Donnington House Care Home

Donnington House Care Home is a care home providing personal and nursing care to up to 28 people in one adapted building. The service provides support to people with health care needs, Parkinson’s disease and frailty of age. At the time of our inspection there were 19 people using the service.

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

The provider did not have effective oversight or scrutiny of the service. Aspects of leadership and governance were not effective in identifying some of the concerns found. The service worked with other agencies. People views were sought about the service they received.

People told us they felt safe and systems and processes protected people from avoidable harm. People received their medicine safely. Risks to people were assessed and mitigated. Infection prevention and control processes protected people form the risk of infection.

People’s nutritional needs were met, and people were complementary about the meals. Staff felt supported and had access to training. People told us the staff were kind and compassionate. We observed positive interactions between people and staff.

People received compassionate and person centred support. There were enough staff to meet people’s needs. People told us staff responded promptly to their care needs and when they required support. Registered nurses ensured people’s nursing needs were met. People received compassionate and dignified end of life care in line with their needs and wishes.

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

The last rating for this service was good (published 1 June 2019).

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.

We received concerns in relation to risk management, deprivation of liberty under the terms of the Mental Capacity Act 2005, responding to complaints and the management and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive 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 the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Donnington House 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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of the service at this inspection.

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.

We found the following examples of good practice.

People told us they felt safe with the infection control and prevention measures that were in place. The layout of the service had been changed to support social distancing. For example, in the lounge chairs were spaced apart from each other and in the dining room people sat at designated places.

Items coming into the service such as deliveries’, post and parcels were subject to a three-day isolation period. All visitors and contractors were required to undertake Lateral Flow Devise (LFD) test on arrival. Visiting was in line with government guidance and had been adapted throughout the pandemic to ensure visiting was compliant with government guidelines. Clear signage around the outside of the premises directed visitors to a sperate entrance.

All people and staff participated in regular whole home testing for Covid 19. Personal protective equipment (PPE) was readily available and there was plenty of it around the service. Staff wore and used PPE appropriately.

The premises were clean and odour free. There was an enhanced cleaning regime in place which included regular sanitisation of high touch areas.

People had been supported to stay in touch with relatives using technology such as video and voice activated devises. A range of activities were available, and people also made use of fully accessible garden area.

People’s experience of using this service:

People were relaxed and comfortable at Donnington House and were complimentary of the care provided. There were plenty of attentive staff on duty to meet people’s needs and they responded promptly when help was requested.

Staff understood how to protect people from all forms of abuse or discrimination. Risks were managed appropriately and care records included sufficient detailed guidance to enable staff to safely meet people’s care needs. Medicines were stored appropriately and administered as prescribed.

Staff were recruited safely and had the skills necessary to meet people’s needs. Training was regularly updated and the new manager intended to introduce new systems to ensure all staff received regular supervision.

Care plans were informative and included information about people’s backgrounds to help staff understand their individual needs. A new digital care planning and record keeping system was in the process of being introduced at the time of our inspection. Staff were comfortable using the new system and people’s care plans had been updated when their needs changed.

An additional activities coordinator had been appointed since our last inspection and there was a varied programme of activities and events planned for people to enjoy. Where people were cared for in bed or declined to participate in group events individualised activities were provided in their bedrooms.

The service was well-led. The staff team were well motivated and told us their managers were supportive and approachable. The registered manager had recently stepped down to become the service’s deputy manager. The new manager had taken over leadership responsibilities on the day of our inspection and staff told us they had confidence in the new manager’s abilities. The service was operated by a volunteer board of trustees who met regularly and provided effective oversight of the service’s management.

There were appropriate quality assurance systems in place and people’s feedback was valued and acted upon.

At our previous inspection the service was rated Good overall but Requires Improvement in Responsive due to the lack of activities provided. (Report published 6 December 2016.)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

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

Donnington House Care Home is run by a registered charity and provides accommodation for up to 28 older people, some of whom are living with dementia and who need support with their nursing and personal care needs. On the day of our inspection there were 26 people living at the home. The home is a large property, spread over two floors, situated in Chichester. There are two communal lounges, a dining room and well maintained gardens.

The management team consisted of a board of trustees, a registered manager, two deputy managers and a business manager. 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 had access to activities on certain days and records and photographs showed that people had enjoyed visits from external entertainers. However, observations showed that people spent their day with very little stimulation or interaction from staff, other than when being supported with their basic care needs. This is an area of practice that requires improvement.

