The inspection of New Haven Care Home took place on 6 and 12 November 2018 and was unannounced on the first day. The service was previously rated good in all domains.

New Haven is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. New Haven accommodates 50 people in one adapted building. On the day of the inspection there were 40 people living at New Haven, three of whom were on respite care.

There were two registered managers who job-share the role, and both were present on each day of the 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.

We found numerous issues with medication including stock levels, administration and record keeping. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment as medicines were not managed safely.

People were safe from abuse as staff could recognise and knew how to respond to possible safeguarding concerns. Risks were managed well as assessments reflected individual need and provided staff with clear guidance in each instance. Falls were effectively managed as the number in the home was low.

Staff were visible and knew people well, although there were intervals where staff were not in communal areas. Staff worked well as a team and communicated efficiently, providing support to each other when needed. They displayed kindness and compassion and were highly supportive of people’s specific needs. Staff ensured people’s dignity and privacy was respected at all times.

The home was clean and well maintained. People utilised the dementia friendly signage. Seating was available in alcoves and at the end of corridors and we observed people access the whole home freely, making full use of the pleasant environment.

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. Some staff did need further support in understanding the significance of Deprivation of Liberty Safeguards (DoLS).

The registered managers demonstrated current best practice knowledge and staff responded quickly to people’s changing needs, which was reflected in care documentation. People were supported with a balanced and nutritional diet and staff understood people’s specific needs, and were also supported to access health and social care services as needed.

Complaints were handled well and the home had received many compliments.

New Haven was clearly people’s home and people were happy and settled. Support offered by staff was discreet and promoted people’s independence. A calm atmosphere pervaded the home during both days of the inspection and this encouraged people’s wellbeing.

Quality assurance measures showed scrutiny over all aspects of care delivery took place, and the registered managers were responsive to feedback from both people living in the home and their relatives. The medicines audit system was not robust or frequent enough to identify the issues we found but we were confident the registered managers would take immediate action to remedy the concerns as they did with other concerns they themselves found.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection of New Haven Care Home took place on 16 May 2016 and was unannounced. The home had not previously been inspected as it only opened in November 2014. It is a purpose built home to accommodate fifty people. It is divided into two units each with their own lounge, dining room and bathrooms. Each room has an en-suite shower room. On the day we inspected there were 31 people living in the home, with 11 of these living in the specialist dementia provision within the home.

The home has two registered managers who job-share. We spoke with both on the day of the 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 told us they felt safe and this was a view endorsed by relatives who spoke of ‘peace of mind’. Staff were able to identify possible signs of abuse or poor care and knew how to report such concerns. We observed staff to be observant during the day, noticing people’s moods or agitation, and responding appropriately. The home reduced the risks to people of falls by pre-empting unsafe manoeuvres by people and managed people’s level of distress to avoid the likelihood of altercations.

We saw staff respond promptly to people and because they were so vigilant meant that people had support as they needed it rather than having to wait too long for attention. The staff worked well together and had clear direction.

Medicines were administered, recorded and stored in line with requirements, and the home was pro-active in seeking reviews if they felt people’s needs had changed.

Staff had received a comprehensive induction and their knowledge was developed through ongoing supervision and regular training. It was evident through the day to day interactions that staff knew the importance of seeking consent prior to offering any support and the home had effective capacity assessment tools in place to support this decision-making.

People were given plenty of drinks during the day to ensure they maintained a good level of hydration and had a positive and pleasant lunchtime experience where they engaged with each other well and received discreet support as needed. Access to external health and social care provision was requested and the advice received followed in practice and recorded in care records.

We observed staff to be kind, caring and patient, and often pre-empted people’s needs showing that they knew and understood people well. There was a high level of awareness of how to support people living with dementia which was evident at all times. Staff paid due regard to respecting people’s right to privacy and promoting their dignity through discreet support.

The home had an activities co-ordinator who showed initiative and drive, helping shape a programme of activities which were relevant and fulfilling for people. This was supported by pro-active staff who also engaged with people ensuring everyone received attention.

Care records were person-centred and reflected people’s current needs, highlighting key pieces of information to ensure staff were able to be provide assistance at an appropriate level and in line with people’s wishes. The home had managed complaints and compliments in a timely manner, paying due attention to any actions required.

The home had a friendly and welcoming atmosphere and people said they were happy living there. This was supported by comments from relatives and from feedback we reviewed.

Staff were supported by effective registered managers who had a sound knowledge of their responsibilities and a clear direction for the home to grow towards. This was reinforced by a robust quality assurance programme which identified issues quickly and ensured action plans were in place to remedy any concern