Archived: Deerplay Care Home

Deerplay Care Home is a residential care home providing personal care to 9 people aged 65 and over at the time of the inspection. The service can support up to 15 people. The home is a converted chapel set in its own grounds. Accommodation is provided in single rooms.

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

People and relatives were generally positive about the service and felt they were well cared for. Health and safety risks had not been addressed appropriately. There were issues relating to the environment and we found the lift had previously been broken for 6 months and mandatory inspections had not taken place.

People did not always have their risks and needs accurately assessed in relation to their behavioural needs. Staff did not have access to appropriate guidance in managing these risks effectively. People’s medicines were generally managed safely, although we identified shortfalls in the storage of prescribed creams.

We received mixed feedback about the food. We have made a recommendation that the service review the menu to ensure that it meets the nutritional needs and preferences of the people living at the service

There were sufficient numbers of staff on duty to meet people's needs and ensure their safety. However, the care staff were also responsible for cleaning and some meal preparation. Following on from our last inspection the provider had agreed to advertise for a cleaner, but this had not materialised. The home was clean and staff followed safe infection control practices.

Recruitment was being managed safely. There were systems in place to record when accidents and incidents took place.

The service worked in partnership with external services appropriately. People's views were sought about the service. People told us the staff were lovely and we observed positive interactions between staff and residents.

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 November 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the environment and that there may be a closed culture at the service. This means a poor culture that can lead to harm, including human rights breaches such as abuse. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The provider made a decision to close the home following the on site visit and at the time of writing this report all residents had been moved from the service to alternative homes in the local area.

Deerplay Care Home is a residential care home providing personal care to 10 people aged 65 and over at the time of the inspection. The service can support up to 15 people. The home is a converted chapel set in its own grounds. Accommodation is provided in single rooms.

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

People told us they felt comfortable and safe living in the home. The provider and staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The home was clean in all areas seen and staff followed safe infection control practices. Following the inspection, the provider assured us the whole staff team would be tested for coronavirus on a weekly basis in line with government guidance.

There were systems in place to record and investigate accidents or incidents. Any learning was discussed with the staff team. The provider understood their responsibility to be open and honest when something went wrong. Following the inspection, the provider developed a template to record all staff handover meetings.

There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. However, the care staff also had additional cleaning duties. Following the inspection, the provider sent us a copy of a job advert for cleaning staff. The provider operated an appropriate recruitment procedure.

The provider had systems to check the quality of the service and to monitor staff practice. People's views were sought about the service and acted on. The provider agreed to consider different ways of providing activities and social stimulation. People were involved in decisions about their care and support. The provider and staff worked with external professionals to ensure people received prompt and coordinated care.

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 18 January 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Follow up

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.

Deerplay Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and personal care for up to a maximum of 15 people. At the time of the inspection there were 14 people accommodated in the home, with an additional person in hospital.

The provider was also the manager of the service. There was no regulatory requirement to have a separate 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 our last inspection on 1 and 2 March 2017, we asked the provider to take action to ensure the principles of the Mental Capacity Act 2005 were embedded in the care planning systems and ensure people were involved in the development and review of their care plan. During this inspection, we found actions had been completed and the overall rating of Deerplay Care Home was changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People living in the home said they felt safe and staff treated them well. People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and welfare had been assessed and preventive measures had been put in place where required. People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and they were up to date with the provider's mandatory training. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. There were appropriate arrangements in place to support people to have a healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and preferences. There were established arrangements in place to ensure the care plans were reviewed and updated regularly.

The service was responsive to people’s individual needs and preferences. People were given the opportunity to participate in social activities. People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care.

Deerplay Care Home is registered to provide accommodation and personal care for up to 15 older people. At the time of the visit there were 14 people living in the home. Accommodation is offered on two floors in single occupancy rooms, 13 of which have an en-suite facility and five have separate lounges. Communal rooms include a lounge with dining area. The home is a detached property set in its own grounds in the semi-rural village of Weir near Bacup.

