Background to this inspection
Updated
1 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
On the first day of our inspection, the inspection team consisted of three inspectors, three specialist advisors, one in governance, one in medicines and one in nursing. We had two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our Experts by Experience had knowledge about people living in a residential environment. One inspector carried out the second day of inspection.
Service and service type
Donisthorpe Hall provides accommodation and nursing for up to 189 people in one adapted building. Donisthorpe Hall is a 'care home'. People in care homes receive accommodation and nursing or 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.
The home had a manager registered with the Care Quality Commission. This meant they and the provider were legally responsible for how the service was run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced on day one.
What we did before the inspection
Before the inspection, we reviewed the information we held about the service, including statutory notifications. Notifications are used to inform CQC about certain changes, events or incidents that occur. We requested feedback from stakeholders. These included the local authority safeguarding and commissioning team and Healthwatch England. Healthwatch England is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider had completed a Provider Information Return (PIR). The PIR is a form provider are required to send us which contains key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 20 people who used the service and seven relatives, about their experience of the care provided. We spoke with the registered manager, project manager, deputy manager, two senior care staff, seven care staff and the chef.
We reviewed documents and records that related to the management of the service, including a range of policies, procedures and guidance used by staff in their role, records of safeguarding and complaints, audits and quality assurance reports. We reviewed four staff member’s files and records associated with the management and administration of people’s medicines. We looked at 20 people’s care plans in detail.
After the inspection
After the inspection, additional evidence was sent to us about people’s capacity and this information was used as part of our inspection.
Updated
1 November 2019
About the service
Donisthorpe Hall provides accommodation and nursing for up to 189 people in one adapted building. The home is split into units, Willow, Maple, Silver Lodge ground and Silver Lodge first floor. At the time of inspection 59 people were living in the home.
People’s experience of using this service and what we found
The registered manager was responsive to any concerns we raised during the inspection; implementing corrective actions where this was apparent and discussing plans where further improvements were required.
Checks and audits had been completed to identify any areas the service needed to improve. However, even though files had been audited capacity assessments had not been picked up by the deputy manager. We did not see people had an input in relation to mental capacity and best interest decisions. We found evidence throughout care plans where not all decisions had been recorded, what had was completed by one senior staff member. Consent to bed rails had not always been looked at.
As a result, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.
We have made a recommendation in the ‘effective’ section of the full report about some areas of people’s care plans and the care planning process.
There were enough staff on duty to meet people's needs in a calm and unrushed manner, but further recruitment was required to minimise the use of agency staff. However, the provider made every effort to use the same agency staff, thereby giving people consistent care. We spoke to the registered manager about the deployment of staff.
Recruitment procedures continued to make sure staff employed were suitable to work with vulnerable people.
Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. Overall, people we spoke with made positive comments about how staff delivered care. They told us they were happy with the general environment and how the home had improved.
People received safe care and treatment. Assessments had been completed to help make sure risks associated with people's care were identified and managed in a way which respected their freedoms and choices. People were safeguarded from the risk of abuse. Accidents and incidents were monitored to identify and address any patterns or trends. People's medicines were on the whole managed in a safe way.
Staff had received the training they needed to develop and update their skills and knowledge. Support and supervision sessions had been provided.
There was a range of social activities and events available for people to take part in if they wished to.
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 Requires Improvement (published October 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.