The Haven provides accommodation and care for up to 29 older people, some of whom who are living with dementia. There were 25 people living in the service when we inspected on 18 May 2017.

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.

At our last inspection in December 2015 we found that people received personalised care which was responsive to their needs and their views were listened to and acted on. At this inspection we found that the service had further developed the way that they responded to people’s needs and were exceptional in the way they tailored every element of peoples care and support to enhance their quality of life. The result of this was that people received an outstanding level of care and support.

People were at the heart of the service. They told us how staff went the extra mile to make sure that they were happy.

The atmosphere in the service was warm and welcoming and there was a strong person centred culture which promoted the importance of supporting people to express their views and understand their wishes. People felt staff listened to what they said and their views were of the utmost import when their care was planned and reviewed. This empowered people to lead their lives as they chose.

Staff were exceptionally compassionate, attentive and caring in their interactions with people. They showed empathy and understanding, were interested in people’s lives and knew them very well. People told us that they felt that their choices, independence, privacy and dignity was promoted and respected.

The management team were dynamic and innovative in their approach. They had a clear vision and set of values which they worked towards, and which were reflected throughout the staff team. Staff, people and relatives spoke highly of the management, and were confident in their ability.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff knew how to minimise risks and provide people with safe care. Procedures and processes provided guidance to staff on how to ensure the safety of the people who used the service.

There were sufficient numbers of staff to meet people’s needs. Staff were well trained and supported to meet the needs of the people who used the service. Recruitment processes checked the suitability of staff to work in the service.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 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.

There were systems in place to support people safely with their medicines. People’s nutritional needs were assessed and met. Professional advice and support was obtained for people when needed. People were offered meals that were suitable for their individual dietary needs and met their preferences.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. The service proactively engaged with these professionals and acted on their recommendations and guidance in people’s best interests.

There was an open and transparent culture in the service. A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner. People, relatives, visitors and staff were confident that any co

We inspected this service on 3 December 2015 and the inspection was unannounced. The Haven can provide accommodation and personal care for up to 27 older people, some living with dementia. At the time of our inspection there were 26 people living at the service.

There was not a registered manager in post; the previous manager had recently left the service. A new manager had been appointed and they had started to make preparation to apply for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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.

During our last inspection on 21 April 2015 we found that this service was not compliant in some areas. There were concerns about the staffing levels and their staff training and how people’s medicines were managed.

During this inspection we found improvements had been made as the provider had taken action and were offering an improved service.

There were enough staff to support people safely and they were clear about their roles. Recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work within the care profession.

Staff knew what to do if they suspected someone may be being abused or harmed and medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent, staff and the manager ensured their rights were protected.

People had enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who became unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s preferences and needs so that they could engage meaningfully with people on an individual basis. The service offered people a chance to take part in activities and pastimes that were tailored to their preferences and wishes. Outings and outside entertainment was offered to people, and staff offered people activities and supported them on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that they were confident that complaints they made would be addressed by the manager.

The service had good leadership; we found an open and positive culture that supported people in a person centred way. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and was supported by the operations manager and the providers visited the service regularly the check the quality of the service. People were asked for their views so that improvements identified were made where possible.

The inspection took place on 21 April 2015 and the inspection was unannounced. The last inspection was on the 30 April 2014 and the service was fully compliant.

The service provides accommodation for up to 29 older people. The previous registered manager had recently left the service and the deputy manager had applied to become the 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.

There were policies available for staff to tell them what actions they should take if they believed people to be at risk of harm or actual abuse and staff were familiar with these policies. People were protected from risk as far as reasonably possible because staff assessed the risks to their safety and took appropriate steps to reduce risk.

Staffing rotas showed that staffing levels fluctuated and there was not a clear rationale of how many staff were needed to meet people’s needs or the effect of reduced levels of staffing on the service delivery.

Medicines prescribed to people were not always properly recorded so we were not assured people always received their prescribed medicines.

Infection control procedures were not always as stringent as they could be.

Staff familiar with people’s needs were always on duty and staff were supported in their roles through regular supervision and training. Staff induction was adequate but could be extended further too clearly demonstrate that staff had the necessary competency and skills.

Observation of staff practices demonstrated that they knew how to appropriately support people with their care and welfare needs and did so with people’s consent. We were not assured that staff always acted lawfully in regards to supporting people who lacked capacity or when making best interest decisions.

There were records to demonstrate how staff monitored people’s nutritional and hydration needs. Where people were at identified risk of dehydration or unintentional weight loss staff took the right actions to protect them.

