About the service: Havenmere Health Care Limited is a care home that provides nursing care and residential care to younger adults. The home is registered to accommodate 40 people. It is purpose built and provides disabled access.

People’s experience of using this service: People receive a service that provided them with safe care. The provider had systems in place to safeguard people from abuse. Medicines were managed safely. Staff followed infection prevention and control practices. Staffing levels were monitored.

Staff received appropriate induction, training and support They applied their learning effectively in line with best practice.

Where people had been assessed as at risk from any activity, support plans provided guidance for staff which enabled them to deliver safe care and support. Staff received appropriate induction, training, and support and applied learning effectively in line with best practice.

Records confirmed people’s input and where they were unable to consent the provider followed appropriate legislation to make sure any decisions were in the persons best interest.

People told us they were happy with the service provided. Staff understood the importance of providing person-centred care and developed positive relationships with people. People received support and staff encouraged their independence to live fulfilled lives free from unnecessary restriction.

Caring, kind and compassionate staff supported people living at the service. People and their relatives were supported to receive information in an accessible way to enable them to be involved in their care and support.

Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs. People’s rehabilitation and independence was promoted and encouraged. People’s dietary needs were met. Where appropriate, plans were in place to ensure people's end of life wishes were taken into account and respected. Complaints raised were dealt with appropriately.

The provider used a range of audits to check quality and safety at the service. Continuous improvement, learning and innovation was encouraged at the service. Community links were promoted. People and relatives had the opportunity to provide feedback about the service. Data security was maintained.

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

Rating at last inspection: At the last inspection the service was rated Good (report published on 01/09/2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Havenmere is a care home that provides nursing and residential care to younger adults. The home is registered to accommodate 40 people. The service is purpose built and provides easy access for people with mobility problems. Havenmere aims to provide a service for people with complex physical and/or mental health needs who may need permanent, rehabilitation or respite care. This may include people living with dementia related impairments, Huntington’s disease, acquired brain injury, learning disability or other mental or physical illnesses requiring support. At the time of this inspection there were 29 people using the service.

Havenmere is located in Immingham, in North East Lincolnshire. There are shops close by and the home is close to transport routes. There is car parking available for visitors and staff.

At the last inspection in October 2014 we issued a compliance action in relation to a breach of regulation 9 Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2010 and relates to regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2014, which came into force on 1st April 2015. This was because care and support plans had not always been developed to ensure people were protected against the risks of receiving care or treatment that is inappropriate or unsafe. We also made a recommendation that assessments of people’s consent to making decisions were in line with the principles underlying the Mental Capacity Act 2005 (MCA).

Following the last inspection the registered provider sent us an action plan that demonstrated how they would become compliant with regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 and regulation 9 HSCA 2008 (Regulated Activities) Regulations 2014 and ensure people’s care and welfare needs were supported. At this inspection we found the service was now compliant with these regulations and that improvements had been made to people’s care plans and that a range of these had been developed to ensure their individual needs were appropriately met in a safe way. Assessments had now been appropriately carried out to ensure that where they were unable to make informed decisions, best interests meetings were held involving people who were involved in the care and support.

There was a registered manager for the service. 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.

Staff had received training on how to keep people safe from harm. Staff were employed following an appropriate recruitment and selection process. This helped the service to make safer recruitment decisions, to ensure staff were safe to work with vulnerable people and did not pose a risk to them.

Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. People were involved in making decisions and choices about their lives and staff held a positive regard for the promotion of their personal dignity and privacy. Staff demonstrated compassion and consideration for people, many of whom experience difficulties in expressing their needs and adapting to their medical conditions. Staff responded to people’s differing and complex needs with kindness and sensitivity, providing positive encouragement and explanations to help them understand what was said. People’s personal care records were securely held and information about them was maintained in a confidential manner.

The registered manager and staff followed the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensured people were not being deprived of their liberty in an unlawful way.

People told us the quality of their food was good and their nutritional sta

The care files we saw provided evidence that people who used the service or their relatives were involved with the development of each individual care plan.

During our inspection we saw numerous interactions with members of staff and people who used the service. Each contact or conversation was supportive and compassionate. It was clear that staff had in-depth knowledge of each person and their needs.

We took a tour of the building and found it to be clean and free form unwanted odours. We noted that the kitchen had recently received the highest possible food hygiene rating from the North East Lincolnshire Council Environmental Health officer.

