Deer Park Care Home

Deer Park Care Home is a residential care home providing personal care to older people, some of whom are living with dementia. On the first day of inspection there were 21 people living at the home, and on the second day there were 22 people, which included a person on respite. The service can support up to 56 people in a purpose-built building which has two floors and a passenger lift.

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

We identified areas for improvement in some aspects of staff training and supervision. We found there was a new breach linked to good governance. Since October 2020, the Care Quality Commission (CQC) have inspected this service eight times to address different concerns. We have taken enforcement action to drive improvement in the service. At this inspection, we saw evidence of improvements but found they still needed time to be embedded and sustained by a new staffing and management structure.

People received their medicines as prescribed, and there were safe systems in place to manage the storage, administration and disposal of medicines. Systems were in place to safeguard people; staff recruitment was well managed.

People and relatives were positive about the staff group. Relatives told us, " My relative is cared for by the staff who seem to be consistent and have been there for a while” and “The staff are brilliant, they are caring … The staff inform us if there are any issues and keep us up to date. She has lots of family visitors and they are looked after too.” We saw people had good relationships with staff.

Improving staff morale and teamwork had been an on-going process. However, on this inspection there was positive feedback from the staff group and praise for the current management team.

The interim manager recognised further work was needed to enhance the staff group's training and to maintain teamwork. They also recognised the staff group would need to develop their skills in their pre-admission assessments before people moved permanently to the service.

The home was clean, and staff adopted good infection control measures. 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. A staff member said, “I hope that Deer Park can move forward to 2023, showing the local community and further a field that it is a lovely home, that has excellent caring staff a supportive management and residents have full and happy lives in their twilight years.”

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 10 May 2022). The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

The previous manager completed a service improvement plan after the last inspection to show what they would do and by when to improve. They also provided monthly reports relating to audits and how risks to people’s health were managed in the service. The interim manager has continued sending CQC monthly reports and was updating the service improvement plan at the time of the inspection.

We have identified a breach in relation to the monitoring of the quality of care, consulting with people living at the service and staff performance at this inspection. We also judged there was an on-going breach relating to training, staff support and induction.

We have made a recommendation linked to the layout of the laundry to improve infection control.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Deer Park Care Home is a residential care home providing personal care to people aged 55 and over at the time of the inspection. On the first day of inspection there were 22 people living at the home. The service can support up to 56 people in a purpose-built building which has two floors. The upper floor can be accessed by a lift. There is an area of enclosed outdoor space.

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

We identified areas for improvement in some aspects of medicine recording and infection control and have made recommendations to improve practice in these areas. However, we judged the previous breaches linked to safe care and treatment and good governance had been met due to improved practice and recording. The provider and manager have been responsive to feedback from the Care Quality Commission and health and social care professionals. They have worked alongside the local authority quality assurance team to look at ways of improving the service and people's experience. The service is no longer part of a whole service safeguarding process because of the improvements made.

People received their medicines as prescribed, and there were safe systems in place to manage the storage, administration and disposal of medicines. Systems were in place to safeguard people; the manager demonstrated their role to safeguard people by their actions. The recruitment process had been revised to make it more robust to protect people living at the home, for example changes to application form and a comprehensive index of checks undertaken on applicants’ files.

People and relatives were positive about the staff group. One relative told us, “They look after Mum extremely well, she has a nice room, and they are always popping in to see her, she loves it when they stop for a chat.” We saw people had good relationships with staff. People and relatives told us staff provided a good standard of care and support. During the inspection, we saw person centred practice by staff, showing sensitivity and compassion. Staff knew people well and people said they felt safe.

Improving staff morale and teamwork was still an on-going process, which the manager showed commitment to addressing through improved training, supervision, regular meetings and being clear regarding their expectations. The manager was clear where further work was needed to enhance the staff group’s training and confidence. They recognised the staff group would need to develop their skills in their pre-admission assessments as it had been a number of months since there had been a new admission.

