Denewood House Care Home

We found the following examples of good practice.

The service was free from clutter and clean. There were cleaning schedules in place for day to day cleaning. Personal protective equipment (PPE) was available at all entrances. Handwashing guidance was displayed throughout the service.

Staff wore face masks at all times whilst at work. Staff wore full PPE when providing personal care and full PPE if a person using the service was self-isolating.

The service had systems in place to ensure staff isolated for the required period should they test positive for Covid-19. Staff breaks whilst at work were staggered for social distancing purposes.

The service provided safe ways for people to visit their relatives during the Covid-19 pandemic. Visiting arrangements were in accordance with Public Health England guidance. Managers held staff meetings in the garden and explained the service’s Covid-19 procedures including visiting procedures.

Staff told us the impact on people using the service had been minimal as the activities co-ordinator had maintained a programme of activities including singers in the garden. The service had also enabled families and carers to have socially distanced visits in the service’s garden, as well as window visits. The service had installed a visiting pod in the garden to facilitate visits during the winter.

The families of people using the service could use a video calling system at any time. The service also provided telephone calls for families and carers at any time.

People using the service and staff had been risk assessed for Covid-19. The service did not have any staff from groups which may be disproportionately at risk of Covid-19.

The service had measures in place to prevent people from spreading infection when admitting a person to the service from a health or social care service. The service had decided not to admit people from the community during the pandemic.

The service participated in the whole home testing programme, this meant people using the service were tested for Covid-19 every 28 days. The service’s staff were tested for Covid-19 every seven days, this was supplemented by twice weekly lateral flow testing (LFT), these are rapid tests used to detect Covid-19.

To enable staff in providing safe care, staff had received additional training in infection prevention and control (IPC) and Covid-19, to ensure they understood what actions to take in the event of people using the service or themselves becoming symptomatic.

IPC audits were completed regularly and included extra measures the home had put in place due to Covid-19. Any shortfalls identified in IPC audits were immediately addressed.

The service is registered to provide accommodation and residential and nursing care for up to 21 older people. At the time of our inspection the service was providing residential care to 17 older people.

Denenwood House 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found that the home had implemented safe systems and processes to ensure people received their medicines safely following some areas we identified during the inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falls or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Activities took place in the home and were enjoyed by people and their families.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below

The home was last inspected on the 23 and 26 January 2015 and found not to be meeting the standards in relation to consent and good governance. We found that there were not suitable arrangements in place for establishing a person’s best interest in line with the Mental Capacity Act (MCA) 2005 and people were not being protected from inappropriate or unsafe care arising from a lack of proper records. At this inspection improvements had been made.

The manager, who was a registered manager, had been working at the service since 2013 and was registered as the manager in January 2015. 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.

The service was safe because there were sufficient staff to meet people’s needs. The registered manager provided details of how staffing had been reviewed and new staff recruited using the appropriate procedures to fill vacancies within the team. A document called the dependency document was used to review the staffing levels required according to people’s changing needs.

People were at reduced risk of abuse because staff knew how to recognise signs of abuse and identify people at risk from harm and had received training in safeguarding and protecting adults from harm. This was reflected in staff training records which showed when staff had received their updates on how to protect people and information collected from their personal training manuals. Staff understood the correct procedures to use when reporting abuse which included reporting concerns to their manager and recording details about incidents or poor practice.

Risks were managed and addressed. Where risks were apparent, action had been taken to address and reduce the risk. For example, one person had experienced a series of falls which led to changes in their care. Healthcare staff were contacted and a review of their care needs was agreed. Staff understood the risks to people and followed the guidance provided to keep people safe.

Plans were in place for how staff responded to emergencies. Emergency evacuation procedures were regularly reviewed and staff were kept up to date on the procedures to follow. Accidents and incidents were recorded, monitored and reflected on to take account of changes that were needed. Staff reported and recorded details in the accident log and peoples’ care records.

People’s medicines were administered safely and on time. People were told what their medicines were used to treat.

The service was effective because consent was sought from people as staff carried out their work and staff were working within the principles of the Mental Capacity Act (MCA) 2005.

People received care and support from staff that were trained , experienced and confident in their roles. People told us that staff understood their needs and were skilled at delivering their care. One person commented “They (the staff) know what support I need; I’m confident in them when they come to help”.

The home manager and registered manager confirmed that staff practice was observed regularly to maintain the quality and safety of care people received and this formed part of their regular supervision and yearly appraisal.

People received the level of support and assistance they needed to enjoy their meals and receive a balanced diet. Staff sat with people who needed support and helped them with their meals while describing and discussing the quality of the food. Staff offered people options and checked if they required more servings.

People were supported to maintain good health and received on-going in-put from healthcare staff. During the inspection we met two visiting health care staff and saw other healthcare professionals who had been requested to carry out health checks and appointments with people.

The service was caring because people were treated in a respectful manner when staff carried out people’s care. Staff were heard explaining procedures to people and reminded them of how to walk, move and maintain their safety. Explanations were clear and unhurried and people were given time to move within their capabilities.

Staff gave us examples of how they protected people’s dignity and respected their privacy. One staff member explained that some people preferred time on their own in their rooms, especially after lunch and this was understood and respected by staff. Other examples included “asking not telling people” when carrying out care and making sure people’s windows were closed and curtains drawn when intimate care was performed.

The service was responsive because people received care that was centred on their needs and reviewed periodically as their needs changed. Records showed that people were assessed before coming to live at the home and soon after they arrived. People, their families and where appropriate other health and social care professionals were involved in discussions about their needs.

People could chose from a variety of activities offered at the service and some people chose to make visits into the local community to participate in local social events.

