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Inspection Summary


Overall summary & rating

Good

Updated 26 April 2018

The inspection took place on12 and 13 December 2017.

Diamond House provides accommodation; support and care for up to 42 older people, some of are living with dementia. People in care homes receive accommodation and 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. Although the service is registered to provide nursing care, this is not provided as the service is not staffed to provide nursing care. At the time of our inspection 35 people were using the service and one was in hospital.

There was a registered manager in place. 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 who used the service and relatives were happy with the care provided and many praised the skills and kindness of the staff.

People received safe care but at times staffing was stretched which meant people living with dementia were left without staff supervision. The shortage of activities staff meant that some people were not meaningfully occupied during the day which had an impact on their quality of life. The manager had strategies in place to try and address the staffing concerns.

Medicines were mostly well managed and people received their prescribed medicines on time. Some stocktaking errors meant we could not be fully assured that all medicines were being given as prescribed. The provider had already identified this as an issue and was taking action to address the issue.

The manager assessed and managed risks well. People were supported to be as independent as possible and any associated risks were incorporated into their care plan.

Staff understood their responsibilities with regard to keeping people safe from the risk of abuse. Staff were confident and knew how to raise concerns. Individual safeguarding incidents were well managed and the provider was open and transparent when carrying out safeguarding investigations.

Infection control procedures were in place and staff demonstrated a good knowledge of how to reduce the risk and spread of infection.

Staff were well trained and supported in their roles. Sone staff had received specific training related to eating and drinking and this was managed very well.

People had good and prompt access to healthcare and staff worked well with other healthcare professionals to meet people’s healthcare needs.

The service worked in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

Staff were kind and caring and demonstrated that they had built up good relationships with the people they were supporting and caring for. People were supported to be as involved in decisions about their care as they wished to be.

People who used the service had the opportunity to follow a variety of hobbies and interests, although it was hoped that this would improve further when new activity staff were recruited.

New care plans were person centred and reflected people’s individual need and preferences. People confirmed that their wishes with regard to their care, were respected.

Care for people at the end of their life was good. There was a commitment to ensuring people had a dignified and pain free death and were not left alone, unless this was their wish.

The service was well-led by the newly appointed registered manager. There was a clear vision for the service and a structured approach to driving improvement. Staff, including the manager, were well supported and there were effective quality assurance systems in place. We had confidence in the manager to continue delivering the good practice we found and to address the concerns, which they themselves had already identified.

Inspection areas

Safe

Requires improvement

Updated 26 April 2018

The service was not always safe.

There were not always enough staff to make sure people were safe.

Medicines were mostly well managed but some stocktaking errors meant records were not accurate.

The provider assessed and managed risks well.

Staff understood their responsibilities to keep people safe from abuse and were confident about reporting any concerns.

There were good procedures in place to reduce the risk and spread of infection.

Effective

Good

Updated 26 April 2018

The service was effective.

Staff were well trained and knowledgeable.

People’s rights were protected and the service operated in line with the Mental Capacity Act 2005. People were not unlawfully deprived of their liberty.

People’s needs related to eating and drinking and to their health were well managed and the service worked in partnership with other healthcare professionals.

The design and layout of the building was suitable for the client group.

Caring

Good

Updated 26 April 2018

The service was caring.

Staff were patient and treated people with kindness and respect.

People were involved in decisions about their care and were very positive about the care they received.

Responsive

Good

Updated 26 April 2018

The service was responsive.

Care plans were being reviewed and replaced with a more person centred format which reflected people’s individual needs.

There was arrange of activities for people but staff shortages had impacted on this. Recruitment for new activity staff was seen as a priority.

There was a complaints procedure in place and people were given opportunities to raise concerns formally and informally.

Relatives praised the staff for the end of life care the service provided.

Well-led

Good

Updated 26 April 2018

The service was well-led.

The service was very well led by a management team who were open, inclusive and empowering.

People were consulted and involved in the running of the service.

There were robust systems in place to monitor the quality and safety of the service and drive continual improvement.