team. At the time of this inspection, 34 people were using the service.

People in care homes receive accommodation and nursing or personal care as a 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.

At the time of the 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.

The provider is aware of the changes in legalisation relating to the right size of the service and is working towards ensuring the service operates in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are helped to live as ordinary a life as any citizen.

People were involved in their day to day lives through being empowered to make their own choices about where, who with and how they spent their time. Their independence was promoted and staff actively ensured people maintained links with their friends and family.

Staff were recruited safely and there were enough staff to take care of people and to keep the home clean. Staff received appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and received regular formal supervision where they could discuss their ongoing development needs.

People who used the service and relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

People were supported to maintain good health. This included access to healthcare professionals, and support with medicines. Medicines were stored and managed safely.

There was enough staff on duty at the right time to enable people to receive care in a timely way. In addition, people had opportunities to access a wide range of activities. The service had made extensive efforts to integrate the service within the local community. Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome.

Staff showed a genuine motivation to deliver

This inspection took place on 10 and 12 July 2017 and was unannounced on the first day and announced on the second day. The service was last inspected on 25 November 2015. At that time the service was not meeting the regulation related to staff training. At this inspection we checked to see if improvements had been made.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and/or autistic spectrum disorder and/or physical disability. There is a separate flat within the home shared by three people with its own staff. At the time of this inspection 36 people were using the service.

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.

People told us they felt safe at Havenfield Lodge.

Medicines were not always managed in a safe way for people because topical creams were not recorded as being administered, or checked to ensure they remained within their expiry date and were therefore effective. Some people did not have ‘when required’ protocols in place and medicine was not always administered in line with National Institute for Clinical excellence (NICE) guidelines.

There were adequate staff on duty to meet people’s assessed needs, although staffing was not always based on assessing each person’s levels of individual need or dependency. We have made a recommendation about considering the use of a dependency tool to allocate staff according to people’s individual assessed need for support.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence, although we saw one person had no risk assessment in place for bed rails.

Effective recruitment and selection processes were in place.

Staff had received an induction and received occasional supervision. We found staff training was not always up to date and so we could not be assured staff had the knowledge and skills to support people who used the service. We found similar concerns at the last inspection in November 2015.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, people’s mental capacity was not always considered when decisions needed to be made and evidence of best interest processes was not always available.

People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being, although one person was not supported to have their health needs met in a timely manner.

Staff interactions were caring and there were good relationships between staff and people using the service. Staff knew how to support people in a way that maintained their dignity and privacy, although we saw two examples where people’s privacy and dignity were not supported.

Staff promoted people’s independence, however, there was limited opportunity for people to sustain or develop independent living skills.

People and their representatives told us they were not always involved in planning and reviewing their care. Care plans contained enough information for staff to deliver person-centred care, although some information had not been updated. People’s needs were usually reviewed as soon as their situation changed.

Whilst most people engaged in social and leisure activities which were person-centred this was not at a level which would meet the needs of all the people using the service. We found there was a lack of interaction for one person with complex needs.

Systems were i

We carried out this inspection on 24 November 2015 and it was an unannounced inspection. This means the provider did not know we were going to carry out the inspection.

Since May 2013, Care Quality Commission inspectors have carried out three inspections. This was because we found areas of non-compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At the last inspection in February 2014, we found the home to be compliant with the regulations inspected at that time.

Havenfield Lodge is a nursing home registered to provide accommodation and nursing care for up to 46 people who have a learning disability and/or autistic spectrum disorder and/or physical disability. There is a separate unit within the home for three people, where staff were provided specifically for that unit. On the day of our inspection, there were 37 people living at the home.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The home did not have a registered manager in post on the day of our inspection, as the previous registered manager had recently de-registered but there was a home manager, who told us they were planning to apply to CQC to become the ‘registered manager’.

People and their relatives told us they felt the service was safe, effective, caring, responsive and well led. Comments included; “It’s a really safe place. It’s home”, “[Staff] ask if I want to do something or ask what I want to do”, “[Staff] are lovely. They always think about what I want first” and “I’ve never needed to complain but I certainly know how if I need to.”

