CQC report explained · a residential care home
What the CQC found at The Haven
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment checks, appropriate training and safer medicines systems. Risks were assessed and managed, and incidents and restraint had reduced.
- Effective?
- Requires improvement
- This key question was not rated in this follow-up inspection. The report says ratings for key questions not inspected were carried over from the last inspection.
- Caring?
- Good
- This key question was not rated in this follow-up inspection. Inspectors did observe staff interactions and found people appeared relaxed, with staff supporting communication and choices.
- Responsive?
- Requires improvement
- Care plans and routines had improved, but daily records were not always person-centred. A shortage of staff who could drive had limited the number and quality of activities outside the home.
- Well-led?
- Requires improvement
- A new manager had introduced an action plan and staff spoke positively about the changes. However, some records, staff meeting arrangements, medicine competency forms and checks about unexplained bruising still needed improvement.
What inspectors found, June 2023
Requires Improvement overall; inspectors found safer care, but records, activities and management still needed improvement.
This was a follow-up inspection after earlier concerns. Inspectors visited on 12 and 18 April 2023. They observed care, spoke with staff, relatives and managers, and checked care plans, medicines, training and management records.
The home was rated Good for Safe. Inspectors found enough staff, safer medicines management, better risk planning and prompt responses to safeguarding concerns. Incidents and the use of restraint had reduced.
Responsive and Well-led were both rated Requires Improvement. People were supported in line with their needs, but daily records did not always show their choices, enjoyment or progress. A lack of staff who could drive had also limited some activities.
The overall rating stayed Requires Improvement. The home had improved since the previous inspection and was no longer in breach of the regulations previously identified. However, inspectors said more time was needed for improvements to become consistent.
Improved safety
Risks were assessed and managed more consistently. Restraint had not been needed for several months and the number of incidents had fallen.
“As a result of consistency and clear guidelines, restrictive interventions (restraint) had not been needed for several months.” from the report
Safe medicines
Medicines were checked weekly and monthly. Staff were trained and assessed before giving medicines, and unclear as-needed medicine instructions were reviewed after the inspection.
“Medicines were managed safely. Medicine checks were carried out by a team leader on a weekly basis and the manager also carried out a monthly audit.” from the report
Staff understanding
Staff knew people’s routines and communication methods. Training covered specialist needs including epilepsy and positive behavioural support.
“Staff knew people and how they communicated. Each person's communication needs had been assessed and recorded.” from the report
More activities starting
Activities were gradually increasing. Two people had started swimming regularly, and planned day trips were being arranged weekly.
“As a result, two people had started to attend swimming regularly and planned day trips were arranged weekly.” from the report
Positive family communication
Relatives said communication was good and that they were kept informed about changes in their relatives’ wellbeing.
“People's relatives felt that there was good communication, and they were kept informed of any changes to people's wellbeing.” from the report
Care records were incomplete
needs fixingDaily records did not always show people’s choices, enjoyment or progress towards goals. The manager had started changing the recording system.
“Daily records were not very detailed. Whilst the records stated what people had done, they did not demonstrate that people had made choices, that they enjoyed what they had been doing and that progress with goals was recorded.” from the report
Limited outings
needs fixingA lack of staff who could drive reduced the number and quality of activities outside the home, particularly for one person who could not use buses or taxis. New driver staff had started or were due to start after the inspection.
“The number and frequency of activities outside of the home was impacted by a lack of staff who were able to drive.” from the report
Management records needed strengthening
needs fixingInspectors found gaps including missing staff meeting minutes, undated medicine competency forms and unclear follow-up about some unexplained bruising. The manager had identified some of these issues and work was under way.
“Whilst body maps were kept if anyone had an unexplained bruise, it was not evident that the reasons for the bruising had always been assessed and that the matter had been referred to the local authority.” from the report
Improvements not yet embedded
needs fixingThe action plan was being monitored, but not every area had been fully completed or sustained in everyday practice.
“However, further improvement was needed to ensure that the progress made is sustained and embedded into everyday practice.” from the report
- 01How are the new daily records showing each person’s choices, enjoyment and progress towards their goals?
- 02How often can each person now go out, and are there enough trained staff who can drive?
- 03How are unexplained bruises assessed and referred when necessary?
- 04Have all staff completed dated competency assessments before giving medicines?