The home was clean, and staff adopted good infection control measures linked to Covid-19. The manager had identified areas for improvement in the internal layout and outdoor space, which were planned once the service benefitted from an increased income from new admissions.

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.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 15 October 2021) and there were breaches of regulation. The manager completed a monthly action plan after the last inspection to show the steps they had taken to improve. At this inspection we found improvements had been made and the provider was no longer in breach of two regulations linked to safe care and good governance.

This service has been in Special Measures since February 2021. During this inspection the manager demonstrated improvements had been made. The service is no longer rated as Inadequate overall or in any of the key questions. 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. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deer Park Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will continue to request an action plan from the provider to understand what they will do to improve the standards of quality and safety in Effective and Responsive. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Deer Park Care Home is a residential care home providing personal care to people aged 55 and over at the time of the inspection. On the first day of inspection there were 35 people living at the home. The service can support up to 56 people in a purpose-built building which has two floors. People living with dementia mainly live on the upper floor, which can be accessed by a lift.

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

People were positive about how staff treated them. Some people had their social needs met and enjoyed the company and friendliness of the home. However, for people living with dementia their environment was less stimulating while their social activities and access to outside space were restricted.

Relatives had been supported to visit during the pandemic but said at times communication was disjointed and they did not always know who to speak with when they rang.

Records of care tasks were not always completed. We found gaps in the recording of repositioning people. Fluid intake was poorly monitored putting people at risk of dehydration. Care plans did not consistently have the required information to support staff in understanding a person's individual needs. Comprehensive assessments were not in place for everybody living at the home.

There had been multiple changes in managers running the home and this had impacted on staff confidence and morale. However, the appointment of a new manager who had immediately begun to address issues of concern was reassuring.

Medicine management had improved. Staff were recruited safely. However, staff training and induction was not effectively managed. Supervisions took place but observations of staff practice had mainly focussed on medicine administration.

Some 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. But for people living with dementia improvements were needed to ensure they had equal choices.

Systems and processes were not effective in ensuring the safety of people or the environment.

Systems in place to monitor and review the quality of care had not been effective in improving standards, and ensure the service was meeting people's needs safely and effectively.

During the inspection, we raised individual safeguarding concerns for some people living at the home. This was to ensure risks to their health and well-being were assessed and reviewed by health and social care professionals.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published March 2021) and there were five breaches of regulation. At this inspection enough improvement had not been made, and the provider was still in breach of regulations.

After the last rated inspection, the provider sent monthly reports to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating. It was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified five breaches in relation to this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider and request an updated action plan 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Deer Park Care Home is a residential care home providing care and support to people aged 65 and over. The service can support up to 56 people in a purpose-built building which has two floors. On the upper floor, there is a unit to provide care for people living with dementia. Access to upper floors is by a lift. At the time of the inspection there were 31 people living at the home.

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

People’s medicines were not managed safely. Arrangements were not in place to store medicines in accordance with manufacturers’ directions. There were not safe arrangements to monitor the expiry dates of medicines.

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

Rating at last inspection (and update): The last rating for this service was Inadequate (published 9 February 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We have met with the provider following this inspection to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Deer Park Care Home is a residential care home providing care and support to people aged 65 and over. The service can support up to 56 people in a purpose-built building which has two floors. On the upper floor, there is a unit to provide care for people living with dementia. Access to upper floors is by a lift. At the time of the inspection there were 31 people living at the home.

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

People’s medicines were not always being managed safely.

The manager and staff had been working hard to keep people safe by ensuring infection prevention and control guidance was followed. Staff had received infection, prevention and control training (IPC) and wore personal protective equipment (PPE) correctly. Staff spoke confidently about challenging their colleagues if they observed poor PPE practices and a community nurse who visited the service every week told us they had not seen any concerns with IPC practices.

Government guidance was being followed to ensure people were protected from the spread of infection, for example seating arrangements in the lounges and dining rooms enabled people to socially distance.

