Dane View Care Home With Nursing

About the service

Dane View Care Home with Nursing is a residential care home, providing personal or nursing care to up to 41 people, some of whom are living with dementia care needs. At the time of inspection, 34 people were living at the service.

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

Right Support: The service is set in a beautiful old convent building and is well designed. There were large spaces utilised effectively for activities and other functions. The service was mostly well decorated and personalised throughout.

Staff worked alongside community health and social care professionals to ensure people received timely care.

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.

Right Care: Management of known risks to people’s health and wellbeing still required improvement. Wound and skin care management had significantly improved since our last inspection, however, we found gaps in people’s records that did not promote safe practice. There was a continued lack of guidance in place for staff regarding people’s mobility needs and risk of falls. Safe medicines practices were not always followed.

People’s assessment documents were not always fully completed, for example, food and fluid records. Feedback from people indicated they were happy with the care they received and felt it met their needs. The mealtime experience was calm and relaxed.

People were protected from risk of harm and abuse by an effective safeguarding system. People and their relatives told us they felt safe.

People were supported by enough staff who were deployed effectively. Safe recruitment processes were in place.

Right Culture: The registered manager demonstrated desire and ability to learn lessons when things went wrong, however, further improvements in relation to safe care and treatment were required. The provider had employed a group quality and compliance manager and a group operations manager to support service development.

Quality assurance processes were not always being used effectively. Senior staff were not always clear on their roles in relation to quality oversight.

The provider was proactive in ensuring staff compliance with required training. Most people and their relatives told us they felt staff were well trained and competent.

Staff spoke highly of the registered manager. Feedback from people and their relatives indicated the home was well managed.

Staff received regular supervisions. Regular staff and relative meetings took place to provide people opportunity to provide feedback.

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 11 August 2023). Breaches in regulations relating to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing, and fit and proper persons employed were identified. The provider completed an action plan after the inspection to show what they would do and by when, to improve and meet the breaches in regulation related to dignity and respect, consent, safeguarding service users from abuse and improper treatment, and fit and proper persons employed. Warning Notices were served for the breaches relating to safe care and treatment, governance, and staffing. At this inspection we found the provider remained in breach of regulations.

At this inspection we found improvements had been made. However, not enough improvement had been made and the provider remained in breach of regulations. This service has been in Special Measures since 22 Mar 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to good governance, safe care and treatment and staffing had been met. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-led which contain those requirements.

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 Dane View Care Home with Nursing on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, and good governance. 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.

Dane View Care Home with Nursing is a residential care home, providing personal or nursing care to up to 41 people, some of whom are living with dementia care needs. At the time of inspection, 36 people were living at the service.

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

People were not always kept safe by the use of an effective safeguarding system and safeguarding incidents were not always reported to the local authority. Risks related to people’s health care needs were not well managed and people were at potential risk of harm due to poor health and safety management.

People’s prescribed ‘as and when’ required medicines were not managed safely and there was a lack of guidance for staff. Medicines were not always safely stored, and people were not always supported with their medicines by competent staff.

Staff were not always deployed effectively or responsive to people’s needs. The provider did not always ensure staff were suitable for their role by obtaining employment references and certificates of relevant qualifications.

People’s privacy and dignity was not always promoted during personal care, support with meals, and by the completion of health and safety checks whilst people slept.

People’s needs were not always identified through the effective use of assessment tools and risk assessments did not always consider people’s health conditions.

The provider failed to ensure staff were supported through supervision or performance monitoring.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s care plans did not always reflect the outcomes of capacity assessments or authorised deprivation of liberty safeguards and conditions.

The garden and grounds were rarely accessed by people living at the service and activities rarely made use of the available spaces within the service.

People and their relatives raised concerns about the quality of food and the lack of available options. People who required specialist diets were provided with meals appropriate and safe for their needs.

Quality assurance systems were not effective and service oversight was poor. The registered manager welcomed support and guidance from external professionals, but this was not aways implemented to improve the care people received.

Relatives were not always involved in the planning of their family members’ care and feedback indicated there were issues around communication and organisation.

Staff told us the registered manager was approachable and helpful. The registered manager was open and forthcoming throughout the inspection and was aware of their legal responsibilities in relation to duty of candour.

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 (published 26 May 2021).

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 received concerns in relation to end of life care, service management and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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.

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 requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to dignity and respect, consent, safe care and treatment, safeguarding people from abuse and improper treatment, governance, staffing and the employment of fit and proper persons, at this inspection. We have sent the provider 3 warning notices, and 4 requirement notices, to request improvements are made.

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.

