Dresden House Limited

We found the following examples of good practice.

• The provider had shared their visiting procedure with relatives, which was updated as government guidance changed. This contained details of the booking system to ensure there was time between visits to complete a thorough sanitisation of the visiting.

• When visits had been restricted other methods were used to ensure people continued to have contact with their loved ones such as, video and telephone calls.

•The environment was clean. Additional cleaning had been implemented and new equipment had been purchased to help lower the risk of cross transmission.

• Individualised risk assessments had been completed to ensure people and staff in high risk groups were supported to remain safe.

• Staff were supported by the registered manager during periods of anxiety and staff had been signposted to external wellbeing services.

Dresden House is a care home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Dresden House is registered to accommodate 25 people in one adapted building. At the time of our inspection 22 people were living in the home. The home accommodates people in one building and support is provided on two floors. There are three communal lounges, a dining area and a garden that people can access. Some of the people living at Dresden House are living with dementia.

There is a registered manager in post. The registered manager was not in post at our last inspection and has been at the home since February 2018. 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.

Improvements were needed as not all capacity assessments were in place or evidence of decisions being made in people's best interests. When people were being restricted applications had been made for these to be considered.

People were safe living at the home and staff knew how to recognise and report potential abuse. We found that risks to people were managed in a safe way and when people needed specialist equipment this was provided and maintained for them. When incidents occurred within the home risks assessments were reviewed and updated to reflect changes. There were safe systems in place to manage medicines.

People enjoyed the food and were offered a choice. People and relatives said they were involved with reviewing their care and when needed people had access to health professionals. The home was clean and designed for people in their preferred way. There were infection control procedures within the home that were implemented.

Staff knew people well them well and they were provided with an induction and training that helped them to support people. We found there were enough staff available to meet people's needs and the provider ensured staffs suitability to work within the home.

People's privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day. They told us they were offered the opportunity to participate in activities and pastimes they enjoyed.

Staff felt listened to and were able to raise concerns. The provider used feedback from people and relatives to bring about changes. Quality monitoring checks were completed to make improvements to the service. When things had gone wrong in the home the provider used this information so that lessons could be learnt and improvements made. We were notified of significant events that had occurred within the home and the provider was displaying their rating of the previous inspection in line with our requirements.

Dresden House provides accommodation and personal care for up to 25 people. People who use the service may have a physical and/or mental health need such as dementia. At the time of our visit there were 17 people using the service.

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 previous inspection in November 2016, we found a breach in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. We found breaches of the regulations related to managing risks to people's safe care and treatment, safe staffing levels, need for consent, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, ensuring only fit and proper persons were employed, requirement to display performance ratings and notification of incidents. We gave the home an overall rating of inadequate. We added a condition to the provider's registration, to restrict admissions and re-admissions to the home. The service was placed in 'Special Measures'. The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Services in special measures are inspected again within six months following the publication of the inspection report.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found that sufficient improvements had been made to remove the service from 'special measures,' we found further improvements were required to meet the regulations relating to consent and notification of incidents. We also found improvements were required in how senior managers assured themselves they were providing a safe service, that ensured people's health and welfare needs were fully met.

Since our last inspection visit the provider had recognised the registered manager needed more support to improve the quality of the service. A deputy manager was in post and a new care director had been appointed to provide guidance and oversight. Systems and processes had been introduced to monitor the quality of the service, but these needed to become embedded in every day practice to be consistently effective.

Following our last inspection, the provider had increased staffing levels within the home. People felt safe living at Dresden House because there were enough staff on duty to meet their care and support needs safely and effectively. Staff were recruited safely because the provider had checked they were of good character. However, improvements were needed in the application form so the provider could identify any gaps in employment history.

Improvements had been made in risk management within the home. Staff had an understanding of each person’s individual risks and ensured they used the correct equipment to keep people safe. Where people had fallen, this had triggered a review of the risks to the person’s safety. Staff had a better understanding of best practice around giving people their medicines and people received their medicines as prescribed. However, further improvements were still required to ensure all risks were managed consistently.

