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Donisthorpe Hall Requires improvement Also known as Donisthorpe Hall Management Committee

Reports


Inspection carried out on 30 September 2019

During a routine inspection

About the service

Donisthorpe Hall provides accommodation and nursing for up to 189 people in one adapted building. The home is split into units, Willow, Maple, Silver Lodge ground and Silver Lodge first floor. At the time of inspection 59 people were living in the home.

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

The registered manager was responsive to any concerns we raised during the inspection; implementing corrective actions where this was apparent and discussing plans where further improvements were required.

Checks and audits had been completed to identify any areas the service needed to improve. However, even though files had been audited capacity assessments had not been picked up by the deputy manager. We did not see people had an input in relation to mental capacity and best interest decisions. We found evidence throughout care plans where not all decisions had been recorded, what had was completed by one senior staff member. Consent to bed rails had not always been looked at.

As a result, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

We have made a recommendation in the ‘effective’ section of the full report about some areas of people’s care plans and the care planning process.

There were enough staff on duty to meet people's needs in a calm and unrushed manner, but further recruitment was required to minimise the use of agency staff. However, the provider made every effort to use the same agency staff, thereby giving people consistent care. We spoke to the registered manager about the deployment of staff.

Recruitment procedures continued to make sure staff employed were suitable to work with vulnerable people.

Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. Overall, people we spoke with made positive comments about how staff delivered care. They told us they were happy with the general environment and how the home had improved.

People received safe care and treatment. Assessments had been completed to help make sure risks associated with people's care were identified and managed in a way which respected their freedoms and choices. People were safeguarded from the risk of abuse. Accidents and incidents were monitored to identify and address any patterns or trends. People's medicines were on the whole managed in a safe way.

Staff had received the training they needed to develop and update their skills and knowledge. Support and supervision sessions had been provided.

There was a range of social activities and events available for people to take part in if they wished to.

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 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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

Inspection carried out on 9 August 2018

During a routine inspection

The inspection took place on 9 and 28 August and 4 September 2018 and was unannounced. At our last inspection published on 16 March 2018 we rated the service requires improvement. At this inspection we found the service remained requires improvement overall but improvements had been made. This is the third consecutive time the service has been rated Requires Improvement.

Donisthorpe Hall provides accommodation and nursing for up to 189 people in one adapted building. Donisthorpe Hall 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.

At the time of our inspection there were 70 people using the service. The registered manager told us they were going to change their registration from 189 to 90. People were lived across four units. The home is managed and run by Donisthorpe Hall, a private organisation. The organisation does not have any other services. The home has a longstanding association with the Jewish community in Leeds but also offers care to people of other faiths or beliefs.

There was a registered manager in post. 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.

There were systems and processes in place to protect people from the risk of harm. Some service certificates were due for renewal.

Usually there were enough staff on duty to meet people’s needs but we found instances when one unit became very busy and task orientated.

Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were arrangements in place for the safe management of people’s medicines and regular checks were undertaken.

The service was clean and had effective systems to protect people by the prevention and control of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s nutritional and healthcare needs had been assessed and were met.

People were supported by staff who were supervised and appraised. Staff were mostly trained but some staff were not up to date with the provider’s mandatory training.

Staff were caring and treated people with dignity and respect. Care plans addressed each person’s individual needs, including what was important to them, and how they wanted to be supported.

People were involved in undertaking activities of their choice. However, one unit did not engage people with activities as much as the others.

People were cared for in a way that took account of their diversity, values and human rights.

People’s end of life wishes were discussed and recorded.

People living at the service, their relatives and stakeholders told us that the management team was approachable and supportive. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed. However, some of the areas of concern we raised during the inspection, the registered manager hadn’t acted upon, but advised us this was due to time constraints.

The registered manager kept themselves informed of developments within the social care sector and cascaded important information to the rest of the staff team.