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.

We found the following examples of good practice.

All visitors to the home were required to complete relevant COVID-19 checks in line with government guidance; Guidance on care home visiting.

There was a high level of managerial presence and support at the home to ensure the environment was used safely and social distancing was adhered to when appropriate.

The provider had robust testing and self-isolation protocols in place for new admissions and hospital discharges.

Effective use of PPE was observed during the inspection in accordance with current government guidelines; COVID-19 personal protective equipment (PPE).

Staff completed weekly Polymerase Chain Reaction (PCR) tests and Lateral Flow Tests (LFT) at the home before the start of each shift.

The deputy manager completed weekly hand hygiene observations of staff to ensure best practice was maintained.

To ensure the wellbeing of staff self-isolating, the registered and deputy managers completed wellbeing checks via telephone.

The registered and deputy managers completed regular health and wellbeing checks with night staff via telephone.

Dane View Care Home with Nursing is a residential care home, providing personal or nursing care to up to 41 people, some of whom are living with dementia care needs. At the time of inspection, 32 people were living at the service.

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

Medicines were administered correctly, however record keeping in this area required improvement. Medicine Administration Records (MAR) were not always fully completed, and body maps showing where certain medicines were applied, were not always completed.

People received safe care and felt safe within the service. Staff we spoke with understood safeguarding procedures and felt confident their concerns would be listened to and followed up. Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing levels were sufficient within the home, and people felt they could get the support they needed from staff promptly.

The service was clean, tidy and well maintained, and staff followed infection control procedures.

Care plans reflected people likes dislikes and preferences. There were examples of personalised care where staff had taken the time to provide meaningful activities for people, which met their individual needs. People and their family were involved in their own care planning as much as was possible.

Staff treated people with kindness, dignity and respect and spent time getting to know them. We observed positive interactions between people and staff, and feedback from people about staff was good.

A complaints system was in place and was used effectively. The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required

Staff felt well supported by the manager, and were motivated to provide good care to people.

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 30 August 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dane View Care Home with Nursing is a residential nursing home providing personal and nursing care, for up to 41 people aged 18 and over. Accommodation is over three floors and provides support to older people, people with a physical disability, sensory impairment and younger adults. At the time of the inspection 15 people were using the service.

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

Medicines were not always managed safely which meant sometimes people did not receive their medicines as prescribed.

Although care plans were in place they provided limited information to describe the care and support people needed. They did not always include some important information individual to the person or include people’s preferences for their end of life care. People did not always receive care that met their needs and preferences.

Staff were aware of risks to people however information about risks and how to manage them was inconsistent. The electronic care planning system made accessing information about people difficult.

Governance systems and processes needed improvement as the current systems did not identify the concerns we or the provider identified.

People told us they liked living at Dane View however felt there were not enough staff to meet all their needs. Staff, although compassionate, kind and caring were under pressure to meet people’s physical needs and were less able to meet their emotional needs.

Although not all staff had received training in safeguarding, they understood their responsibilities, how to recognise the signs of abuse and knew the processes to follow to manage any allegations of abuse.

Accidents and incidents were recorded, investigated but it was not always clear if trends were identified or learning shared with staff.

Staff had not always received appropriate training, induction and supervision. We made a recommendation about this.

Potential risks to people's health and welfare had been assessed, there was limited guidance for staff to reduce risks. Risk assessments had not always been updated in a timely manner when people's needs or health had changed.

Recruitment procedures were not always robust. Systems were not in place to report practice amongst nursing staff that fell short of their professional standards.

The environment did not support people living with dementia to remain as independent as possible. We made a recommendation about this.

People told us they did not feel there were enough activities and they were bored. People liked the meals and were provided with a choice of food and drinks. People were supported to see healthcare professionals when they needed them.

Care plans did not always identify how people were to be supported to have maximum choice and control of their lives. However, staff understood the importance of supporting them in the least restrictive way possible and in their best interests.

A complaints procedure was displayed. People and relatives knew how to raise concerns and were confident these would be dealt with appropriately.

The provider had recognised the service was not meeting the regulated standards prior to our inspection and had taken action to make improvements. They had done this by employing a new manager and providing support and resources to make the necessary improvements. The They were proactive in keeping CQC informed when changes were made.

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

Rating at last inspection:

This service was registered with us on 22 November 2018 and this is the first inspection.

Why we inspected:

This inspection was brought forward due to concerns received about the standard of care people were receiving.

We have found evidence that the provider needed to make improvements. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to safe handling of medicines and ensuring people received person centred care. You can see what action we told the provider to take at the back of the full version of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.