- 05How are staff meetings and keyworker checks now being recorded and reviewed?
This was a follow-up inspection that rated Safe, Responsive and Well-led; the report says ratings for key questions not inspected were carried over from the previous inspection. This explanation was written from the published report of 21 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Requires Improvement; inspectors found ongoing risks around staffing, medicines, restrictions, personalised care and management.
The inspection took place on 14 and 21 April 2022. Inspectors observed care, spoke with staff and managers, reviewed care plans, staff files, medicines records, incidents and management records, and gathered views from relatives and professionals.
The home was not always safe, effective or responsive. There were too few suitably skilled staff, heavy use of agency staff, unclear medicines instructions, poor incident reviews and conflicting care plans. People were not always supported to make choices or take part in activities and goals.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. The report says this was the second consecutive Requires Improvement rating, and the home remained in breach of regulations from the previous inspection.
Regular medicines
Inspectors found that regular medicines were given safely. Staff had medicines training and competency checks before administering medicines.
“Medicines prescribed on a regular basis were given safely.” from the report
Staff support and training
Permanent staff received a range of essential and specialist training. New staff shadowed experienced workers and had their competence assessed.
“New staff shadowed experienced staff until they felt confident and their competence was assessed before they started to provide support independently.” from the report
Relatives felt people were safe
Relatives told inspectors they were satisfied with the support and felt their loved ones were safe.
“Three people's relatives told us they felt their loved ones were safe.” from the report
Communication support
Staff knew how people communicated, and records described communication methods such as objects of reference, iPads, writing and facial expressions.
“Permanent staff knew people well and how they communicated.” from the report
Clean and infection controls
The home appeared clean and hygienic, and inspectors were assured about several arrangements for visitors, personal protective equipment, testing and infection outbreaks.
“Although the home appeared clean and hygienic, there were gaps in cleaning records which had been an ongoing issue that was being addressed with individual staff members.” from the report
Too few suitably skilled staff
seriousThere were high staff vacancies, regular use of agency workers and shifts below the assessed minimum. This affected one-to-one support and activities, and not all agency staff had the specialist training needed.
“There was not enough staff on duty who were suitably qualified to meet people's needs.” from the report
Medicines instructions and records
seriousPRN medicine protocols were unclear or inaccurate. Records did not always show why medicines were given, and storage temperature records had regular gaps.
“The provider could not be assured that people who needed 'as required' (PRN) medicines received them as prescribed.” from the report
Restrictions and video monitoring
seriousPeople were not always supported using the least restrictive option. Video monitoring information was inconsistent, and the home did not initially have an overall procedure to protect people and staff.
“Staff appeared to be risk averse and people at times had imposed restrictions without considering the least restrictive option.” from the report
Outdated and conflicting care plans
needs fixingCare plans contained different versions of people's routines and advice about their needs. This increased the risk of inconsistent support, particularly with agency staff.
“People did not always receive person centred care.” from the report
Weak management oversight
seriousThe home had no registered manager, and quality systems did not identify several problems or check that improvements continued. A warning notice was issued for good governance.
“Although there were systems to monitor the running of the service, they were not always effective, and they had not identified many of the shortfalls we found on inspection.” from the report
- 01How many permanent staff are now in post, and how will you ensure every shift meets the assessed minimum staffing level?
- 02How do you check that agency staff have the specialist training needed for each person living here?
- 03How are PRN medicines, their protocols and storage temperatures checked and kept up to date?
- 04How are restraint incidents reviewed, including injuries, causes and actions to prevent them happening again?
- 05How has the use of video monitoring been reviewed, and how do you protect people's privacy and choice?
This inspection looked at Safe, Effective, Responsive and Well-led, including infection prevention and control; the Caring rating was not given and the report used the previous rating for any key question not inspected. This explanation was written from the published report of 29 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Haven
3 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2022Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2019Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: GoodWell-led: Requires improvement
- August 2018
Registered with the Care Quality Commission on 10 August 2018.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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19 live-in carers within about an hour of East Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
“When he point blank refused to go into hospital for a life saving blood transfusion she talked him through the situation and agreed to go in the ambulance with him and stayed until he was settled.”
“Una felt safe, secure and loved in her time with Debbie which is a gift that I am eternally grateful for.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.