Details about the level of independence were recorded in people’s care plans. This included whether they required one to one support or the help of more than one staff member to wash, bathe and move about. Some people needed assistance to eat their meals safely. This included making sure people were positioned safely or according to the instructions from the Speech and Language Therapist .

Complaints and concerns were acknowledged, investigated, explored and addressed. We looked at two complaints. These had been investigated and considered. Advice was sought from other agencies where appropriate and actions were taken to resolve people’s concerns. Written responses were sent following each investigation.

Staff were made aware of the risks which could compromise the quality of the service people received. Care plans, risk assessments and reviews showed details about the care support and treatment people required and staff had received record management training. Some records called daily records used by staff at the service revealed that the level of details recorded were improved since our last inspection but varied in quality and quantity.

Leadership was visible during the inspection where we met the provider, the registered manager and the home manager. Staff, people living at the home and their relatives all confirmed the availability and accessibility of the management team at other times. One person commented, “There’s always someone at the top about” while a relative said, “The managers are often available in the office and will come out to help”.

Staff spoke of a strong and developed team that worked together to support each other. Staff told us that the managers were responsive to their ideas and suggestions and that they were available when needed.

Management meetings took place where discussions involved staffing levels, admissions, progress and improvements. Checks called audits took place to ensure that the service was regularly monitored and developments continued.

People and their relatives told us that managers were readily available if they wanted to speak with them and that staff were positive when carrying out their roles and responsibilities.

An annual quality assurance survey, used to gather feedback, showed that people and their families had been asked for their views and experiences about the service. Several outcomes arising from the survey showed that actions had been implemented.

Is the service safe?

While we found that most people's care reflected what was written in their care plans, some required attention. Overall we found that people's care was safe and that people and their representatives felt that care provided at the home was good.

Some people living at Denewood House Care Home lacked the capacity to make decisions about their care. The service was not fully compliant with the provisions of The Mental Capacity Act 2005 and had not acted to ensure all people living at the home who lacked capacity were protected, taking account of the latest legal judgements and guidance. The provider was not aware of these changes and did not have a plan in place of how to address this. Some people using the service had complex needs and were unable to give appropriate consent to decisions about where they lived and their care and treatment. The provider had not always consulted with others who knew the person to help determine how best to care for people safely. We were told that staff had booked training to learn about The Mental Capacity Act 2005 changes.

We found that some aspects of hygiene and cleanliness had been addressed since our inspection in October 2013 but there were still areas in need of improvement. Two people's flooring, including carpets required repair, cleaning or replacement. The provider told us this was being addressed.

People, their representatives and staff told us that staff were busy and could not always meet their needs. One staff member said "We end up rushing and taking some people's independence away due to timescales and because it's quicker." A relative said "Staff often seem very busy and rushing about." This meant that people were at risk of not receiving the care they required. A compliance action has been made for this and the provider must tell us how they plan to improve.

People's records including medical records were not accurate or fit for purpose. In one care file we saw that a review of someone's care was indicated by the term 'No change' and this was recorded numerous times across several months. Records were not kept securely and could not be located promptly. We asked to see recent care related documents. These had been archived and stored at the registered manager's private residential address. This meant that records relating to people's recent care were not easily accessible. A compliance action has been made for this and the provider must tell us how they plan to improve.

Is the service effective?

We looked at care records and found that some, but not all of the care people required was being delivered according to the individual assessed needs. The relatives of people we spoke with told us that although the service was providing some of the care people needed, they commented that they had not always been involved in the review of their family's care needs. People's health needs were supported by health care professionals. Staff at Denewood House Care Home told us that people were referred to these services which included community nurses and chiropodists.

People's nutritional needs were met. Support was given to people at mealtimes in line with their care plans. People were provided with fortified foods and drinks to help them maintain their weight and provided with nutritional supplements to their diet, where required.

Is the service caring?

People were supported by staff that were attentive and demonstrated a kind and friendly approach. We observed staff supporting and assisting people with their care. One person told us that the staff were caring and thoughtful. We talked with relatives of people living at the home and one relative told us that they felt staff made them feel "welcomed".

Is the service responsive?

During the inspection, we were told by the registered manager that a service spot check took place recently at night time and this led to action taken by them. While inspecting we saw one person who was at risk of harming themselves. We observed that staff took immediate action to make the person safe. We also found an emergency exit unsecured leading to a stairwell. This was immediately addressed at the time we drew this to the attention of staff.

Is the service well-led?

Checks and audits were being carried out across different parts of the service. While some showed clear findings and actions taken, not all the audits provided enough detail to determine the quality of these checks. Staff had not been included in any recent feedback or surveys about the quality of care people received. Relatives of people living at the home described having received questionnaires and being provided with the opportunity to give their views but had not been made aware of the results of this survey. A compliance action has been made for this and the provider must tell us how they plan to improve.

Staff understood about safeguarding adults from abuse and knew how to report concerns. We found that the majority staff had undertaken training in safeguarding adults.

People were not cared for in a clean, hygienic environment. We saw that systems for cleaning were not consistently completed throughout the home. We saw there were not effective systems in place in the laundry to reduce the risk and spread of infection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. All the staff we spoke with told us they received training to give them the skills to do their job and they felt supported to meet people's needs.

The provider had a system to regularly assess and monitor the quality of service and management of risks but not all audits were effective.

One person that we spoke with said 'There is an easy going atmosphere you are not pushed into anything.' A relative told us 'Staff treat people well here from what I see when I visit.'

One relative old us about the services and said "I haven't been asked for feedback."

People told us they felt safe in the home but we found that staff did not always know what to do to keep people safe.

Staff did not have regular supervision and appraisal as well as some relevant training such as training in dementia care.

The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.