People were supported to remain connected with their friends and families via the use of technology.

Visitors to the service were prevented from catching and spreading the infection because safe and effective measures were in place. This included people’s temperatures being checked on entry and the wearing of PPE.

Visit times were staggered, and two newly created visiting rooms enabled people to visit their loved ones safely, in line with current visiting guidance. Families were enabled to visit their loved ones, who were at the end of life.

People were safely admitted to the service from hospital and/or the community; regular testing of people and staff was taking place, and the vaccine had been rolled out to people and staff. Risk assessments were not in place to protect people and staff who were assessed as being in a vulnerable category, however the provider took immediate action to rectify this at the time of the inspection.

The laundry area was safely managed, with systems in place to handle laundry in line with guidelines. Cleaning routines were in place which included high touch areas, such as door handles and light switches.

The manager and consultants recognised the importance of staff’s wellbeing and were taking steps to further enhance the support that was being offered in helping to sustain staff morale and personal resilience.

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

Rating at the last inspection (and update)

The last rating for the service was Inadequate published on (9 March 2021). The service remains Inadequate.

The overall rating for the service has not changed following this targeted inspection and remains Inadequate. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deer Park Care Home on our website at www.cqc.org.uk.

Why we inspected

We undertook this targeted inspection because we received concerns in relation to the management of people’s medicines and infection, prevention and control practices.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Please see the Safe key question section of this full report.

Enforcement

We have identified a continued breach in relation to the management of people’s medicines at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Following the previous inspection on 4 December 2020, when a warning notice was served, we carried out a follow up inspection on 11 December 2020. The compliance date for the warning notice was 8 December 2020. The follow up inspection found there were still concerns surrounding infection control procedures in the home. This inspection was carried out on 22 December 2020 to seek assurances that the service had addressed the concerns relating to infection control procedures in the home. We were assured that the service now met good infection prevention and control guidelines.

We found the following examples of good practice.

We reviewed the Deer Park Care Home Coronavirus (Covid 19) management for Care Homes Policy dated 1 October 2020, and saw from training records, the commitment to ensure all staff would be trained in the safe use of Personal Protective Equipment (PPE) had been met. Staff had received up to date training and further support had been provided by outside health professionals to ensure the safe use of PPE and effective infection control procedures.

At our inspection on 11 December 2020, a staff bike shed funded by an infection control grant was full of discarded equipment making it unusable for its original purpose. Following that inspection, the provider told us the equipment had been removed and the bike shed was available for staff. This inspection found that the bike shed had been cleared and returned to its original use.

On 11 December 2020, we completed a tour of the building. Laundry procedures needed to be improved further to ensure effective infection prevention and control practice as processes were still unclear. The layout of the laundry did not allow for there to be separate areas for soiled and clean washing entering and leaving the area. Information on washing temperatures for soiled and unsoiled clothing was not clear.

Following that inspection, the service had implemented a new laundry procedure. The layout of the laundry area had been made clearer to ensure the separation of soiled and clean washing entering and leaving the area. Where necessary, clothing and bedding was being double bagged and clearly labelled with a date that permitted them to be laundered in order to reduce the risk of cross infection. There were clear instructions stating the minimum temperature of washes was 60 degrees. Recording of washing machine temperature checks had been implemented to ensure safe laundry procedures. This inspection found these measures were in place, being followed and documentation confirmed these checks were in place.

Since our inspection on 11 December 2020, the service had allocated an infection control lead to oversee the cleanliness of the service. Infection prevention and control audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule for all areas of the home was in place and implemented to ensure the whole home was effectively cleaned on a regular basis. This included mop heads and buckets which were colour coded and charts were in place to show they had been washed.

PPE was readily available around the building, including outside people’s individual rooms. We saw there was a good supply of PPE for staff to use. Staff were observed to be wearing PPE appropriately, which was disposed of in clinical waste bins. The provider had purchased an additional clinical waste bin to cope with the increased use of PPE in the home.