Staff understood their responsibility to record and report any concerns they had about people’s health or wellbeing. Safeguarding concerns had been referred to the local authority as required.

Staff had received essential training to meet people’s needs safely and effectively. However, further training was required in the implementation of the Mental Capacity Act 2005. Managers and staff did not always follow the principles of the Act to ensure people were always supported to make their own decisions, and any restrictions on people’s liberty were the least restrictive as possible.

People were offered meals that were suitable for their individual dietary needs and met their preferences. They were supported to eat and drink according to their needs. Staff monitored people who were at risk of malnutrition and obtained advice and support from other health professionals to maintain and improve their health.

People were positive about their experience of living at Dresden House and told us staff were kind and caring. People valued that staff encouraged them to maintain as much independence as they wanted to. Staff were patient and understanding of people when responding to people’s requests for assistance.

Care plans were sufficiently detailed to support staff in meeting people’s needs in a way they preferred, taking into account their likes and dislikes. Staff were knowledgeable about people’s needs and their wishes and preferences.

Improvements had been made in providing people with activities that were meaningful to them and gave them opportunities for social engagement as a group or on a one to one basis.

People and staff felt the provider had been open about the issues identified at our last inspection visit and managers were available and approachable. They felt able to raise any concerns and were confident they would be listened to.

The provider had improved the governance of the home, but still needed to ensure they notified us of all reportable incidents and events as required under the regulations.

You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide accommodation and personal care for up to 25 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 23 people were using the service.

There was a registered manager at 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 and associated Regulations about how the service is run.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not always managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always reported as required. Safe recruitment systems were not in place to ensure staff were of suitable character to work with the people who used the service.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

People told us they enjoyed the food. However, we found that some people did not always receive the support they needed to eat and drink. People’s risk of malnutrition and dehydration were not being effectively monitored.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. We identified one person who was potentially being unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours.

People were involved in the planning of their care. However, people’s care plans were not always accurate and up to date which meant staff didn’t always have the information they needed to provide safe and consistent care.

There was a programme of social and leisure based activities on offer to people. However, we found some people were not always supported to engage in activities that were meaningful to them.

The registered manager and provider did not always notify us of reportable incidents and events as required. The inspection rating was not being displayed at the home as required by law.

People spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people were not consistently treated in a caring manner as staff were often busy supporting people with care tasks.

Some people were offered regular choices about their care. However, improvements were needed to ensure all people were offered daily choices about the parts of their care they could make decisions about.

There was an effective system in place to enable people to complain about their care. Complaints were investigated and managed effectively to make improvements to people’s care.

People’s right to privacy was promoted and people and staff described the registered manager as approachable.

At our last inspection, we found that improvements needed to be made in how medicines were stored, recorded and disposed of. We also identified that changes need to be made with how care records were stored and updated.

During this inspection, we saw that the required improvements had been made. People were protected from the risks associated with the administration of medicines, because appropriate systems were now in place. Care records were stored securely and were updated to reflect changes to people's needs.

People told us they were happy with the care they received and we observed people getting the care that had been planned for. One person told us, 'I am very comfortable here. I get whatever I need'.

People told us they were very happy with the food that was served. One person said, 'All the food is nicely cooked and we are offered seconds if we want them'. We saw that choices of food and drink were made available and people's feedback was used to make changes to the menus on offer.

People told us they felt safe and we saw that systems were in place to identify and report any concerns about people's safety.

We spoke with six people using this service, three relatives and six members of staff. We also spoke to a health care professional who visited the service. People using the service told us that they like living in the home. One person said, 'I like it very much here, the staff are good at everything'. Relatives that we spoke with told us that they were happy with the care provided. One relative said, 'I am happy with everything that they do for X'.

During our inspection we saw that people were supported to make decisions and were involved in the planning of their care. Where people could not make decisions for themselves, decisions were made in their best interests with involvement from their families.

We observed people receiving appropriate care and treatment by staff who had the required knowledge and skills to provide the care that people required.

We saw that there was a complaints system in place which people were aware of.

We saw that medications and care records were not stored securely and that systems were not in place to ensure that some medications were kept at the required temperature or disposed of appropriately.