Archived: Dewi-Sant Residential Home

Dewi-Sant Residential Home (hereafter Dewi-Sant) is a residential care home providing accommodation in one adapted building across three floors for up to 34 older people who require personal care. The service specialises in supporting people living with dementia. At the time of the inspection 26 people were living at the home.

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

People were not protected from the risk of avoidable harm. Risks to people were not always identified. Where risks had been identified, sufficient action had not been taken to mitigate those risks and keep people safe.

Safeguarding systems and processes were not always followed. The registered manager did not always report and investigate safeguarding concerns. As a result of this inspection we made 10 safeguarding referrals to the Local Authority to investigate and where appropriate, take any necessary action to mitigate risk to ensure people were safely protected from harm.

There were indications that a “closed culture” may be developing at Dewi Sant. A 'closed culture' is a poor culture that can lead to harm, including human rights breaches such as abuse. In these services, people are more likely to be at risk of deliberate or unintentional harm.

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. Meeting bathing and toileting needs were not based on individual needs but were carried out on a rota basis. People, relatives and care records evidenced people being left in undignified states for long periods of time.

There were insufficient numbers of competent or skilled staff on duty to meet people's needs safely. We were not assured the service was following safe infection prevention and control procedures.

People had been identified as displaying behaviours that may challenge others and themselves. There was limited information within these peoples care records to determine what the behaviours that may challenge others were and what staff should do to support people effectively through this.

Following our inspection we wrote to the provider who worked with The Local Authority to reduce some of the risks and concerns that we had with the service.

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 on 24 January 2020).

Why we inspected

We received concerns in relation to poor standards of care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, further concerns and risks were identified so a decision was made to carry out a comprehensive inspection to include the key questions effective, caring and responsive.

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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dewi-Sant Residential 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in regulation in relation to safe care and treatment, safeguarding people from abuse, staffing, consent, dignity and respect, person centred care, notifications of other incidents and governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. On arrival visitors were asked to consent to a lateral flow test (LFT) and their temperatures recorded.

Where possible staff encouraged people to keep a safe distance from each other.

Staff were adhering to personal protective equipment (PPE) guidance and practices. There was a plentiful supply of PPE at all PPE stations close to people’s bedrooms.

Clear plans were in place for those who may be required to self-isolate. For those people who may struggle with isolation additional support would be provided.

Staff continued to support people to access healthcare and arrangements were in place should people need to attend hospital and return to the home safely.

Dewi-Sant is a residential care home providing accommodation and personal care to a maximum of 34 older people. Some people could be living with dementia and other age-related health conditions. The home is an older style property and accommodation is spread over three floors. People with bedrooms on the upper floors who may have mobility difficulties have the use of a stair lift to access lower parts of the home.

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

We found some improvements were needed in the overall maintenance and upkeep of the home. Although the home was warm and welcoming, we found some people’s bedrooms and communal areas were in need of decoration and maintenance. Some bathrooms and flooring in hallways needed improvement to ensure they continued to meet people’s needs and remained fit for purpose. We spoke with the registered manager in detail about the parts of the home that needed attention. They were aware of the need for improvement and had some plans in place, including the decoration of hallways, replacement of flooring and installation of a wet room.

People told us they liked living at Dewi-Sant and that they felt safe. There was a relaxed and caring atmosphere between people and staff. Staff knew people well and were kind, caring and attentive.

People were protected from the risk of harm. People’s risks associated with their health, care and lifestyle were understood by staff and were well managed. Staffing levels were organised in a way that ensured people were safe and their needs were met appropriately. People’s medicines were managed safely, and they received them in a way they wanted and needed. People were protected from discrimination and abuse because staff knew how to safeguard people. Recruitment practices ensured staff working in the home were fit and appropriate to work with the people being supported.

People’s needs were assessed, and support plans provided staff with information about how people chose and preferred to be supported. Staff liaised with health and social care agencies to help ensure people’s full range of care needs were met effectively. Health needs were understood and well-met. People were supported to enjoy a healthy well-balanced diet and any particular dietary needs were understood and met. People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with respect and ensured their privacy and dignity was maintained and promoted. People were supported to maintain their independence as much as possible and the use of specialist equipment and technology was used where possible to support this. Other agencies were positive about the care and support provided to people at the end of their life.