People’s temperatures were taken twice daily to help monitor for signs of Covid 19. There was a separate area for staff to change in and out of their uniforms, which was good practice.

Deer Park Care Home is a residential care home providing personal care to people aged 55 and over at the time of the inspection. On the first day of inspection there were 47 people living at the home. The service can support up to 56 people in a purpose-built building which has two floors. On the upper floor, there is a unit to provide care for people living with dementia.

When we inspected on 11 December 2020, we were not assured that this service met good infection prevention and control guidelines and we will inspect the service again. Improvements were needed regarding staff practice, guidance, laundry management and infection control.

Following the inspection, we shared our concerns with the provider. We shared this information with commissioners and health colleagues. Deer Park Care Home did not have a registered manager in place, although interviews were taking place. A consultancy company was overseeing the management of the home on behalf of the provider and were addressing the breaches of regulation highlighted at the last CQC inspection which began on 29 October 2020.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 17 December 2020) and there were multiple breaches of regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate

CQC has introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We have identified a continued breach in relation to infection prevention and control at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Deer Park Care Home is a residential care home providing personal care to people aged 55 and over at the time of the inspection. On the first day of inspection there were 47 people living at the home. The service can support up to 56 people in a purpose-built building which has two floors. On the upper floor, there is a unit to provide care for people living with dementia.

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

Risks to people’s health were not well managed. Steps to reduce these risks were not followed. For example, people were not moved at specific times to reduce the risk of pressure ulcers. Health professionals raised concerns that changes to people’s health and well-being were not always identified in a timely way. Some equipment was broken or there had been delays in accessing additional items or replacements. There were a number of fire safety concerns and infection control was poorly managed which put people and staff’s health at risk. Medicine administration and storage was not safe. There was poor management of staff training, induction and supervision. Staff turnover was high and morale was low. Staff did not feel valued by the provider.

The service was not well-led. The provider had not recognised the quality of the service had significantly deteriorated and had therefore put people at risk of unsafe care. There were inadequate systems in place to monitor and review the quality of care, and ensure the service was meeting people's needs safely and effectively.

During the inspection, we raised individual safeguarding concerns for some people living at the home. This was to ensure risks to their health and well-being were assessed and reviewed by health and social care professionals.

There was no registered manager in post. An application to register a new manager was being processed by CQC at the time of the inspection but the person chose to withdraw their application. During the inspection, the provider arranged for a manager from another of their services to oversee Deer Park Care Home as a temporary acting manager. In the acting manager’s first week, they began to address poor infection control, gaps in staff training and began to improve practice. Two people’s care needs were re-assessed, and as it was identified the care home was not suitable for their needs.

After our inspection, the acting manager sent us an action plan to address immediate risks. This showed they took the concerns raised seriously and took quick action to start improving the quality of the service and the safety of people living there.

Following the inspection, a whole service safeguarding enquiry was started by the local authority. Two local authorities put a block on funding new admissions, and the provider agreed to a voluntary suspension of new private admissions. CQC informed the fire service of our concerns and contacted another regulator regarding personal protective equipment.

Despite the above concerns, people living at the service praised the kindness of staff and their caring attitude. Their comments included, “The staff are kind and willing and will do anything you want”, “They are very kind and yes if I had a sad day, they would talk to me. They are all very nice” and “They are very caring and if I felt down in the mouth, I would find a carer for a chat.”

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 July 2019).

Why we inspected

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns about infection control and lack of support from the provider. A decision was made for us to inspect and examine those risks.

We inspected and found there were concerns with other areas such as medicines, the running and safety of the service, quality assurance, identifying and addressing risks for individual people. So we widened the scope of the inspection to become a focused inspection which included all areas covered by the key questions of safe and well-led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deer Park Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the Covid 19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid 19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, safeguarding service user from abuse and improper treatment, premises and equipment, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 meet with the provider.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service:

People said they felt safe and their needs were being met by staff who knew them well. One person said, “We are well looked after, sometimes there is a short wait, but they are very good.”