Inspection carried out on 20 February 2018

During an inspection to make sure that the improvements required had been made

We undertook an unannounced focused inspection of Donisthorpe Hall on 20 February 2018. This inspection was done to check that improvements to meet legal requirements after our comprehensive inspection in November 2017 had been made. The team inspected the service against three of the five questions we ask about services: is the service well led, safe and responsive. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last inspection in November 2017 we rated the service as requires improvement. At the four previous inspections we rated the service as inadequate or requires improvement. The service had been in special measures since November 2015. At the last inspection we found the provider had made improvements in some areas but they were not meeting legal requirements in three areas which related to management of risk, person centred care and governance. We found they had made improvements and were meeting legal requirements. The well led question’s rating improved from inadequate to requires improvement and therefore the service is no longer in special measures.

Donisthorpe Hall is registered to provide residential and nursing care for a maximum of 189 people. Care was provided in five units. The management team told us there were 69 people using the service when we inspected. The home has a longstanding association with the Jewish community in Leeds and also offers care to people of other faiths or beliefs. 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.

At the time of the inspection the service did not have a registered manager although a manager was in post and had submitted their application to register as the manager of Donisthorpe Hall. 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.

At this inspection we found the provider had improved how they assessed and managed risks to people who used the service. They managed people who were at risk of falls more effectively. They had introduced a better accident and incident recording and reporting process. We observed good manual handling practice by single staff and paired staff. The local safeguarding authority told us the number of concerns raised by relatives and by hospital staff had decreased. People lived in a safe, clean and pleasant environment.

Medicines were usually managed safely although some issues were found around documentation. We have made a repeated recommendation about the management of some medicines.

The provider had improved how they planned people’s care. Guidance was more detailed which helped staff understand how to meet people’s needs. The provider was continuing to develop the care planning and documentation process to ensure care delivery was consistent.

People were offered a range of individual and group activities, which included external entertainers. On the day of the inspection people enjoyed the performances of a singer and guitarist. The activity programme was not always followed because the service only had limited activity resources. The manager said they were increasing the number of activity workers to a minimum of three.

People who used the service and relatives told us they were happy at Donisthorpe Hall and said it was well managed. Staff told us they enjoyed working at the servic

Inspection carried out on 8 November 2017

During a routine inspection

This inspection took place on 8 and 14 November 2017 and was unannounced. At the last inspection in April 2017 we rated the service as requires improvement. At the three previous inspections we rated the service as inadequate. The service has been in special measures since November 2015. At the last inspection we found the provider was in breach of three regulations which related to how they managed medicines, consent to care and governance. At this inspection they were no longer in breach of regulations which related to management of medicines and consent to care but they had not made improvements to their governance arrangements. We found they were also in breach of two additional regulations; management of risk and person centred care.

Donisthorpe Hall is registered to provide residential and nursing care for a maximum of 189 people. Care was provided in five units. The management team told us there were 72 people using the service when we inspected. The home has a longstanding association with the Jewish community in Leeds and also offers care to people of other faiths or beliefs. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the service did not have a registered manager although a manager had been appoint ted and told us they would be applying to register as the manager of Donisthorpe Hall. 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.

At this inspection we found the provider had further improved their medicine systems and we concluded these were managed safely. We have made a recommendation about the management of some medicines.

People told us they were happy living at Donisthorpe Hall and the staff were kind and caring. During the inspection, we saw lots of examples of good care practice and people enjoyed the company of staff and others they lived with. However, in one unit staff sometimes focused on tasks rather than encouraging people to engage. People were offered a varied menu and told us they had enough to eat and drink. People received appropriate support to make sure their health needs were met.

We saw people were given opportunity to make day to day decisions and staff obtained verbal consent before providing care. However, there was very little evidence to show how people or their representatives had been involved in making decisions about their care. Care plans and risk assessments varied in quality and these did not always show how to keep people safe and provide person centred care.

People lived in a clean pleasant, well maintained and spacious environment, however the environment did not enable people living with dementia to maintain their sense of wellbeing.

At the time of the inspection there were enough staff to keep people safe, however, the provider did not use a system effectively to determine how many staff they required. Three weeks before the inspection the provider had re-opened one of the units. We saw people who had transferred to the unit could not eat their main meals in the unit’s dining room.

