This inspection took place on 9 February 2017 and was unannounced. At our previous inspections in June and October 2016, we judged that the provider was not meeting the required fundamental standards of care. We identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was placed into ‘special measures’ following the June 2016 inspection because it was rated as ‘Inadequate’ overall. The service remained in ‘special measures’ following our October 2016 inspection because one of the key areas we looked at; ‘is the service safe?’ was rated as ‘inadequate’.

Services that are in ‘special measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that significant improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 31 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 and associated Regulations about how the service is run.

Risks to people’s health, safety and wellbeing were assessed and planned for. Staff knew how to keep people safe and risks were managed effectively to promote people’s safety.

Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

Medicines were managed safely and people received their medicines as prescribed.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when needed.

Staff knew people well which meant they could interact with them positively and effectively. People were treated with kindness and respect and staff promoted people’s independence, dignity and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to participate in leisure and social based activities that met their personal preferences.

People knew how to complain about their care and an effective system was in place to manage complaints.

Effective systems were in place to assess, monitor and improve the quality of care. Feedback from people was sought to enable the provider to identify if improvements to care were needed.

The registered manager understood the requirements of their registration with us and they reported notifiable incidents to us.

We carried out an unannounced inspection of this service on 1 June 2016. At that inspection, we identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as ‘inadequate’ and was placed into ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this unannounced comprehensive inspection on 18 October 2016 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Haversham House on our website at www.cqc.org.uk.

At this inspection, we found that some of the required improvements had not been made. Some breaches of Regulations were still present and although the service is now rated as ‘requires improvement’ overall, the safe domain has been rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 34 people were using the service.

The service did not have 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 and associated Regulations about how the service is run. A new home manager had been appointed and had applied to register with us.

At this inspection, we found that that new systems were in place to assess, monitor and improve the quality of care. However, these systems were not yet effective. This meant some areas of unsafe or inappropriate care were still not being identified and rectified by the manager and provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely. This meant that’s people’s safety, health and wellbeing was not consistently promoted.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not

We inspected this service on 1 June 2016. This was an unannounced inspection. Our last inspection took place in March 2015 November 2015. At that time we found the provider was meeting the required Regulatory requirements.

The service is registered to provide accommodation and personal care for up to 59 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 47 people were using the service. However, one of the people had been admitted to a local hospital after sustaining a serious injury at the home.

The service did not have 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 and associated Regulations about how the service is run. A new home manager had been working at the service for approximately two months. However the provider informed us this manager left the service in the 48 hours following our inspection.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely and people were not always protected from the risk of abuse. This meant that’s people’s safety, health and wellbeing was not consistently promoted.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. Some people who could make choices about their care were being restricted unnecessarily and were unable to move a

The inspection took place on 19 March 2015 and was unannounced.

Haversham House provides accommodation with personal care for a maximum of 59 people. The service specialises in providing care for people with dementia over 65 years of age.

A registered manager was 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.

People’s risks were assessed in a way that kept them safe from the risk of harm. Where possible people’s right to be as independent as possible was respected.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s care needs. Staff were trained to carry out their role and the provider had plans in place for updates and refresher training. The provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Staff knew how to support people in a way that was in their best interests and advice had been sought from other agencies to ensure formal authorisations were in place where people may be restricted.

People were supported to maintain good health and were referred to relevant health care professionals as and when required. People had enough to eat and drink and were supported with their nutritional needs.

People told us that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld.

People had opportunities to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure available for people who used the service and complaints were appropriately managed.

There was a positive atmosphere within the home and staff told us that the registered manager was approachable and led the team well. Staff received supervision of their practice and had opportunities to meet regularly as a team.

The registered manager had systems in place to monitor the service and we saw that improvements had been made when identified as necessary.

Haversham House consists of two units the main home which provided care and support for elderly people some of whom have dementia. Many of the people have mobility problems. The Rainbow unit provided care and support for older people who had more advanced dementia or more challenging needs.

People who used the service at Haversham House were treated with respect and their dignity was protected, but there were not always sufficient activities available for people. A person who used the service said, “There’s not much to do most of the time”.

People’s care and treatment was planned and delivered in a way which met their needs. A relative of a person who used the service said, “The staff seem very friendly and look after my relative very well. My concern was safety, before they came here, but now I feel better knowing they are safe”.

We found that Haversham House was clean and tidy. Staff had been trained in infection control procedures and had a good understanding of their role.

There were sufficient suitably qualified, skilled and experienced staff on duty at all times to meet the needs of people who used the service. A person who used the service said, “You take it from me, it’s marvellous here”.

The provider had a complaints policy. Complaints were recorded and responded to in a timely manner and complainants were updated throughout the process.

During the inspection we spoke with people who used the service and their relatives. We spoke with staff and the registered manager and we viewed records. We did this to help us understand the outcomes and experiences of selected people who used the service.

We observed staff treating people who used the service with dignity and respect. Staff listened to people's wishes and acted upon them. People we spoke with told us that they were happy with the support provided. One person told us, "All the staff are very good and they always listen to what I have to say".

We saw that people appeared comfortable when staff were providing support and staff we spoke with understood the procedures to follow if they felt that someone was at risk of harm.

Staff had received an induction at the start of their employment and staff we spoke with told us that they felt supported in their role. Staff had opportunities to undertake training and to develop their skills.

The provider had systems in place to monitor the service provided and where improvements had been identified an action plan had been put in place.

We carried out this review to check on the care and welfare of people using this service. We visited Haversham House in order to up date the information we hold and to establish that people's needs were being safely met.

There were 58 people living at Haversham House when we visited on 10 January 2012. The visit was unannounced which meant the provider and the staff did not know we were coming.

When we arrived some people were sitting in the lounge areas, whilst others were in the dining room having breakfast. One person having breakfast told us, “The food is very good here; you can see our plates are clean.” Another told us, “They know I like a newspaper in the morning and there is one waiting for me after breakfast.”

There was a separate unit within the home, Rainbow House. We were told this unit, which had ten people living there, was for people who required extra support. The unit had a separate lounge, dining area and garden.

During the visit we spoke with people living at the home, family and friends who were visiting and staff members. One person living at the home told us “Staff are very nice, polite and very helpful.” A staff member told us, “I enjoy working here, I feel supported to do my job.”

We looked at the plans of care for four people living at Haversham House and found little evidence that people had been involved in the development of the plans and little documentation in relation to people providing consent to care. We were told that care planning was being reviewed and a new process was due to be implemented.