There had been some shortfalls in staffing numbers over the previous weeks prior to this inspection. This was due to staff sickness and staff leaving. The manager had recognised that the current staffing arrangements needed reviewing and had already agreed with the provider to increase by two additional care staff per shift. This was being implemented within a few days of our inspection visit. We have made a recommendation for the service to follow best practice and utilise a dependency tool to keep staffing levels under review. Staff recruitment was robust, and staff understood how to keep people safe and report any concerns they may have.

The manager had discussed the need to streamline the management structure with the provider and this was work in progress. They had implemented a number of good initiatives to respond to the local community needs. This included procuring three NHS- funded beds within the home, a respite care bed and adapting a small lounge into a suite for use by couples. They were also in the process of setting up day care in a separate building but on site, for up to 10 people. This showed they were responsive to the local community needs and were working in partnership with other stakeholders to achieve this.

Risks were being assessed and actions put in place to keep people safe. This included risk of falls, pressure damage and poor nutrition. People’s medicines were managed safely and recording of topical creams had improved since the last inspection.

There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

Rating at last inspection: At the last inspection this service was rated overall good with good in all key areas except Safe which was rated requires improvement. (Report published 18 April 2018)

Why we inspected: We carried out this focussed inspection because we had received several concerns which had a key theme of there not being enough staff and people’s needs not being met in a timely way. We also received information about a person who had been admitted to hospital with pressure sores. This inspection did not specifically look at this issue, but we wanted to assure ourselves other people were not at risk from developing any pressure damage.

During this inspection we looked at two key areas of Is the service safe? and Is the service well-led. ? At the last inspection we found safe was requiring some improvements. At this inspection we rated safe as requires improvement, but for different reasons.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the “Is the service Safe?” section of the full report.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.

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

Deer Park 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.

Deer Park is a purpose built service on two floors which accommodates up to 56 people. Most people living at the service are older people with conditions associated with frailty and/or dementia. Some younger people live at the service that has complex nursing conditions.

Since the last inspection the registered manager had resigned but continued to work as part of the clinical team. The service’s development manager had taken over the role as an interim arrangement, but has now agreed to register and was in the process of applying during this 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.

When we met with the manager and provider in February 2018 to review their service improvement plan, they gave us further assurances that the risks we had identified in June 2017 had been improved upon. This had been achieved by ensuring care plans and risk assessments had been updated with more detail and direction for staff. Training had been completed by nursing and care staff in core areas of ensuring people’s healthcare needs were being met. The service had been supported by a senior community nurse from NHS who had been seconded for a three month period to assist them with making the right clinical improvements. They had also been supported by the Devon County Council Quality improvement team. They had also employed a clinical lead who had experience and knowledge of key nursing needs.

Improvements had been made to the way medicines were administered to ensure they were done in a timely way. However we found some areas of improvement were still needed in respect of the record keeping of some medicines. The provider gave assurances this would be actioned by the following day of inspection we saw what improvements had been put in place in respect of topical creams.

We made a recommendation in respect of ensuring staff had the right training in the electronic record keeping so accurate records could be maintain of when people had been checked and what actions staff had taken. For example if they had assisted them to move position to help with the prevention of pressure damage. We did not see any direct impact of this not being recorded, which led us to believe staff were taking the right actions but recording it incorrectly. The manager agreed she would complete an audit on this aspect of care.

There was sufficient staff with the right skills training and support to meet people’s needs. People were offered a good variety and choice of meals to help them maintain good health.

Staff understood how to protect people from harm and safe recruitment practices ensured only staff who were suitable to work with vulnerable people were employed.

People’s emotional, social and diverse needs were considered. There was a comprehensive activities programme which people said they enjoyed taking part in.