Staff received training which helped them understand how to do their job well but there was a lack of support and supervision. There was no formal system for supporting volunteers.

Although the provider continued to develop the service progress was slow. They had failed to manage systems and processes effectively. They did not consistently identify trends or how they could learn lessons and prevent repeat events. Further changes in management had impacted on the service delivery. The recently appointed manager showed a good understanding of their role and described their essential elements of leadership. We rec

Inspection carried out on 19 April 2017

During a routine inspection

This inspection took place on 19 and 24 April 2017. Day one was unannounced and day two was announced. At the three previous inspections in June 2015, March and August 2016 we rated the

service as inadequate. At the inspection in August 2016 we found the provider was in breach of six regulations which related to safe care and treatment, staffing, person centred care, governance, consent to care and nutrition.

At this inspection we found the provider had improved the service sufficiently to meet three of the regulations. They needed to make further improvements to ensure the service was consistently safe, effective, caring, responsive and well-led. The provider was still in breach of three regulations relating to safe care and treatment, consent to care and good governance.

Donisthorpe Hall is registered to provide residential and nursing care for a maximum of 189 people. Care was provided in four units. The management team told us there were 83 people using the service when we inspected. The home has a longstanding association with the Jewish community in Leeds and also offers care to people of other faiths or beliefs.

At the time of the inspection the service did not have a registered manager although the home manager had submitted an application and this was being assessed. 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.

At this inspection we found medicines were better organised and the provider had reintroduced a paper based system which staff found easier to use, however, medicines were still not being managed safely. Staffing arrangements had improved; there was a more regular team of workers and a big reduction in agency workers which meant people received care from staff they knew. The provider told us they were actively looking at reviewing the staffing levels and increasing where possible. Risks to people were identified, assessed and usually managed although we found some examples where management of risk was not effective. People lived in a safe, comfortable, clean and pleasant environment.

Systems for assisting people to make decisions in line with the requirements of the Mental Capacity Act 2005 had improved but not sufficiently to meet regulation. Consent records and care plans did not consistently evidence people or their representatives were in agreement. We found the process for managing Deprivation of Liberty Safeguards was not effective.

Staff told us they received more opportunities to receive training and better support, including regular supervision. Staff told us the quality of training was good and it had helped them understand how to do their job well. We observed meal times and observed people had a pleasant experience. People told us they enjoyed the food and were offered a varied menu. People received appropriate support to make sure their health needs were met.

During the inspection we saw many examples of good care practice. Staff were observed to be caring and kind in their interactions with people. Stakeholders told us the service was caring. People who used the service and visitors were complimentary about staff. People looked well cared for, with hair styled and clean clothes. Although feedback was positive we received some comments from people that further improvements were required, for example around support at meal times.

We saw staff worked as a team. They communicated with each other and checked who had eaten and who needed assistance. Staff knew the people they were supporting and referred to them by name. When we looked around the service we saw there was information available which helped to keep people informed. For example, there were leaflets and notices around promoting dignity

Inspection carried out on 30 August 2016

During a routine inspection

This inspection took place on 30 and 31 August and 9 September 2016. Day one was unannounced and days two and three were announced. At the two previous inspections in June 2015 and March 2016 we rated the service as inadequate. At the inspection in March 2016 we found the provider was in breach of six regulations which related to safe care and treatment, staffing, person centred care, quality assurance, consent to care and notification of significant events. At this inspection we found the provider was still in breach of five of the same regulations and was in breach of an additional regulation because they were not meeting people’s nutritional needs. The provider had made improvements in one area; they had better arrangements to support staff.

Donisthorpe Hall provides residential, nursing and dementia care for a maximum of 189 residents. Care is provided in six specialist units. The management team told us there were 119 people using the service when we inspected. The home has a longstanding association with the Jewish community in Leeds but also offers care to people of other faiths or beliefs. At the time of the inspection, the service did not have a registered 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 who used the service were not protected against the risks associated with the administration, use and management of medicines, and other areas of risk such as pressure sores and choking were not well managed. People did not always receive their oral medicines or creams at the times they needed them or in a safe way. Improvements had been made to the way accidents and incidents were managed.

