Damfield Gardens

Damfield Gardens is a purpose built care home that provides accommodation and personal care to up to 67 people; some of these people are living with dementia. At the time of our inspection, there were 64 people living in the home.

People's experience of using the service and what we found

During our inspection we found a number of improvements that were needed in relation to record keeping and governance. The registered manager and provider were responsive to the issues found and took immediate action to address them. However, this is the third consecutive inspection where issues have been identified with records associated with medicines and risk management and governance processes.

People spoke positively about the care they received, and family members were confident their loved ones were well looked after. People told us they felt safe and could talk to staff about any concerns they had.

Risks to people's health and well-being had been assessed and staff had a good level of knowledge and understanding about people's individual risks and how best to support them. We observed enough staff to meet the needs of people living in the home. However, some staff and people told us that during busy periods staffing levels were low.

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.

The registered manager had effective systems in place to learn from accidents, incidents and safeguarding concerns in order to prevent them from occurring in the future.

The environment was clean and hygienic. Staff received training in infection prevention and control and were provided with regular updates and changes to guidance; particularly in response to COVID-19. Staff and people using the service accessed regular COVID-19 testing. The service supported family members to regularly visit their relatives safely and had processes in place to prevent visitors from catching and spreading infections.

Staff spoke positively about their experience of working at Damfield Gardens and told us they felt well-supported by the registered manager. They told us they could speak openly about any concerns they had and were confident action would be taken where necessary.

It was clear from observations and conversations with the registered manager that they knew people well and had built positive relationships with those living at Damfield Gardens.

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 requires improvement (report published 3 May 2019) and there were breaches of regulation. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found the provider remained in breach of regulation.

Why we inspected

We received concerns in relation to the standard of care people received; particularly in relation to personal care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for this service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

Please see the safe and well-led sections of this full report.

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

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.

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

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.

• The service followed safe visiting procedures to minimise the spread of infection. Visits were restricted to essential visitors only and pre-arranged. Temperature checks and health screening assessments were completed on all visitors. They were provided with personal protective equipment which they were required to use throughout the visit.

• Shielding and social distancing rules were complied with. The environment had been adapted to support social distancing. There was a dedicated part of the service identified to accommodate people with COVID-19 and those showing symptoms.

• Safe procedures were followed for admitting people to the service. Virtual assessments were completed, and people were only admitted following evidence of a negative COVID-19 test. On moving into the service people were required to self-isolate for 14 days.

• There was a good stock of the right standard of personal protective equipment (PPE) and staff used and disposed of it correctly. Well stocked IPC stations were located around the service. There were designated IPC leads and they shared good working practices and updates across the staff team.

• People and staff had access to regular testing.

• Current IPC and PPE procedures were clearly visible across the service and available in picture format.

• Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with their family and friends throughout the pandemic.

• People told us they felt safe living at Damfield Gardens and staff told us they felt safe and well supported at work.

We were assured this service were following safe infection prevention and control measures to keep people safe.

Further information is in the detailed findings below.

Damfield Gardens is a purpose-built care home in Maghull that offers residential care for older people and specialises in care for those living with dementia. The service can accommodate up to 67 people. Following our last inspection, the provider voluntarily stopped admissions, but recently commenced this again and when we visited there were 42 people living at the service.

People’s experience of using this service:

At the last inspection in November 2018 we asked the provider to make several improvements. This included the management of medicines and risks to people’s safety, governance and record-keeping, levels and consistency of competent staff, as well as person-centred care. The provider met with us following the inspection and sent us an action plan as well as regular updates. At this inspection we found some actions had been completed, but others required further improvement.

Although the provider had made good improvements to the management of people’s medicines, there were still some aspects that were not always safe. The management of known risks to people’s safety, the planning around this, as well as record-keeping, governance and quality assurance processes were still not always effective.

We recognised that staff had worked well together and as a team had made noticeable improvements to the quality of the service and ultimately people’s experience of it. Through getting to know and understand people better and developing their own skills and confidence, the service demonstrated clear progress. The provider had focussed on improving person-centred care and the quality of people’s service through an increased offer of meaningful activities and a better dining experience. There were now more consistent levels of competent staff, although some aspects needed further attention. We made a recommendation regarding this.