We saw evidence that staff received appraisals on a yearly basis and had supervisions six times a year and this was confirmed by staff. The registered manager told us, “We do daily appraisals of the staff, if we see any issues we discuss them straight away.”

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We saw that thorough assessments had been completed when people were admitted to the home and that this information had been used to develop individual plans of care. Care plans included information about a person's ability to consent to their care and their ability to make decisions about their care.

People told us that they received good care and support - one person said, "Staff speak to me nicely and I like living at Havenmere". They said that they could speak to any of the staff if they had a problem and the staff would try to put it right.

We saw that medication was obtained, stored and administered safely by staff who were trained to do so. Staff also received training on safeguarding adults from abuse and displayed an understanding of the different types of abuse and the action they needed to take if they observed poor practice.

We saw that there were sufficient numbers of staff on duty and that they responded quickly to requests from people who lived at the home.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the staff and care provided and told us that staff treated them with respect. Everyone we spoke with felt they were involved in their care and in making decisions about their treatment.

We received comments such as "All the staff are alright here", "Feel safe here", "Can go out with the family when I want to" and "Staff are very good."

During the visit we spoke with relatives who gave us positive views about the care being received by their family member.

Comments included "Staff are great", "Can go to any staff member and the manager to ask questions, no matter how small and they are patient with me" and "Have had two reviews and felt able to contribute."

Everyone we spoke with who uses the service told us the food was good and they were never hungry.

This unannounced inspection took place on over two days on 16 October and 21 October 2014 and was unannounced. At our last inspection in August 2013 the service was meeting the regulations inspected.

Havenmere is a care home that provides nursing and residential care to younger adults. The home is registered to accommodate 40 people. The home is purpose built and provides easy access for people with mobility problems. Havenmere aims to provide a service for people with complex physical and/or mental health needs who may need permanent, rehabilitation or respite care. This may include Dementia related impairments, Huntington’s disease, Acquired brain injury, Learning disability and other mental or physical illness requiring support. Havenmere is located in Immingham, in North East Lincolnshire. There are shops close by and the home is close to transport routes. There is a car park at the property for visitors and staff.

There was a registered manager in post at the service. 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.

Staff demonstrated a clear understanding of their role in keeping people safe and were able to describe different forms of abuse. Staff had received training about safeguarding vulnerable people from harm or abuse. People’s care records contained details and techniques staff should follow to ensure known risks to people were minimised and avoided where possible.

A variety of training was regularly provided to enable staff to have the right skills to carry out their roles and support people who used the service. Staff received regular supervision and appraisals to enable them to develop their careers.

Staff demonstrated a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and the use of Deprivation of Liberty Safeguards (DoLS). People were supported to make informed decisions and choices that were in their best interests. Assessments used by the registered provider to determine people’s capacity to consent to making specific informed decisions were not fully in line with the principles underlying the MCA and were global in detail. We recommend that the service considers the Department of Health guidance on the Mental Capacity Act and the Mental Capacity Act Code of Practice

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Checks had been carried out of new staff to ensure they were safe to work with vulnerable adults. Staff were deployed in sufficient numbers to make sure they were able to support people’s needs.

People were involved in decisions about their support and staff respected their right to make choices. Staff demonstrated compassion and consideration for people, many of whom experience difficulties in expressing their needs and adapting to their medical conditions. Staff responded to people’s differing individual needs with kindness and sensitivity, providing positive encouragement and giving explanations to help them understand what was being said.

People were able to contribute their views about the service and how it was run and could make complaints to enable their concerns to be addressed and where possible resolved.

The registered manager carried out regular checks to make sure the health and wellbeing of people who used the service were promoted.

Medicines, including controlled drugs were stored securely and administered to people in a safe way. A medication error had led to a safeguarding investigation being carried out by the local authority. The provider took prompt action about this to ensure this issue was minimised in the future, with additional medication training provided and regular audits of medication carried out.

People who used the service were provided with a diet that was wholesome and nutritious. Assessments about people’s nutritional needs and associated risks were recorded, with details about their personal preferences and dislikes. Staff monitored people’s weight and diet and involved specialist health care professionals where required. A safeguarding concern about a person experiencing a deterioration in their ability to swallow had been recently raised. An up to date care plan about this had not yet been developed despite a decision about this being made the previous week, which is a breach of Regulation 9 of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.