People told us there were not enough staff and they sometimes received care from staff they did not know. We found the service used a high number of agency staff although the provider had tried to ensure there was better consistency by requesting regular agency workers. Care managers worked on the individual units of the home and were more easily available to people who used the service, staff and visitors. The provider had effective recruitment and selection procedures in place.

People told us they felt safe and staff understood procedures which related to protecting people from abuse and harm and knew they should report any concerns to the management team. The provider had introduced better systems to make sure staff received appropriate training and support to do their job. However, staff did not understand what they must do to comply with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and did not act within the law.

People who used the service and their family and friends mostly told us they were satisfied with the care although concerns about receiving care from a high percentage of staff that did not know them was a recurrent theme. During the inspection we saw examples of good care practice and poor care practice, and concluded people had different experiences and received inconsistent care. There was a lack of consistency in how people’s care was assessed, planned and delivered. And information about people’s history, likes and preferences was not available so staff did not know what was important to people.

Before the inspection we received information of concern from other professionals and some relatives because they felt the service did not always contact health professionals when it was appropriate. We found this was still a problem. The provider had started to introduce a better system to make sure people’s health needs were being met and other professionals were made aware when specialist support was needed but the system still needed further improvement to make sure it was effective.

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Inspection carried out on 14 March 2016

During a routine inspection

This inspection took place on 14, 17 and 21 March 2016 and was unannounced. At the previous inspection in June 2015 we found seven breaches in regulations which related to safe care and treatment, staffing, person centred care, quality assurance, safeguarding people from abuse, consent to care and notification of significant events. We rated the service as inadequate. At this inspection we found the provider was still in breach of six of the same regulations. We found the provider had made improvements in one area and was safeguarding people from abuse.

Donisthorpe Hall provides residential, nursing and dementia care for a maximum of 189 residents. Care is provided in six specialist units. The management team told us there were 127 people using the service when we inspected. The home has a longstanding association with the Jewish community in Leeds but also offers care to people of other faiths or beliefs. At the time of the inspection, the service had a registered 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 told us they felt safe but we found they were not protected from risks associated with unsafe or inappropriate care. People told us there were not enough staff and we observed sometimes people did not receive care in a timely way. The service used a high number of agency staff which resulted in people regularly being cared for by staff they did not know. People using the service were not protected against the risks associated with the administration, use and management of medicines.

Staff did not always receive appropriate training and support although the provider had introduced more training opportunities and was supporting all care staff to complete the ‘care certificate’ which is an identified set of standards that health and social care workers adhere to in their daily working life. Some senior care workers and managers were undertaking management training. Staff did not understand what they must do to comply with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and did not act within the law. The provider had effective recruitment and selection procedures in place.

People told us they received appropriate care. However, there was a lack of consistency in how people’s care was assessed, planned and delivered. There was not always enough information to guide staff on people’s care and support. Some people’s health and well-being needed to be closely monitored but we found this was not being done properly. People’s care records showed they had accessed a range of health professionals.

People lived in a pleasant and well maintained environment. They enjoyed the food and were offered a choice of meals. Drinks and snacks were offered to people throughout the day. People also enjoyed the range of social activities provided at the home and in the local and wider community.

The service was disorganised. The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not always implemented. Information was displayed about how people could make formal complaints but some people were unsure who to talk to if they wanted to discuss concerns.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe

Inspection carried out on 10 & 15 June 2015

During a routine inspection

At the last comprehensive inspection in October 2014 we rated the service as requires improvement. We found three breaches in regulations because people were not protected against the risks associated with unsafe management of medicines, staff were not adequately trained and the provider did not have suitable arrangements for assessing and monitoring the quality of service delivery. We told the provider they must take action to meet the regulations.

After the comprehensive inspection in October 2014, the provider wrote to us to say what they would do to meet the regulations in relation to each breach. They told us they would complete all actions by the end of March 2015. At this inspection which took place on 10 and 15 June 2015 and was unannounced, we found that the provider had not completed their plan of action and legal requirements were still not met. We also found additional breaches.