Improvements had been made to the quality monitoring systems. Systems and audits ensured the service was well maintained, safe and considered the views of people and their relatives. Complaints were taken seriously and investigated. People and staff were confident their views were taken into account in the running and development of the service.

At this inspection completed in June 2017 we found that although some improvements had been made in respect of supervision and support to staff, further improvements were still needed in relation to how consent to care was recorded. This related to the lack of records in relation to best interest decisions where restrictive practices had been used to keep people safe. This included the use of bedrails and pressure mats which alerted staff when people might be at risk of falls. We also found other areas where the service was not meeting the regulations.

Before this inspection we received some information of concern about staffing levels from an anonymous source. We also received some information from visiting professionals about the lack of a proactive approach in meeting people’s needs and in particular about end of life care. At this inspection we found there were adequate staff but their deployment was not always ensuring people’s safety and comfort. For example no staff presence in lounge areas for periods of up to half an hour. We also found some of the care planning around end of life care and the skills of some nursing staff in ensuring effective and safe pain relief, required some improvements.

The local authority quality assurance team (QAIT) had been offering support and guidance to this service in developing an improvement plan and reviewing the care plans to ensure they were more personalised. This work had been halted at the services’ request as they had decided they needed to remodel their service and were working with Devon County Councils business relationship manager to implement this. The remodelling involved reducing the nursing staff by one per shift and skilling senior care staff to take on some of the medicines and care planning processes. At the time of our inspection this had not been implemented.

Deer Park nursing home is registered to provide personal and nursing care for up to 56 people. They provide care and support for frail older people and those people living with dementia. On the day of the inspection there were 46 people living at the home, including one person who was having a short break there.

There was a registered manager who has been in post for just under 12 months. 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.

People were not fully protected against the risks of unsafe medicine management. Medicines were not given on time and nurse practices and competencies had not been checked. The treatment room was disorganised and this made it difficult for nurses to have enough space to prepare medicines and to find the right equipment. By the third day of our inspection the medicines and treatment room had been de-cluttered and the registered manager had checked nursing staff competencies. They had also changed the start of the daily routine so that nursing staff received a short written handover report which freed their time to start the medicines for the morning at an earlier time. It was reported this was working to good effect and that the morning medicines were completed in a more timely way than when we had inspected.

Risks had not always been fully assessed and monitored which placed people at risk of receiving unsafe care and support. This related to the way one person was supported to eat and their risk of choking. We also found one person who was at risk of poor nutritional intake whose daily records did not assure us they were getting sufficient amounts to maintain good health. Records in relation to wound care were not clear as to how often dressings were needed or if they had been changed. It was difficult to assess if improvements to wounds were being fully monitored. By the third day of our inspection, these areas of concern had been addressed.

Although there were sufficient staff working at the home, they were not always deployed to ensure people’s safety and comfort. For example, on the first day of the inspection there was a period of over one hour where people sitting in the lounge had very little staff interaction. Following feedback the registered manager and provider were taking actions to address this. This included changes to the routines of staff roles and advertising for another full time activities coordinator.

Healthcare needs were not always responded to in a timely way. We received feedback from healthcare professionals who gave examples of needing to direct the staff to seek medical assistance for specific conditions. This included checking for basic common health issues such as a urinary infection. In some instances nursing staff did not have a proactive approach to referring to other healthcare professionals.

The service had achieved a national beacon status for end of life care. However, improvements were needed in some of the nurses’ skills for managing with complex pain relief. Records in relation to end of life care were not personalised.

People were at risk of receiving inconsistent or inappropriate care. This was because not everyone had a care plan in place to guide staff about how best to plan and deliver care and support. Care plans were not person centred and did not reflect people’s needs, preferences, interests, hobbies or past lives. This meant staff would have limited knowledge about people and events that were important to them, and would limit what staff could talk to people about. The registered manager had created some basic care plans for those who did not have them in place by the end of the second day of our visit. They had also organised some additional training and support for improving their care plans.