People told us they felt safe living at the service and we read relatives comments that stated, “I can sleep at night now knowing [my relative] is in safe hands.” Staff told us they had previously been worried about the service, but they were not now. People and their relatives praised the staff team and we observed warm, caring and patient interactions in a noticeably more relaxed atmosphere. Staff felt well supported and told us how much they enjoyed working with the people living at Damfield Gardens. People, relatives and staff were involved in the development of the service through regular meetings that had been introduced.

Rating at last inspection:

At the last inspection (20 November 2018) we rated the service as Inadequate for Safe, Requires Improvement for all other key questions and therefore Requires Improvement overall. At this inspection, we found the provider had made improvements which led to a better rating for Safe, Caring and Responsive. The overall rating remained unchanged.

Why we inspected:

This was a planned inspection, based on the service’s previous rating. We inspected to check whether necessary improvements had been made.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service through the provider’s action plan updates, notifications and conversations.

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

Damfield Gardens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Damfield Gardens opened in April 2018 and is a newly-built care home providing accommodation for up to 67 people. The service is laid out across three floors, with two floors dedicated to people living with advanced dementia. The service is situated in a residential area of Maghull, with nearby facilities including shops and public transport. At the time of the inspection, there were 51 people living at the home.

The service had a registered manager. A registered manager is a person who has registered with CQC 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 was our first inspection since the service registered with CQC in April 2018. The registered provider and registered manager were open and honest about the difficulties they had encountered, as well as the improvements they were aware needed to be made.

During this inspection we found breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what actions we told the provider to take at the end of the full report.

People, relatives and professionals told us there were not always enough staff to meet people’s needs and keep them safe. The service had identified staffing as a main difficulty themselves.

The knowledge and confidence of staff, including agency staff, to provide safe, person-centred and specialist care to people needed to be developed.

The management of people’s medicines was not always effective, which meant some people did not receive their correct medicines or did not receive them on time. The provider was changing to a different medicines management to make it more effective.

Risk monitoring and assessment processes were not always effective to keep people safe. Aside from other injuries, four people had fallen and sustained fractures in less than three months. Quality processes and audits were not always effective at leading to improvements and ensuring safer, better quality care for people.

The service did not always meet people's individual needs.

Feedback from people using the service, their friends and families, staff and visiting professionals was mixed. We heard about things the service did very well, but equally about concerns. However, all those who had concerns agreed that they had confidence that, given time and support, the service would make the necessary improvements. We heard comments about a warm, caring and open culture that had developed and we observed this during our inspection.

Staff knew safeguarding procedures and had confidence managers would address any concerns. Safeguarding concerns were referred to the local authority, but the service’s recording of these needed to be clearer.

Care files showed staff had completed risk assessments to assess and monitor people's health and safety. These had not always been reviewed following accidents and incidents to show what lessons had been learned.

Recruitment checks for permanent staff was robust. The service had not always received all relevant information about agency staff before they worked within the home.

Regular health and safety checks of the premises were in place. We discussed with the service checks that needed to take place more often, as well as improvement needs to the building.

We found the environment to be generally clean and bright. Staff were knowledgeable about good infection control practice.

The service was working with professionals to specialise the environment for people living with dementia and make it safer.

Where people could not consent to care and treatment, the use of appropriate assessments needed to improve. However, we also found good examples of working together in people’s best interest. Appropriate applications to the local authority had been made.

The service was working with a variety of other health professionals to maintain people’s wellbeing. This needed to be developed further through greater staff confidence and competence. Communication within the service and with others was not always effective.

Staff told us they felt well supported and could raise any issues with the registered manager.

People had enough to eat and staff supported them to choose from a variety of meals. At times, recording and support for people to have enough to drink needed to improve.

We observed staff interacting with people in a patient, supportive way. Overall, people and relatives told us staff were kind, caring, treated them with respect and made them feel welcome.

Relatives felt involved in the planning of their loved one’s care, but involvement of people and their wishes needed to be developed.

People’s care plans contained person-centred information, but needed to be more detailed and consistent to guide all staff more clearly and protect people.

Complaints were recorded appropriately, acted upon and responded to by the registered manager.

The service had recently employed an activities coordinator, but they were still developing the activities on offer to stimulate and engage people.

Team meetings, residents’ and relatives’ meetings took place regularly.

People, relatives and staff praised the registered manager and the provider for being open, available and supportive. We observed both being present around the service and engaging with everyone. We also noted the new manager had identified good development plans.

The registered manager had submitted relevant notifications to CQC, but we needed to clarify a few additional ones they needed to send in line with legal requirements.