Donisthorpe Hall provides residential, nursing and dementia care for a maximum of 189 residents. Care is provided in seven specialist units. The home has a longstanding association with the Jewish community in Leeds but also offers care to people of other faiths or beliefs. At the time of the inspection, the service had a registered 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.

At this inspection we found people were not protected from risks associated with unsafe or inappropriate care. People using the service were not protected against the risks associated with the administration, use and management of medicines. People did not always receive their oral and topical medicines at the times they needed them or in a safe way.

Some people felt safe others did not. People were not protected from abuse or allegations of abuse because the provider did not always take appropriate action or report allegations to the appropriate agencies.

The service used a high level of agency staff and people were sometimes supported by staff who did not know how to meet their needs. We observed people did not always receive care in a timely way. Staff did not always receive appropriate training and support. The provider had effective recruitment and selection procedures in place.

There was a lack of consistency in the approach of staff. Some supported people in a kind and caring way but other staff lacked compassion. Most people felt staff treated them with kindness and respect.

People enjoyed the range of activities provided at the home. They received a varied and nutritional diet. People told us they received support with the healthcare but records to show people’s health needs were met were not always completed. People did not always consent to their care and treatment.

There was a lack of consistency in how people’s care was assessed, planned and delivered. There was not always enough information to guide staff on people’s care and support.

The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not always implemented. The management team were visible and described by the staff team as approachable. The provider had recently recognised the home was not providing a good service and had commissioned an external agency to assist them to identify and address shortfalls.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 and a breach of (Registration Regulations) 2009. You can see the action we have told the provider to take at the end of this report.

Inspection carried out on 21 & 23 October 2014

During a routine inspection

This inspection took place over two days on 21 and 23 October 2014. The first day of the inspection was unannounced and the second day was announced.

Donisthorpe Hall provides residential, nursing and dementia care for a maximum of 189 residents. Care is provided in seven specialist units. The home has a longstanding association with the Jewish community in Leeds but also offers care to people of other faiths or beliefs.

At the time of the inspection the home manager was not registered but had submitted a registered manager’s application. Soon after the inspection the registration application was processed. 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 and associated Regulations about how the service is run.

At this inspection we found people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff were not always enabled to take part in learning and development that was relevant and appropriate to their role.

There was a lack of consistency in how people’s capacity was assessed and their care needs were assessed and planned. Some care plans clearly identified how care should be delivered whereas others did not contain sufficient information which puts people at risk of not receiving the care they needed. Risks to people had been identified and assessed.

The provider had a system to monitor and assess the quality of service provision which should identify areas where the service was working well and where they needed to improve. However, this was not always effective because there was a lack of consistency in how this was used throughout the home. Although there were inconsistencies in how individual units were being managed we found there were appropriate overarching management arrangements in place.

The home manager and chief executive officer had only been in post for a few months. We received positive feedback about the new management team and their approach. Staff told us the new management team were visible and spent more time talking with people.

People were happy with the care they received and we observed good care being provided. Staff were kind and compassionate in their approach, and understood how to maintain people’s privacy and dignity when delivering personal care. People received appropriate support to make sure their healthcare needs were met.

Many people enjoyed spending time in the main foyer, where there was a cafe and shop and different areas with easy chairs. An activity programme was provided which included outings to the local community. The in-house activity programme included flower arranging, keep moving, music time, bridge, choir, bingo and art class. There was limited participation with some of the activities. 

People told us they felt safe. Staff were visible and present in all areas of the service during the inspection and regularly checked to make sure people were safe.

People received a choice of suitable healthy food and drink ensuring their nutritional needs were met. Lunch was well organised and people enjoyed their meal experience. People told us they enjoyed the food and there was always plenty to eat and drink.