Audits and systems for checking the quality of care and support delivered had not identified the number of issues we found, including three people having no care plan, MCA information not being well documented in terms of best interest decisions and the skills and competencies of staff not being reviewed and monitored.

People were positive about living at Deer Park and were complimentary about the caring nature of staff, the cleanliness of the home and the quality of food they were offered. Comments included; “I am very happy with the staff. They treat me well…they are good, helpful people” and “Most staff are kind and very willing. I know some of the local girls working here, which is nice.”; “Yes, I feel I am always treated with respect and that my dignity is preserved.” Similarly, relatives were positive about the care their family member received. One said “I do believe they offer the right care. I can sleep at night knowing they are well cared for.”

The home was kept clean to a high standard and infection control procedures were followed to ensure people were protected from the risk of cross infection.

People were protected from the potential of unsuitable staff working at the service. This was because staff were only recruited once they had all the checks in place to ensure they were suitable to work with vulnerable people. Staff understood what may constitute abuse and how and to whom they should report any concerns.

Staff felt valued and believed their opinions and views were listened to. People and staff felt confident any concerns they raised would be dealt with appropriately by the management team. Staff spoke about the increased use of supervision and training being useful to help them understand their role and develop their skills.

There were surveys, meetings and one to one discussions with people to ensure their views were gathered in relation to feedback about the service and how to improve for the future.

In light of the findings of this inspection the management team have decided to voluntarily suspend any new placements to the service for a four to six week period. They want to spend some time consolidating their training, care plans and other actions taken to mitigate risks we identified. They have also provided CQC with actions about addressing staff training, records and audits.

We found six breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report.

Deer Park Nursing Home is registered to provide accommodation for 56 people over the age of 18 years old who require nursing and personal care. At the time of our inspection there were 46 people living at the home.

There was no registered manager in place. However the new manager was currently in the process of registering. 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.

Staff did not always comply with the Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. This was not being done and had led to relatives making unlawful decisions on other people’s behalf. For example, consent to care plans.

Staff received a range of training to keep their skills up to date in order to support people appropriately. However, staff had not been receiving on-going supervision and appraisals in order for them to feel supported in their roles and to identify any future professional development opportunities. There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs.

We heard staff referring to people who required their food prepared in a manner that supported them to not choke being referred to as ‘feeds’ as if this was their surname or name. This was not respectful. We raised our observations with the manager and provider. They told us they would raise this with staff and monitor the situation to ensure other unacceptable language had not become the norm. However, staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. People said there were plenty and varied activities which they could engage with or not as they chose. The organisation’s visions and values centred around the people they supported.

A number of methods were used to assess the quality and safety of the service people received. However, these methods had not picked up on the issues we identified as part of our inspection. For example, the correct application of the Mental Capacity Act (2005). We were assured by the manager their quality assurance processes would look more closely at the areas we identified for improvement.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf.

Care files were not personalised to reflect people’s personal preferences. However, their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

End of life care was undertaken with compassion for the person and their family and with regard to the person’s dignity.

Staff spoke positively about communication and how the manager worked well with them.

There were two breaches in regulation. You can see what action we took at the end of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Deer Park alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Deer Park had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them and in some cases with the input from relatives. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

The quality of recording seen was of a good standard enabling nurses and care staff to use the information correctly.

Is the service caring?

We spoke with five people and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'wonderful' and 'Staff are very friendly' and 'Very considerate carers'. When speaking with staff it was clear that they genuinely cared for the people they supported.

People's preferences and interests had been recorded and basic life histories were evident.

Deer Park had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive? Many people who lived at Deer Park had complex health and care needs and were either not able, or chose not to join in group activities. The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The home employed activity co-ordinators and during our inspection we observed people being taken out for a ride in the company's vehicle during the morning and in the afternoon a group of bell ringers entertained a large group of the people who lived at Deer Park.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.