Havenmere Health Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We received mixed feedback from people about feeling safe. Risks associated with people’s care had not always been managed to keep them safe from otherwise avoidable harm. For example, people requiring pressure relief, did not always receive this consistently and information to guide staff was not always in place. Safe recruitment processes were used. However, we found some gaps in employment records. We saw that regular servicing and maintenance had taken place on equipment to ensure its safety and protect people from avoidable harm. However, systems to assure themselves people were protected from the risk of fire were not always completed. A system was in place to record and analyse accidents and incidents to assist in preventing reoccurrence. We saw staff delivered care which was respectful. We observed interactions with people were friendly. Feedback from people and their relatives was mixed in terms of the consistency. People and staff spoke positively about the management of the service. Staff we spoke with demonstrated a clear understanding of what abuse was and how to manage and report any situation of this kind.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us that if they raised any concerns with staff action would be taken. They said, “I have weekly meetings every fortnight with [Registered Manager] on the phone which is beneficial to everyone involved in [relatives] care”.

Staff said there was a proactive culture of safety, in which concerns about safety were listened to and acted upon. Staff told us, ‘Lessons learnt are circulated on each unit and we have to sign to say we have read them. We also get them from other homes where a lesson has been learnt as a result of an incident or accident’.

There was a robust process in place to monitor incidents, accidents, and near misses. Staff recognised incidents and reported them appropriately, and managers investigated incidents and shared lessons learned. Senior staff maintained a record of accidents and incidents and these were reviewed regularly to identify patterns and trends.

People were supported to access healthcare, such as GP’s and district nurses. Feedback from relatives identified equipment to support people was not always available. For example, relatives purchased equipment for their relatives, including walking frames and tables.

People were supported from a range of professionals to meet their individual needs. Staff discussed how they shared concerns and the importance of maintaining good relationships to ensure external advice was discussed, recorded and implemented to help people maintain and improve their health and wellbeing. Staff told us families and people important to service users were involved in care plans and reviews, however, this was not always recorded on the online care planning system. Comments included, “We speak a lot to all involved in service users lives. We don’t record that at the minute on the online system”.

We received mixed feedback from partners. One partner gave positive feedback about the service, saying, “The partnership working with the provider was excellent”. Whilst another said, “Concerns received demonstrates themes, particularly in relation to staffing levels, quality concerns, individualised care approaches, and meaningful activities. The services standards may have fallen below the expected level”.

The provider had processes in place to ensure safe system, pathways and transitions were maintained. This included an initial needs assessment at the start of a service being provided. Records reviewed showed referrals to other professionals were complete, such as dieticians, Speech and Language Therapy (SALT) and Occupational Therapy (OT). There were mixed recordings of family involvement in reviewing of care plans. Some records evidenced involvement whilst others did not. Activities were not person centred and were decided by the activities team without people involvement. The Registered Manager had identified this and had implemented processes to support people’s engagement and meaningful activities.

We received mixed feedback from people about feeling safe at Havenmere. Comments included, “[Relative] is absolutely safe with no concerns at all” and “I do not feel safe”.

Staff had a clear understanding of safeguarding. Staff were able to discuss how to access required policies and procedure. They were able to discuss personal values which were appropriate for their roles and responsibilities. Staff felt supported by the management team.

Staff and the management team spoken with were all open and welcoming during the visit. People appeared to be comfortable living at the home, and in the company of staff supporting them. People confidently approached staff and where engaging and comfortable in their presence.

Staff received training and had access to relevant information and guidance about protecting people from harm. Staff understood what was meant by abuse and were confident reporting safeguarding concerns. Any safeguarding concerns were recorded appropriately and reviewed to ensure the relevant professionals were notified. The provider was able to work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found DoLS applications had been made where required. Some records in relation to the MCA were not robust. For example, some people had comprehensive MCA’s in place where others did not. Recording systems for best interest decision meetings were not always accurate or completed. Also where restrictive practices were implemented such as lowered beds, there were no supporting MCA or best interests in place. The Registered Manager was working to improve these.

Relatives were happy with the care received. Comments included, "I trust all the staff, in my absence I have too, they [staff] are kind, caring, dedicated, and respond to [relative], and are just wonderful”. While the people and relatives we spoke to said they were happy with the service and staff, our assessment found elements of care did not meet the expected standards.

Staff told us they routinely involved a range of professionals to support people. Staff told us they could see the positive change in care plans as they had moved to an online system. Staff told us post incident de-briefs when restraint had been carried out did not involve the service user. The Registered Manager told us they had implemented a questions and answers session with staff to examine and look at risks for service users.

Staff were seen using equipment as intended. Staff spoke to people before, during and after any task. They did this by checking about their safety in a respectful, gentle way. Staff were seen encouraging people to complete tasks independently. For example, to make drinks and food, tidy their rooms. People were supported to keep well hydrated and nourished.