The provider was also the manager. There was no regulatory requirement to have a separate 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 our last inspection on 15 and 16 October 2015, we found the provider was not operating an effective recruitment procedure and as a consequence was in breach of one regulation. We also recommended the principles of the Mental Capacity Act 2005 were embedded in the care planning systems and arrangements were made to involve people in the care planning process and decisions about their care. During this inspection, we found improvements had been made to the recruitment procedure. However, limited progress had been made in meeting the recommendations and our findings demonstrated there were two breaches of the regulations in respect of these matters. You can see what action we told the provider to take at the back of the full version of the report. We also made a further recommendation about ensuring people were offered a more varied diet and a choice each mealtime.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse.

Suitable arrangements were in place to manage people’s medicines. Regular auditing and ongoing checks were carried out to ensure appropriate standards were maintained.

Staff received training which equipped them for their roles and supported them in providing safe care for people. Staff spoken with told us they were well supported through a system of regular supervisions and meetings.

Care plans and risk assessments had been completed to ensure people received appropriate care. Whilst all care plans and risk assessments had been updated on a monthly basis, some information was brief and lacked detail. The provider acknowledged the care plan documentation required development. We found people were not routinely involved in the care planning process and there was no evidence to indicate people’s mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005.

People made complimentary comments about the food. However, the menu was repeated on a weekly basis and people were not usually offered a choice at mealtimes.

People were encouraged to remain as independent as possible and were supported to participate in daily activities. People’s rights to privacy and dignity were recognised and upheld by the staff. Healthcare referrals were made appropriately to outside agencies when required. We received positive feedback about the service from a visiting healthcare professional during the inspection.

People had access to a complaints procedure which was displayed in each bedroom. One person made a complaint during the inspection which was investigated by the provider.

Quality assurance systems were in place which included regular checks and audits on all aspects of the operation of the home. Feedback was sought from people, their relatives and staff on a regular basis.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This a summary of what we found:

Is the service safe?

We spoke with six people using the service and all told us they felt safe and well cared for at Deerplay Care Home. One person told us 'Everything is perfect. I have nothing but praise. They look after me in every way'.

Staff spoken with had an understanding of the procedures in place to safeguard vulnerable adults and confirmed they had received training on these issues. We found the home had appropriate written policies and procedures along with the relevant contact numbers readily available for staff reference.

Risk assessments had been carried out to gather information about risks to people's health, welfare and safety.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. While no applications had been submitted, proper policies and procedures were in place but none had been necessary. Relevant staff had been trained to understand when an application should be made, and in how to submit one. People's human rights were therefore properly recognised, respected and promoted.

Is it effective?

All people spoken with expressed satisfaction with the service provided. They told us staff knew them well and were knowledgeable about their needs. We observed sensitive and kind interactions between the staff and people living in the home. One person told us, 'They are so good, I can't think of anything they could do better'.

All people had an individual care plan which provided guidance for staff on how best to meet their needs.

Is it caring?

People told us they were happy with the care they received. One person said, 'They (staff) are wonderful. They can't do enough for you'. Another person commented, 'They are very good and very caring'.

We observed staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people's dignity and promoted their independence.

Staff had received training to meet the needs of people living in the home. Staff spoken with had an understanding of people's care and support needs and their individual preferences.

Is it responsive?

People's needs had been assessed before they moved into the home. This meant the provider had ensured people could be cared for properly. Records seen confirmed people's preferences, interests and past experiences had been recorded and care was delivered in accordance with people's wishes. Care plans had been reviewed and updated following any changes in needs or circumstances. Daily records maintained showed staff responded to people's needs as required day and night.

There were sufficient staff on duty and people told us the staff responded in a timely way when they required assistance. One person said, 'When I use my buzzer, they come straight away'.

Is it well led?

The registered provider was also the manager of the home. People and staff spoken with told us the home was well managed and organised.

There were systems in place to regularly assess and monitor the quality of the service. We saw evidence the staff knew when to consult with health and social care professionals when required. This meant any decision about people's care and support was made by the appropriate staff at the appropriate level.

All the people asked said they enjoyed the meals. People's weight was monitored and when necessary advice was sought from other healthcare professionals.

We found that procedures and training for all members of staff was in place for the prevention and control of infection.

We saw that members of staff were attentive to people's needs and responded promptly when people required assistance.

We saw that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.