The Devonshire Nursing Home

We found the following examples of good practice.

The home was clean and tidy. Cleaning schedules had been updated in response to COVID-19, this included regular cleaning of high touch and frequently used areas. There were designated housekeeping and laundry staff who had completed COVID-19 and Infection Prevention Control (IPC) training alongside care and nursing staff to ensure safe procedures were followed to help prevent the spread of infection.

The home had previously experienced a COVID-19 outbreak, a number of staff and people living at the home had tested positive. The registered manager had worked with staff to adapt shift patterns and ways of working to ensure people continued to receive safe care whilst isolating in their rooms. Staff had changed their shift patterns and some had moved into the home along with the manager to provide continued support when staffing numbers were reduced due to staff isolating at home. At the time of the inspection one person was isolating in their room after recently moving into the home. People who were no longer required to isolate were able to use communal areas of the home.

The home had implemented a testing programme and staff and people were being tested regularly in accordance with latest government guidance. Any visitors to the home were required to complete a risk assessment and have a lateral flow COVID-19 (LFT) test before entering the building. Garden and window visits were also available, and there was a designated pod for safe visiting.

There were good supplies of Personal Protective Equipment (PPE) available for staff and visitors throughout the building, with clinical waste bins available for safe disposal once PPE was removed.

The registered manager spoke highly of staff and was proud of how they had worked together and the resilience shown by staff during a very challenging period.

The Devonshire Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 42 older people and people with physical disabilities. At the time of the inspection there were 31 people living at the home. Some people had complex health care needs and required nursing care and support, including end of life care. Other people needed support with personal care and assistance moving around the home due to frailty or medical conditions, such as a stroke and, some people were living with dementia.

The registered manager was present during 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.

At our last inspection in February and March 2016 we rated the service as good. Although we had asked the provider to make improvements in relation to safe moving and handling; to ensure staff followed current guidelines when assisting people to move around the home. At this inspection we found these improvements had been made and the evidence continued to support the rating of Good.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

An effective quality assurance and monitoring system was used to identify areas where improvements were needed and appropriate action had been taken to address them. For example, audits of the care plans showed that they had not consistently been reviewed each month. The registered manager and nurses had introduced ‘resident of the day’, so that all aspects of the person’s care and support provided was reviewed and updated as required.

People discussed and agreed the care provided with staff, who had a good understanding of people’s needs, preferences and choices. Risk had been assessed and people were supported to be as independent as possible in a safe way. The activities were varied and agreed with people through regular discussions, feedback surveys and resident’s meetings.

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.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Systems had been developed to support people with sensory loss and staff assisted people to use glasses and hearing aids.

People said the food was very good; they were offered choices for each meal and staff provided assistane when required. Relatives and visitors were made to feel very welcome and people were supported to keep in touch with them.

People, their relatives, staff and professionals said the registered manager was very good, and felt the service was well-led. Feedback was sought to improve the quality of the service and residents meetings and surveys encouraged people and relatives to put forward suggestions for improvements.

Further information is in the detailed findings below.

The home is registered to provide personal support and nursing care for up to 45 older people. There are shared rooms that are used as single rooms, unless a couple requests to remain together, therefore the maximum number of people is usually 37. There were 36 people living at the home during the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Other people needed support with personal care and assistance moving around the home, due to physical frailty or medical conditions, and some people were living with dementia.

A registered manager was responsible for the day to day management of the home. 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.

This inspection took place on the 24 February, 3 and 4 March 2016 and was unannounced.

People were assessed before they moved into the home to ensure staff could meet their needs. Care plans, including risk assessments, were developed from this information to ensure their safety. However, staff did not always follow the guidance and risk assessments in the care plans when supporting people to move around the home.

People said there were enough staff working in the home and that staff provided the support and care they needed. New staff were required to complete an induction programme in line with the Care Certificate, and the ongoing training programme supported staff to meet people’s needs. The registered nurses attended fundamental training and additional training to ensure their nursing competencies were up to date.

Systems were in place to ensure people were protected and support was provided safely. This included safeguarding training and staff had a good understanding of abuse and how to raise concerns if they had any. Staff were trained in the safe administration of medicines; they followed relevant policies, gave out medicines safely and signed the administration records after they had been taken.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (Dols) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were up to date with current guidance to ensure people were protected.

People, relatives and staff said the management were very approachable, and were involved in decisions about how the service developed with ongoing discussion on a day by day basis and during residents meetings. In addition feedback was sought from people, their relatives, healthcare professionals and other visitors to the home, through satisfaction questionnaires.

People told us the food was very good. Staff asked people what they wanted to eat, choices were available for each meal, and people enjoyed the food provided. People told us they decided what they wanted to do, some joined in activities while others chose to sit quietly in their room or communal areas.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

Visiting professionals told us they felt care at the home was good. We were told, 'Care is related to people's needs and staff communicate that very well.' We were also told, 'Overall it's very good here, especially communication.'

We spoke with visitors to the home. One said, 'People are so well looked after, and it's very clean here.' Another visitor told us, 'It's excellent, from the top to the bottom.'

We saw that staff treated people with respect. People were involved in making decisions about their care needs. We looked at the care plans and saw that people received care in line with their assessed needs.

Staff had a good understanding of safeguarding and were able to report concerns appropriately. Staff received on-going training and updates. There was a system in place to assess and monitor the service that people received.

People told us they were able to do what they wished during the day. Some people told us they enjoyed the activities provided by the home. Another person told us 'I don't join in with activities but I have plenty to do during the day.'

We looked at people's care plans and we saw that people and where appropriate their representatives were consulted about the care and treatment provided. We saw that people's care and treatment was planned and delivered in a way that ensured their safety and welfare.

We looked around the home and saw it was clean and tidy with adequate hand washing facilities throughout the home. There were systems and practices in place that ensured a good level of cleanliness was maintained throughout the home.

We saw there was a complaints policy in place at the home. Visitors to the home told us they were happy to discuss concerns with the staff. One visitor told us, 'I know if I say anything it will be addressed immediately.'