People were protected from abuse. The home followed adequate and effective safeguarding procedures. Care records were person-centred and contained relevant information for staff to provide personalised care and support. People and their relatives had been involved in care and support planning.

Staff were supported well and received regular supervisions. There were some concerns that staff have not received recent training in subjects relevant to their role, which may mean they may be out of date with current good practice The home manager, who was new in post, told us they were aware of this.

We found good practice in relation to decision making processes at the service, in line with the Mental Capacity Act Code of Practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

There were regular quality-monitoring and audits carried out at the home. We saw that, where concerns had been identified, the deputy manager had developed an action plan for actions to be taken. These actions were not always signed when completed. We spoke with the home manager and deputy manager, who told us they would ensure this was done in future.

Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.

During our inspection, we found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the registered provider to take at the back of this report.

At our previous visits in May 2013 and October 2013 we found that the service was not protecting people who lived in the home against the risks associated with medicines. We asked the provider to take action to improve. We carried out this visit to check whether appropriate arrangements were now in place for the safe management of medicines. We found significant improvements had been made and overall we found medicines were now being safely and appropriately managed.

We checked the medicines records and stocks of twelve people who were living in the home. We spoke with two people living in the home and whilst nobody was able to discuss their medicines in detail with us; no-one expressed any concerns about how their medicines were handled.

We inspected the home in May 2013 and we found some concerns about the safe handling of medicines. After our visit the provider wrote to us to tell us how they would improve the way medicines were handled in the home.

During this inspection we found that the home had completed the majority of actions as stated in their action plan. However, a pharmacist inspector from the Care Quality Commission who was part of the inspection found that people were still not protected against the risks associated with the unsafe use and management of medicines.

Following some concerns we had received, we looked into the staffing levels at the home. We found that here were enough qualified, skilled and experienced staff to meet people’s needs.

We issued a compliance action following our last inspection in November 2012. This was because we found that some staff files did not include adequate information and we could not be satisfied that relevant checks regarding recruitment had been carried out. Havenfield Lodge submitted an action plan following our inspection detailing the actions they intended to take in order to achieve compliance in this area.

We visited the service on 22 May 2013 as part of our scheduled inspection programme and also to check that improvements had been made to requirements relating to workers. We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw that relevant documentation relating to staff was now recorded.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. One person told us that staff provided them with “enough information” to make their own decisions.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person told us “I like living here. I like the staff.” There were various activities on offer for people living at the home.

Appropriate arrangements were not in place for the recording, handling, safekeeping, dispensing and safe administration of medicines

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us of house meetings and a service user forum where they were encouraged to become involved and share their experiences of the service provided and delivered.

We saw that people’s privacy, dignity and independence was respected and staff used a positive, friendly and kind approach with people. People told us they were treated with respect and staff listened to what they had to say. They said they were able to make their own choices about what to do during the day. One person said, “There’s no pressure to do things, if you don’t want to.”

People described the care they received and we found that the care, treatment and support provided met their needs. People said they felt well cared for.

People were cared for in a clean and hygienic environment. People told us cleaners, cleaned the home daily and staff wore personal protective equipment when carrying out personal care.

Documents were not available to demonstrate an effective recruitment procedure had taken place. One person using the service told us the provider had started to involve people using the service when staff were recruited. This person had been involved in the recruitment of one member of staff.

People told us about the complaints process. People were confident that they were listened to, including when they needed to make a complaint. They knew how to make a complaint, had done so and received a response to their complaint.

People told us that staff were “Good”.

People told us that they liked living in the home.

People told us that staff listened to them and involved them in decisions about their lives.

People living in the home told us they were generally happy and that staff helped them with meeting their needs. Staff told us they had received training to ensure they knew how to protect vulnerable adults and enable them to meet their needs, but one said that they had not received formal professional supervision to help them to do their job and progress their career development since January 2010.