People were supported by staff to keep in good health and staff responded appropriately to any changes in people’s needs.

Peoples care needs were known by staff and clearly documented. However more precise information would support staff in working consistently with people.

The home had staff to specifically provide activities to meet people’s identified interests and hobbies and help keep people mentally stimulated.

People were routinely asked about the service provided to them and there were processes in place to deal with any concerns people had about the service.

Staff were caring and well informed about people’s needs which helped them provide effective care which was responsive to their individual needs.

There was strong management and a genuine desire to put people first by providing the right staff and involving and engaging with the local community, families and friends of people using the service.

There was a quality assurance system which measured the quality of the service being provided in line with people’s needs and potential risks to people’s health and safety. This enabled the acting manager to make any required improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an inspection on the 30 April 2014 to follow up concerns identified at the previous inspection on the 16 October 2013. We also met with the provider to discuss our concerns and to ask how they intended to improve the service and sustain improvements. The Local Authority also worked closely with the service provider at this time.

At this inspection we identified some clear improvements to the service. The previous manager, deputy manager and area manager had all left and there was a new manager in situ. They were not yet registered with the Care Quality Commission in respect of this service but was registered for another home owned by the same provider. The manager was confident they could successfully manage both services and said there were effective deputy managers and heavily supported by different members of the management team.

We spoke with twelve out of the twenty-four people who used the service, three staff, and one relative and observed the care being provided at different times of the day in the home. We observed lunch and social activities being provided. We looked at three care plans and other care records. We looked at staff training, recruitment and induction records, the homes annual quality audit and other audits. We considered our inspection findings to answer 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?

This is a summary of what we found;

Is the service safe?

There were sufficient staff on duty to meet people’s need and we saw that people were regularly monitored for their own safety. We did not hear any call bells throughout the morning and judged that some people would not be able to use them. We saw the provider had not assessed people to see if they would be able to use the call bell, but we found people were checked at least hourly, more if required and there were records to show this.

We found no restrictions for people and they were free to move about the home. One person had sustained a number of injuries and these had been unwitnessed. We saw that some people had sensors in their bedrooms alerting staff to when they were moving around. We saw that one person had been assessed as requiring bedrails and other people had crash mats on the floor which had been assessed as appropriate for their needs and to help reduce the risk of injury. This meant staff would know to check them to ensure their safety.

Records showed that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded and protected from harm. Staff had received annual updated training in protecting people from abuse and had access to policies and procedures so that they knew what actions they should take to keep people safe. The manager had taken appropriate action in response to events affecting the well-being and, or safety of people using the service and had responded appropriately to complaints and concerns.

We saw records documenting people’s care needs and their preferences of care. However we noted that some risk assessments were inaccurately completed which meant that staff had not been appropriately trained to carry out risk assessments and people might receive inappropriate care. We also observed some poor manual handling practices by staff. The provider assured us that all staff would have updated manual handling training and observations of practice before the end of the week to ensure people were safe.

The environment was well maintained and in good decorative order. There were sufficient staff employed for the purpose of maintaining and cleaning the home over seven days a week. Routine audits were completed to check that the building was safe and regular checks were completed on fire safety equipment and equipment used in the home such as hoists, and wheelchairs/ to make sure they were safe to use. We identified a number of minor concerns for the provider to address.

Is the service effective?

We observed the care provided and saw that there were sufficient staff to meet people’s needs and help them join in social activities. We saw that the staff tried to encourage people’s independence and offer people appropriate choices.

People’s care was planned in a way which intended their safety and well-being. People’s needs were assessed and evaluated regularly to ensure the care being provided was effective. Where risks had been identified steps had been taken to ensure the risk was controlled but initial risk assessments had not always correctly identified the level of risk.

Is the service caring?

We saw some very good staff interactions and we saw displays of genuine warmth and affection between staff and residents. Staff were tactile and knew residents well which enabled them to respond to their needs appropriately. During the day we saw staff responding appropriately and quickly to people and saw some good team work between the staff. The provider employed regular staff who were familiar with people’s needs.

Is the service responsive?

We saw a range of things for people to do during the day to keep them engaged and active. Activities were provided to meet the needs of individuals and there was improving involvement with the local community and community groups. Life stories were not complete for each person and would have helped staff support the person more appropriately. We noted that ‘All about me’ documentation helped staff know how people liked to be cared for and staff showed a good understanding of this.

We saw from people’s records that their health care needs were being met and they received the services they needed, like chiropody, district and community nursing and speech and language. We saw from people’s daily records that changes to people’s health needs were quickly identified and actions taken to prevent the persons health declining.