People were protected from harm and abuse. There were good levels of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. People told us that they felt safe, one person told us, “I feel safe. I leave the curtains open at night and the windows open during the day. I always feel safe, there’s always someone around”. Another person told us, “I feel very safe because of the way they look after us”. People received their medicines from registered nurses, they had these on time and according to their preferences. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked their consent before being supported and staff had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. One member of staff told us, “Some people without mental capacity have to have decisions made for them in their best interests. There is a process around this which is part of the Mental Capacity Act”. Another member of staff told us, “We always assume people have capacity unless we are sure they don’t”. Care plans documented people’s needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.

Staff worked in accordance with people’s wishes and people were treated with respect and dignity. It was apparent that staff knew people’s needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. One person told us, “The staff are very jolly. I can’t choose between them”. Another person told us, “They are very good indeed, no complaints there, very, very caring staff. We have a laugh”. One member of staff told us, “I would place any of my relatives here if they needed to go into a home. People are treated with such respect”.

People’s health needs were assessed and met by registered nurses who made referrals to external healthcare professionals when required. People’s privacy and dignity was respected and maintained, observations showed staff using privacy screens when supporting people in communal areas to move and position. People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The meals are very good”.

The registered manager welcomed and encouraged feedback and used this to drive improvement and change. There were rigorous quality assurance processes in place to enable the registered manager to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. People, relatives and staff were complimentary about the leadership and management of the home. One member of staff told us, “This is by far the best run home I’ve ever worked in. I’d heard about it before I came here. I’m so happy to work here”. Another member of staff told us, “The manager and the team are great”.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People's health and care needs were assessed before they moved into the home. We saw that care plans contained clear information about people's support needs. We also found the risks associated with people's care and treatment had been assessed and there was clear information on how any risks could be minimised. People confirmed they received the support and care they needed and liked. The home ensured relevant health care professionals were contacted when needed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke to told us they "felt safe" and a relative of someone living at the home said they considered the home to be a safe place for people to live.

The deputy manager told us that all of the management team had received training in Mental Capacity Act 2005 and that care staff would be trained in the near future. The deputy manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). At this time no applications had needed to be submitted. Guidance was readily available to support the management team should an application need to be made in the future.

Is the service effective?

People told us they were involved in decisions about how they were looked after and had choices about how they wished to spend their day.

Staff were knowledgeable about people's personal, behavioural, social and health needs.

Staff received appropriate professional development. We spoke with one care staff who was able to describe their role and what was expected of them. They said they had structured supervision sessions every eight to twelve weeks, which provided the opportunity to discuss their performance and identify training needs.

Is the service caring?

People living at Donnington House were positive about the staff and management.

We saw that people were supported by staff who were kind and attentive. Staff showed patience and gave encouragement when supporting people. They were aware of people's needs and the preferences and how people wanted care to be delivered. For example we observed the people being offered choices as to when they received support with their personal care and what they wanted to eat for lunch.

A relative told us staff were "kind and caring".

People's diversity, values and human rights were respected. During our discussion with staff they told us how important it was to respect the individual's right to make choices.

Is the service responsive?

We saw that care plans were reviewed monthly and amended as people's needs changed.

Records showed that people were able to engage in a wide range of activities which enhanced their well-being.

The relative we spoke with told us they had regular contact with the home and they could speak to one of the management team or staff at any time. They said they were kept informed about any issues which affected their relative.

The provider took account of complaints and comments to improve the service. The complaints procedure was displayed in the front entrance hall for all to refer to if required. People said they had no complaints about the service and that if they did they would speak to the staff or one of the management team.

Is the service well led?

The home was well managed and there were clear lines of leadership in place, which meant the home was organised and communication was effective.

Annual surveys were sent out to stakeholders including, professionals, staff, people who used the service and their families. The deputy manager told us that the analysis for this year would be completed once all surveys had been returned. Analysis of previous surveys were available to view in the front entrance hall.

All staff received supervision once every eight to twelve weeks. Staff performance issues were discussed and training needs were identified.

We spoke with four relatives. They told us that the staff were very kind and accommodating. One said, 'The care here is wonderful'. In a letter of thanks to the home we read, 'Our experience with you and the staff at Donnington House leaves us speechless in so many ways; so much time, care, good humour and atmosphere'.

We spoke with four members of staff, the manager and a representative of the provider. Staff told us that they enjoyed working at the home. One said, 'It's a good home; the residents appreciate us and we appreciate them. We have a laugh'. Another told us, 'Relatives always give us feedback on how welcome they feel here'.

We found that the home was clean and bright and that people looked well cared for. During our visit there was an activity taking place and people were participating with enthusiasm. Staff were welcoming and we saw that they supported people with kindness and respect, always in an unhurried manner.