Archived: Delaheys Nursing Care Home

Delaheys Nursing Home provides personal and nursing care to 23 people aged 65 and over at the time of our inspection. The service can support up to 28 people. Bedrooms comprise of 16 single and six double rooms. Delaheys provides accommodation spread over three floors with lift access. There are sufficient washing and toilet facilities along with a large garden to the rear. There are three lounges and a dining area for people’s choice and comfort. Delaheys Nursing Home will be referred to as Delaheys within this report.

People’s experience of using this service and what we found

People and relatives told us they felt safe at Delaheys. One person said, “I feel perfectly safe.” Care records held risk assessments intended to mitigate the risk of unsafe or inappropriate care. Staff had training to underpin their skills in preventing abuse or harm and demonstrated a good awareness of reporting procedures.

The management team had implemented an innovative system to keep their workforce updated to good infection control and medication practices. They ensured staff had relevant training, regularly assessed their competency and checked the continued safe management of people’s medication.

People commented staffing levels were sufficient to meet their needs in a timely way. When asked about this one relative stated, “Yes, I do think so, they constantly keep an eye on her.” The provider’s training programme included easy access to guidance to develop a skilled workforce.

People commented the food was very good and they had plenty of choice. A relative said, “From what I have seen the meals are fantastic. They get three courses for lunch and there is plenty to eat.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. One staff member explained, “If I was supported by someone who took my independence away by just taking over and making all the decisions I would be mortified.”

People told us staff were supportive, patient and caring. A visitor said, “Yes, I am happy with the care [my friend] receives.” The management team completed a one-page profile for each person to guide staff about how they wished to be supported.

There was a list of planned activities and events on the notice board intended to optimise people’s social stimulation. A relative said, “The activities co-ordinator is so good she is like a “Red Coat” entertainer.”

People said the management team was visible and accessible. One person said, “[The registered manager] comes and sits to talk to me. She is very comforting. I would not swap her”. The provider received commendations from national organisations about care delivery.

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

Rating at last inspection

The last rating for this service was good (published 13 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Delaheys is a care home with nursing registered to offer personal and nursing care for up to 28 people. The home is a detached property with accommodation located on the ground, first and second floors. A passenger lift is in place for ease of access. The property is surrounded by garden areas and there is a large conservatory at the front of the building. Accommodation is in single and shared rooms, some with en-suite facilities. At the time of our inspection there were 24 people residing at the home.

The service had a 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.

At the last inspection visit carried in January 2016, we found the registered provider had not met the fundamental standards. We identified concerns in relation to medicines management, consent to care, safeguarding and assessment of risk. We asked the registered provider to submit an action plan to demonstrate what improvements they were going to make. We used this inspection visit in December 2016 to check the required improvements had been made

During this inspection, we found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

We have made a recommendation about the introduction of formal supervision for staff.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at Delaheys Nursing Home. This was confirmed from discussions with staff.

Staff responsible for administering medicines were trained to ensure they were competent and had the required skills. There were appropriate arrangements for storing medicines safely.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able to speak with us told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans were organised and identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at Delaheys Nursing Home. The activities were arranged for individuals and for groups.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people and their relatives for input on how they could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

Delaheys is a Care Home with nursing registered to offer personal and nursing care for up to 28 people. The home is a detached property with accommodation located on the ground, first and second floor. A passenger lift is in place for ease of access. The property is surrounded by garden areas and there is a large conservatory at the front of the building. Accommodation is in single and shared rooms, some with en-suite facilities. The home is furnished to a high standard.

The registered manager was available and received feedback throughout the inspection. The registered manager was also the nurse on duty during our 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 that the service provided a good standard of person centred care. Feedback from people who lived at the service was positive in regards to the care and support from staff. People told us that they felt safe and well cared for.

We found that the service had a safeguarding policy and procedure. However this was not easily accessible for people who lived at the service and or their relatives. We found that staff lacked knowledge about types of abuse and referral procedures. Some staff had undertaken training for safeguarding vulnerable adults as part of their health and social care diploma; however we found that service specific training has not been undertaken. Training should identify internal procedures and the local safeguarding authority referral process to enable staff to identify and report abuse.

The environment was clean, safe and well maintained. A very high standard of interior was maintained throughout the service and the providers prided themselves on maintaining this.

We looked at care records and found that staff worked positively with community professionals such as dieticians and speech and language specialists to ensure that people’s needs were met.