People were comfortable raising concerns with members of staff or the management team. The service had information displayed around the home that informed people about their care and support and where they could go if they needed any additional help. The provider had a range of surveys which showed people were encouraged to share their views and comment on the quality of the service.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 21, 27 August 2013

During a routine inspection

When we inspected Donisthorpe Hall in May 2013 we found people were not adequately protected from the risk of abuse because the provider had not followed local guidance or national regulations on the reporting of abuse. We carried out this inspection to check what changes the provider had made to ensure people were protected from the risk of abuse.

Three of the units at the home are specifically to support people with dementia. People with dementia are not always able to express their feelings or wishes clearly and can be at greater risk of abuse. As part of our inspection visit we also wanted to check how people with dementia were protected and supported to live well.

We spoke with the Registered Manager, Dementia Care Manager, Training Manager, two Unit Managers, nine care assistants, people living at the home and relatives. We observed how people were supported during the day and at lunch time on Units 1, 3, 4, 5 and Silver Lodge.

Staff told us they were confident they were able to meet people’s needs safely. They said they had received training in dementia awareness, how to identify triggers for people’s behaviour and how to respond. They were able to give examples of approaches applicable in relation to different scenarios.

Staff told us they enjoyed their jobs. One said, “I like working here, I think residents get good care. It’s like a family home.” A relative told us “The staff are very supportive and approachable, they take time to listen to what you have to say.”

We observed how people were supported. We found staff were in the main respectful and attentive to people’s needs. We saw several examples of good practice and thought being given to people’s individual needs. However, we also observed instances where opportunities to enrich people’s experiences were missed and staff responded to people in a perfunctory manner.

Inspection carried out on 28 May 2013

During a routine inspection

People who used the service were given information about their care and treatment. They had help to understand the information given to them and had choices about their care and treatment. They could choose what they had to eat and when they got up and went to bed. One person said, “If I sleep in they bring my food to my room.” The provider had appropriate arrangements to record people’s consent to treatment. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People had individual care plans. Their needs were assessed before they moved into the home and reviewed as their needs changed. The staff were aware of the needs of the people they cared for and knew where to obtain advice. People told us the staff helped them to be independent. One person said, "I like my independence (but) if I need help they give it.”

The provider had supported staff to identify the possibility of abuse and prevent abuse from happening. However the provider had not always followed locally agreed procedures or regulatory requirements regarding the reporting of abuse.

Staff received appropriate professional development. They had regular supervision and were able to obtain further relevant qualifications.

People were made aware of the complaints system and were given support by the provider to make a comment or complaint where they needed assistance.

Inspection carried out on 21 December 2012

During a routine inspection

Donisthorpe Hall is a large residential and nursing home which is divided into seven separate units. We visited one of the units caring for people with dementia. The unit was clean and pleasantly decorated. We saw that some people were visiting relatives who were living at the home. We spoke with three of the visitors and asked them about the care their relatives received. One of the people visiting the home told us that “The staff are very good, they tell me if they have any concerns.“ Another we asked about the home said “Its brilliant, it’s a good warm environment, (people) are well cared for.”

The people we spoke with said that they were kept informed about the care their relatives received and were involved in decisions about them. However we found that the provider’s records were not always kept up to date and there was a risk that some urgent care could be delayed.

We found that care plans were detailed and included appropriate risk assessments. The staff we spoke with knew about the needs of the people they cared for and could describe how they kept them safe from abuse.

We saw that the provider had effective arrangements for the recruitment, induction and training of staff.

The provider had effective systems to monitor and assess the quality of the service provided. We saw how the provider sought the views of residents and relatives and acted on the findings.

Inspection carried out on 21 March 2012

During an inspection in response to concerns

This review was based within two of the three units providing services for people living with dementia. Most of these people were unable to verbally communicate with us but the two that we spoke to on the residential unit told us that they liked it and felt well looked after.

We spoke with a number of relatives who also told us that they were happy with the service and felt that they were involved in the decisions regarding care. They also told us that they felt that the staff respected the people using the service. One person told us "It is absolutely marvellous, the staff are very very good, I can't fault them."

People using the service appeared well looked after, they were dressed appropriately and supported by the staff at appropriate times.

Reports under our old system of regulation (including those from before CQC was created)