People were mainly happy about how they were supported to occupy their time and visitors were welcomed into the home. Some people said they would like more meaningful activity and would like staff to be able to sit and spend more time with them. This was fed back to the registered manager who assured us they would take these comments on board and review activities and listen to feedback.

There was an open, positive and inclusive culture in the service. People, staff, relatives and other agencies said they felt the management of the service was good and their views were listened to and valued. Systems had been developed to ensure performance remained good and continued to improve. For example, there were regular audits of the environment, medicines, accidents and incidents. The registered manager was very open and responsive to any discussions about on-going improvement to the service.

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 28.07.2017) The rating at this inspection has remained the same.

Why we inspected: This was a planned inspection based on the last rating.

Follow up: We will continue to monitor the service to ensure people receive safe. Compassionate, high quality care. Further inspections will be based on the rating. If we receive concerns, we may bring the inspection forward.

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.

Some of the people who lived in the home had limited communication therefore we spent time observing people.

At the last inspection, on the 29 April and 5 May 2015 the service was rated Good overall. However it was Requires Improvement in Safe because medicines were not being managed safely and call bells were not always answered promptly.

At this inspection we found the service remained Requires Improvement in Safe but Good overall.

People’s medicines were not always managed safely or properly. People received their medicines safely and all medicines were signed for. However, there was an error in medicines that required additional security that had not been investigated or reported to the appropriate authorities. This error had been found between the weekly audits. Only one staff was witnessing medicines that required additional security being administered to people and hand written entries on Medicines Administration Records (MAR) only had one signature. The registered manager took immediate action to investigate the error during the inspection and changed procedures to ensure safe practice on medicines.

People and staff told us there were sufficient staff to meet people’s needs. A new call bell system had also been installed and no one commented on the waiting times being excessive. Risk assessments were completed to enable people to retain their independence and receive care with minimum risk to themselves or others. People said; “I am sure I could talk to any of the staff” and “The staff are wonderful and they help me when I am worried.”

The Provider Information Record (PIR) recorded; “Each individual also has a hospital passport with a summary of their details. None of our residents go into hospital without the support of staff, this ensures that they feel safe and that a thorough handover is completed.”

People continued to receive effective care and support from a staff team who were knowledgeable and had the skills required to effectively support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives and staff supported people in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required.

People all agreed that the staff team were very caring. We observed staff being patient and kind. There was a calm atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. One person said; “1st Class care.” And a relative said; “Mum is well cared for.”

The staff team remained responsive to people's individual needs. Personalised care and support was provided to each person to help ensure people were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “Any concerns and I would talk to the staff.”

People were supported to take part in a range of activities according to their individual interests. Trips out were also planned for people.

The service continued to be well led. People and staff told us the registered manager was approachable and “Had an open door policy.” The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

We have made a recommendation about the management of some medicines.

Staff interacted with people in a friendly respectful way. They were attentive to people's needs. Staff gave people time without rushing and answered call bells without delay.

Care plans demonstrated people's care needs and how they were being met. The unregistered manager was in the process of involving family with this process but this had not yet been completed.

The environment was clean and there were systems in place to minimise the risk of infection.

We visited seven bedrooms, a dining room, four toilets, two bathrooms, a kitchen, laundry room, two lounges and a conservatory. While most areas appeared very clean and well maintained, we saw that some areas were not clean, in some higher areas thick dust and cobwebs had gathered.

It was not clear from some care documentation how people who use the service were involved in decisions made about their care and treatment. However, we could see from observation that staff carried out care as documented in personalised care plans. We saw that staff were considerate of people's needs. Care records did not contain information about mental capacity and the home did not have a policy on the Mental Capacity Act 2005. Not all staff had received training about the Mental Capacity Act and Deprivation of liberty safeguards.

People's dignity was protected and we saw that people were offered choice and involved in activities. We saw that staff talked to people in a kind, friendly and respectful manner.

We found that the home had made many improvements since our last visit on 26 January 2012. One person living at the home told us 'I think it's very good here now we have got a new manager.'