Risks to people were not always assessed or managed safely. Care plans and risk assessments did not always demonstrate people were involved in managing risks. Risks to people were not always clearly documented in their care plans to ensure people's needs and risks were mitigated or managed safely. For example, 1 person’s care plan had conflicting information regarding their skin integrity, support, and treatment. Another person's care plan stated they had diabetes. However, there were limited person-centred guidance in place for staff to follow to support this person safely. Records did not always evidence important information about people using the service. For example, repositioning charts did not always evidence requirements as identified in care files. There was little evidence people, or their families had been engaged with when planning their care or managing risk. Rescue medications were not accessible in a way that would support administration promptly. The Registered Manager was responsive to our feedback during the inspection and began making improvements in this area.

Feedback from people was generally positive about their personal room environment. Were appropriate, people were able to have input in relation to their room décor.

Staff told us they are not involved in time simulated evacuations. Staff said, “We are not involved in evacuations. We are not trained for ski mats yet”. The Registered Manager told us this was an area for improvement and would implement. We received positive feedback about the environmental improvements in the home and how this is benefiting service users.

Some areas of the home needed maintenance work to meet safety and hygiene standards. We additionally noted areas of the home that were not always clean. Bathrooms were cluttered with moving and handling equipment. Areas of the home are very clinical. A service improvement plan was in place.

All required checks and maintenance to the buildings and equipment were mainly completed or current. However, time simulated evacuations had not taken place to ensure, safe and timely evacuation could be achieved. We could not be assured evacuation of a compartment was in line with guidance. There was nothing recorded within the fire risk assessment to suggest additional measures were needed when the time could not be achieved. On 1 unit, the fire alarm could only be activated using a key, staff on that unit did not have keys meaning they would need to return to the nurses’ station to sound the alarm in the event of a fire. The Registered Manager gave assurances this would be addressed immediately.

People received support when they needed it and requests for support were answered promptly. Some relatives commented that staffing had improved recently.

We received mixed feedback about staffing. Some staff felt there were enough staff on each shift, whilst other staff felt the numbers did not reflect people’s needs. Some staff told us not all staff were skilled which had been raised with the management team. Examples were shared where medication rounds were delayed significantly due to staffing. Staff told us they do not receive regular supervision or appraisals. Staff told us supervisions are seen as a negative experience because they were generally completed when something has gone wrong. The Registered Manager gave assurances this would be reviewed and addressed. The Registered Manager told us they routinely reviewed people’s needs and staff were adjusted accordingly. The use of agency was implemented to support full time staff and they confirmed recruitment was ongoing to provide people with consistent care and support from people they knew.

We observed calm and relaxed support during the visit. Staff had time to sit and chat with people. Staff took a genuine interest in people's days and views and interests. However, we did observe where communication was challenged due to 1 service user not understanding English language.

Staff were not receiving regular 1:1 supervision or appraisals. There had been some infrequent supervisions around specific topics. The registered manager was aware and provided assurances this would improve. Staff were recruited safely. However, employment history was not always available. The Registered Manager was aware of this and had started reviews of staff files. Staff had completed Oliver McGowan training. Staff were trained in safeguarding, MCA and equality and diversity. There were systems in place to enable the provider to identifying staff’s equality, diversity or inclusion needs.

People and relatives we spoke with did not raise concerns with the cleanliness of the home.

Staff said they had received appropriate training in infection prevention and control and were aware of safe hygiene practices. Staff were able to confidently explain infection control processes. However, explained they have not received any enhanced training or direction for supporting people who were having chemotherapy treatment. We received mixed feedback on how to escalate an isolation plan on each unit.

We observed the laundry to be disorganised without the appropriate separation of laundry. For example, soiled sheets were in piles with non-soiled laundry within separate bags, stored on the floor. We observed bathrooms on each unit were cluttered with moving and handling equipment, commodes, peoples clothing and toiletries.

Infection control systems were in place. However, some areas of the service needed repair or replacement and therefore, could not be effectively cleaned. This was discussed with the registered manager who said there was a service improvement plan and refurbishment plan in place, and they would take action to ensure the service was well maintained during these works. The provider had cleaning schedules in place to make sure all areas were kept hygienically clean. Audits were carried out and actions identified. The home had an infection, prevention and control lead in place and hand hygiene assessments were completed to show compliance.

People did not raise any concerns about their medicines with us. Relatives told us people were supported to take their prescribed medicine. One person told us, “I know all the medicines and changes are always notified to me”. People were given their medicines safely and in a timely manner. This was recorded on their medicines administration record (MAR). Staff interacted kindly with people whilst conducting the medicines administration round. People’s behaviour was not inappropriately controlled by medicines.

Staff told us they had completed a training and induction process for medicines management. Staff told us they had access to information which supported them to manage medicine’s safely and effectively. Staff could describe how they would follow up urgent queries and access urgent medicines.

There were processes in place to ensure the safe and effective use of medicines. However, competencies for the administration of medicines were not always assessed regularly to make sure staff had the necessary skills. People who were prescribed ‘when needed’ (PRN) medicines had a clear plan to direct when, how, or why these should be safely administered. Where a medicine was prescribed with a variable dose for example, to take one or two, plans were in place to guide staff in deciding which dose to administer.