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Denewood House Care Home Good


Inspection carried out on 20 October 2018

During a routine inspection

The inspection took place on 20 October 2018 and was unannounced.

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

Inspection carried out on 28 April 2016

During a routine inspection

The inspection took place on the 28 April and 03 May 2016. The first date was unannounced and the second date was announced. Denewood House Care Home provides care and support for up to 21 older people. On the days of the inspection 19 people were using the service. The home has a ground floor and a first floor with rooms that have ensuite toilet and wash basin facilities. There is a communal garden area enclosed at the back of the home.

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 balanc

Inspection carried out on 23 and 26 January 2015

During a routine inspection

This inspection took place on the 23 and 26 January 2015 and was unannounced. Denewood House Care Home provides accommodation and personal care for up to 21 older people. There were 16 people living there when we visited. 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 and associated Regulations about how the service is run.

We inspected the home in June 2014 and had concerns about how: people were protected from infection; how many staff they had available; how the provider made sure care was good and the quality of record keeping to ensure safe and appropriate care.

We asked the provider to take action about these areas. At this inspection we found that improvements had been made in all these areas but the concerns about record keeping had not been addressed adequately. This meant there was a continued breach of regulation.

People were not protected from identified risks because records necessary for monitoring care were not kept consistently. This included records that related to people’s personal care and what they ate and drank.

People’s care was not delivered in line with the Mental Capacity Act 2005 Code of practice. When people could not consent to their care, decisions about the care they received were not made following the principles of the act.

There were systems in place to identify where improvements were needed. However the resulting actions did not always resolve the concerns identified. For example memo reminders to staff to complete records had not been effective.

There were enough staff to meet people’s needs and people did not have to wait for care. The staff were confident in identifying and responding to abuse and had the training they needed to support people appropriately.

People told us they were supported to access health professionals and health professionals told us the staff followed their advice and instruction.

People and their representatives told us that staff were kind and caring. They told us staff knew about their preferences and supported them in ways that promoted their independence.

The service was led by a registered manager and provider who were liked and respected by people and their relatives. Staff, people and representatives told us they were comfortable talking with them and were confident that any concerns they raised would be addressed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 related to records not being accurate and complete. 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 4, 5 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

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.

Inspection carried out on 27 September and 1 October 2013

During an inspection looking at part of the service

During this inspection we received positive feedback from the people we spoke with about the care people received. Everyone that we spoke with told us that staff knew what their needs were and how to meet these needs. One person told us, �They are very good. Everyone is very good to me�

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.

Inspection carried out on 14 November 2012

During a routine inspection

One person who uses the service told us �The staff are friendly, you can approach them at anytime.� A relative told us that staff use prompts to gain consent in providing care and �Staff treat people well here.� Another relative told us �They make you feel at home." Relatives/friends of people who use the service told us that they were happy with the care that was provided.

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.

Inspection carried out on 27 January 2012

During an inspection looking at part of the service

One person told us their room was clean.

People we spoke with told us they received their medicines at the times they expected to each day.

People living in the home told us staff were very thoughtful and took the time to listen when they were upset. One person said staff always visit them in their room and chat about their interests.

Inspection carried out on 22 July 2011

During an inspection in response to concerns

People living in the home believe the staff meet their care needs. Changing health needs are not always clearly recorded with the action to be taken which could put people at risk. Food preparation practices do not always follow best practice.

People told us that when they are unwell they see someone quickly.

People told us they feel safe and staff listen when they are concerned.

The home is not following the latest guidance on managing and controlling the risk of infection.

People told us that they get their medicines when they need them but errors have occured which is a risk to people living in the home.

Action has been taken by the provider to improve the communal areas of the home.

People tell us that there are enough staff to meet their care needs. Long hours worked by some staff could increase risk of errors occuring.

People told us that staff understand them and their needs. Training is in place to ensure staff understand how to support the health and welfare of people living in the home. Support and supervision is not happening consistently to ensure staff are competent to meet peoples needs safely.

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