Care plans were being developed to move from a medical model to person centred. Care plans showed that people were encouraged to participate in the care planning process. However we found that this was not always in line with the Mental Capacity Act 2005.

Records showed that mental capacity assessments were not always undertaken prior to making a decision on the person’s behalf. We found the manager and care workers lacked knowledge about the Mental Capacity Act 2005 (MCA 2005) and the related Deprivation of Liberty Safeguards (DoLS). This meant that people were not always provided care and support that had been assessed in line with the MCA 2005.

We found that staff training and development required improvement. Staff told us that they felt confident in their roles and supported.

We looked at how the service protected people from avoidable harm and injury. We found that people who lived at the service had been assessed for risks associated with clinical care, such as skin integrity and malnutrition. However we found that personal emergency evacuation plans were not in place to enable emergency evacuation at the service should it be needed.

We discussed this with the providers who agreed to take immediate action.

We found shortfalls in medicines management that placed people at risk of not receiving their medicines as prescribed. Shortfalls included inaccurate recording on medicine charts, unsafe administration and ineffective care planning around people’s medicine regimes and preferences.

We found that people were supported to maintain a healthy and balanced diet. People were assessed against the risk of malnutrition and encouraged to maintain a good intake of foods and fluid.

We observed the lunch time meal service and found that people were offered choice and control. One person did not like the pudding options so were offered an alternative.

We found that the presentation of texturised meals required improvement to ensure that people with such needs experienced the same meal presentation of those who were able to eat a normal consistency meal.

We received mixed feedback about the food people received. Some people were very positive; others commented that they would like more choice on the menu.

We found people who received end of life care and those needing bed rest were provided a very good standard of person centred nursing care. People appeared comfortable and stimulation was provided in each person’s bedroom. One person enjoyed listening to 1920’s music.

We observed staff interact with people in a kind and compassionate way. Staff understood the needs of people who lived at the service and were passionate about maintaining people's independence and wellbeing. Throughout the inspection we observed staff take time to sit and talk to people. Conversation was free flowing and we could see that positive and trusting relationships had been built between staff and people who lived at the service.

People told us that they felt confident to raise their concerns and felt listened to. Records of service user meetings were not available; however people who lived at the service told us that they felt involved in the running of the home. We have made a recommendation about maintaining written evidence of how the service involved people in the general running of the home.

We looked at how the service managed complaints. We found that the registered manager did not effectively record when she had dealt with people's concerns and how she managed complaints. However we received very positive feedback about the running of the service and people felt able to disclose their concerns.

Surveys were issued on a regular basis for people who lived at the service, relatives, staff and external professionals. Results were analysed by the registered manager. However evidence of survey feedback to stakeholders was not evidenced.

We found that the registered manager, who was also the provider and nurse, played an active role at the service. They lived on site and were very much committed to providing person centred care. People told us that the family run business was well managed and that they felt confident that the manager responded to their concerns.

Activities at the service were planned on a day to day basis. We received mixed feedback about activities; some people were happy others wanted more choice.

We looked at how the service was monitored for quality. We found that audit records were not available, however the registered manager told us about how they continually assessed the service and acted upon changes needed. We discussed with the registered manager the importance of maintaining written records to show how they monitored the service for quality and development.

The registered manager told us that they had recently invested in a new care system for policies and procedures and they intended to roll out auditing processes based on this new system.

We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safeguarding, risk assessment, medicines, need for consent, staff training and support and governance. You can see what action we have told the provider to take at the back of the full version of the report.

People told us that they were very pleased with the level of care and support received and that they liked the staff team. One person said, 'The staff are all very nice, all good, there is nothing bad to say'. A relative explained, 'They are so helpful and caring and interested. We are well pleased'.

Although people living at the home could not really remember whether they had seen their care plan or whether this had been discussed with them, comments were all positive. One person told us, 'I cannot remember whether I know anything about my care plan but it does not really matter. I am very happy with the care. They always try their best'.

We looked at the internal and external environment of the home that was well maintained and furnished and decorated to a high standard. People told us that they were comfortable in their bedroom accommodation, could have their own things around them and that the home was kept, 'Very clean'.

One person explained that she had been asked if everything was to her satisfaction. We were told, 'Overall it's a pretty good place, and everything seems to be really quite good'.

Nobody expressed any concerns only compliments.