About the service: High Haven is a residential care home that was providing accommodation and personal care to 31 people at the time of the inspection. Care and support are provided in three separate areas, including a reablement unit, and a dementia care unit.

People’s experience of using this service:

The risks to the quality and safety of the service were identified and acted on. There were enough staff on duty to enable people to remain safe and receive care in a timely way. The environment was safe, and people had access to appropriate equipment where needed. People were supported to take their medicines in a safe way.

People, their relatives and staff told us the registered manager was approachable and they felt listened to when they had any concerns or ideas. Some community professionals we spoke with gave us mixed feedback about their relationship with the home’s management. Both the home’s management and community professionals told us that work was underway to make improvements in this area.

Staff had received appropriate training and support to enable them to carry out their role safely.

Staff were kind and caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively supported people to maintain links with their friends and family.

People's records clearly identified their preferences. Staff provided effective care for people, which met their needs through person-centred care planning. This enabled people to achieve positive outcomes and promoted a good quality of life. People enjoyed an extensive programme of activities both in the home and accessed the local community regularly. Complaints were managed within the provider’s stated process.

Staff were motivated and enjoyed good team work. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

Rating at last inspection: Good (Published September 2016)

Why we inspected: This was a scheduled inspection based on our previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We conducted an unannounced inspection of High Haven on 22 August 2016.

High Haven is a service that provides residential care and accommodation for a maximum of 40 older people, some of whom may be living with dementia. On the day of the inspection, there were 34 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 consented to their support and were involved in the planning and review of their care. The registered manager ensured that people were able to contribute to the running of the service and encouraged people to be involved.

Staff supported people safely and knew what to do to protect people from the risk of abuse. Recruitment procedures ensured staff had the appropriate values when they were employed and were supported to gain skills and qualifications shortly after they started work. There were enough staff on duty to attend to people’s needs in a timely way and keep them safe. People were treated with dignity and respect.

People received their medicines in a safe manner and when they needed them.

People had access to healthcare services and received on-going healthcare support for example through their GP, hospital doctors and specialists. Referrals were made to other professionals such as community nurses and dieticians if the need arose.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions about their care themselves.

Risk assessments and care plans for people using the service were effective, individual, and detailed. People’s individual care needs were recorded daily and this information was shared with staff so that the care delivered was responsive to people’s needs. There was a strong focus on supporting people in returning to independence following an admission to hospital following illness or injury.

Quality assurance systems were in place to assess and monitor the service people received. Families were consulted so that their views could be gained. These views were acted upon with actions taken and improvements made. Complaints were appropriately responded to, in line with the providers’ policy.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary pleased read the full report.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. We saw staff speaking to people politely and giving them time to respond without hurrying them. People said they felt safe and staff understood how to safeguard the people they supported. One person told us, “Staff are very good and always polite.”

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This meant that the risks to people were identified and action taken to reduce risk as much as possible and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all people living in care services. While no applications have needed to be submitted, proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with told us they were happy living at High Haven. They told us they received the care and support they needed. One person told us, “I’m glad I came here, it was the right thing to do.” Another person said, “It’s very good here and the food is good too.” People spoke to us about wanting to be as independent as possible, with one person saying, “Staff help me with my shoes, otherwise I do for myself.”

People’s health and care needs were assessed with them and they were involved in writing their care plans as far as possible. People confirmed they had been involved in discussions about their care and one person said, “Staff have talked to me about my care but I don’t know anything about a care plan.” Another person told us, “The girls talk to me about what I need.” We also spoke with relatives and they confirmed that they were involved in discussions about their loved one’s care plan and reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when speaking with or supporting people. The people we spoke with confirmed that staff treated them with care and consideration. We saw that staff supported people in a warm, friendly and respectful way.

People told us they could spend their time where they pleased. Some people were enjoying the afternoon sunshine; sitting at the front of the home and watching people go by. Other people were in various communal areas or their own rooms. One person said, “Everything about High Haven is good.”

Is the service responsive?

People knew how to make a complaint and the complaints process was available in booklets kept in the entrance hall. All complaints and incidents were investigated and learning took place as a result. People told us they were very satisfied with the care they received. We were told, “I’m well satisfied. I’ve got nothing to complain about.”

People’s needs were assessed on a monthly basis and where they changed we found that the service responded promptly and appropriately. They sought advice from other health and social care professionals and acted on the advice given. Care records showed that the service worked well with other agencies and services to make sure that people received their care in a joined up way.

Is the service well led?

Resident meetings were being held every three months and a quality satisfaction audit was taking place at the time of our inspection. This meant that people’s views were being taken into consideration. Actions were taken where possible in response to people’s comments.

Staff told us they were clear about their roles and responsibilities. They understood the ethos of the home and had access to training and development that enabled them to provide appropriate care and support. Staff said they felt well supported although staff supervision sessions had not been taking place regularly until recently.

People's standard of health and welfare was maintained. Staff had access to detailed care records to ensure that they provided people with safe, appropriate, individual support and care. A person who we spoke with told us that High Haven was, "Very good. Like a home from home.” The two external healthcare professionals we spoke with also told us that they had no concerns around people’s care at High Haven.

When reviewing medication administration records (MAR) charts, we saw evidence of accurate documentation to ensure that people were protected against the misuse of medication.

There were effective staffing levels in place to ensure the safety and well-being of people who lived at the home.

We found that the provider managed risk effectively through care records; this was because we found evidence which demonstrated to us that the provider maintained and monitored personalised care records for people who used the service.

People who used the service had the right level of information to make a decision about their support, care and treatment. A healthcare professional we spoke with told us that, "Consent was obtained and documented." A person who we spoke with went on to tell us that, "(Staff) ask permission before undertaking support and personal care."

People's standard of health and welfare was maintained. Staff had access to detailed care records to ensure that they provided people with safe, appropriate, individual support and care. A person who we spoke with told us, "No fault to find here – 100%."

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection spreading as there were effective systems in place to reduce the risk.

Effective staff recruitment was in place to make sure that people who used the service received support and care from suitable, skilled, and knowledgeable staff.

There was an effective complaints system in place to ensure that people were able to make a complaint without any concerns.

On the day of our visit we spoke with a number of people who live in different units within the home who told us how they felt included in the decisions made that had an impact on their lives. They told us about the choices they make, activities they choose and how they are listened to by a “great team of carers.” “You cannot fault the support and dedication,” was one comment. Another person could not praise the day and night staff enough, telling us that “They bend over backwards to ensure we have what we need.”

We noted that people who were cared for in the unit designated for people living with dementia gave smiles and acknowledgement to the staff on duty. People were seen to recognise voices, reach out to touch the staff member and to be smiling.

The people we spoke with told us they were asked from time to time about the care support they were given. Out of eight people spoken with there was only one minor concern that was made about the meals at teatime not always being to their liking, otherwise all comments were positive.

The people told us that they could talk to any staff member or the manager about any concerns and worries they had. They explained that the manager kept them informed about what was happening and that this reassured them.