The manager was proactive in dealing with concerns and complaints and met with family members to try and resolve concerns.

Is the service well led?

There have been a number of changes to the management of the service although there has been good retention of care staff. During our inspection there was a new management team who were familiar with the home and had already started to establish improved links with health care professionals and community groups. We saw that the management team were trying to lead by example by working alongside care staff and observing their practices and identifying any training needs. We saw that staff were receiving regular supervision and observation of practice.

We saw that the provider was hands on and was regularly assessing the quality of the service provision and identifying necessary improvements whilst maintaining high staffing levels despite a number of vacant beds.

We last inspected this service on the 29 May 2013 where we found that people’s privacy and dignity was not respected. Since this inspection we received further concerns about the quality of care, the environment and the management of the service. We arrived at the service at 6 am because of concerns we received about people being assisted early in the morning. We found that there were already five people up and dressed at this time.

We spoke with seven people using the service and observed the care they received throughout the day, including breakfast and lunch time. We found that staff were kind and caring and treated people with dignity and respect.

We looked at four care plans and ‘How to support me’ documents. These provided a good overview of the support people required, however we found that people's care and treatment was not planned and delivered in a way that was intended to ensure their safety and welfare. We identified improvements were necessary in terms of monitoring risks to people’s health and documenting their specific care needs.

We found that people were not cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were not adequately supported to deliver care and treatment safety and to an appropriate standard.

Systems in place to monitor the quality of service were not robustly carried out and did not identify, assess and manage risks to the health, safety and welfare of the people using the service.

On our inspection we found that that were many positive staff interactions and that care plans were person centred. However, we also saw poor interactions with people and some moving and handling techniques that did not respect people's dignity.

People's care and welfare was protected through risk assessments and detailed plans of care. One person told us "The food is good, they look after us here." Another person told us “I am very happy here, the staff are good, they help over and above what they are required to do, and the food is generally good.” We spoke with one person and their relative who told us that they were more than satisfied with the service, “The staff were lovely and very caring, the food excellent and there are plenty of snacks between meals”. One person commented “If I could improve anything, I would like to see more activities, my relative lacks stimulation.”

We found that people were cared for in a safe, clean and well maintained environment.

There were adequate numbers of staff on duty and people were attended to promptly. Staff had regular meetings and supervisions and had recently undertaken training. Staff were able to obtain further qualifications from time to time relevant to their job role.

Records for the service were up to date and stored securely. Where audits had been carried out and concerns noted, actions had been planned and carried out to address them.

At the time of our last inspection, in July 2012, we had many concerns about quality of care provided at the home. Since that time the local authority safeguarding team had led investigations at the home. As a result the local authority decided not to place people at the home because of their concerns. Following improvements that were made at the home the embargo was lifted in December 2012.

During this inspection we noted that many improvements had taken place and that people’s needs were being met in a more consistent way. There had been some improvements to the provision of support and training to the staff team which had enabled them to carry out their roles more effectively. However, the home did not have a manager as they had recently left the home. The provider had recently employed an area manager who was overseeing the management of the home.

We had also identified areas of the home in which improvements were still needed. For example, areas of risk associated with the accommodation for people still needed addressing. Improvements were also still needed with regard to record keeping and ensuring that people were treated with dignity and respect.

We spoke with people who use the service but their feedback did not relate to this standard.

During our inspection we had conversations with five people living in the home and with two relatives who were visiting at the time of our inspection. One person told us, ”I like it here. If you ask for anything they try and help. Staff are very helpful. There is nothing I can think of that could be better.” Another person said that the majority of staff were very good but a few staff “don’t speak to residents respectfully and sometimes don’t talk to you much.” A relative confirmed this, they told us: “Most of the staff are very good and dedicated but a few are not so good.”

People were complimentary about the food and the catering support and told us that choices were always available. One relative told us that standards in the home “have not been so good” since the manager left four weeks prior to our inspection. They said that care staff were “very nice” but considered that the standards of personal hygiene were “not consistent” and felt that people “lacked stimulation”.

Most of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we were able to hold a verbal conversation with one person. Other people were able to make comments about specific issues, such as Christmas and the care provided.

People with whom we spoke confirmed that they were respected and involved by staff wherever possible and reported that they were satisfied with the care and attention provided by staff.

Visitors with whom we spoke told us that they were consulted with about the care that their relative were receiving and felt able to talk to staff. They confirmed that they were satisfied with the levels of care and welfare provided to their family member. They also told us that if they had any concerns about the care being provided they felt able to approach staff and were confident that these issues would be addressed appropriately.