Davigdor Lodge Rest Home

Davigdor Lodge Rest Home is a residential care home providing personal care to up to 25 people. The service provides support to adults, many of whom were living with mental health conditions. At the time of our inspection there were 23 people using the service.

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

People were not always kept safe using the service. Risk assessments were not always completed for known risks to people or were not detailed to guide staff to support people safely. We discussed our concerns with the registered manager during the inspection who acted immediately to investigate the concerns raised and reduce the risk.

Auditing systems were not robust or effective to ensure management had oversight on identifying risk and acting on lessons learnt. The concerns found during this inspection had not been identified through internal quality assurance processes.

People medicines were managed safely and regular audits including competency checks of staff were undertaken. There were enough suitably trained staff to meet people’s needs and keep them safe. Robust recruitment processes were in place to ensure staff employed were safe to work with the people living at Davigdor Lodge.

Staff were caring in their approach towards people. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff demonstrated a good knowledge of the mental capacity act, and it was clear its principles were applied throughout everyday practices. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and staff spoke positively about the open culture at the service. They described a registered manager who was approachable and expressed confidence that any concerns raised would be dealt with appropriately.

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 27 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, staffing levels and information not being shared with appropriate external agencies. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Davigdor Lodge Rest Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, including fire safety and oversight of quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service: The service met the characteristics for a good service in each of the key areas, more information is in the full report.

• People said they felt safe living at Davigdor Lodge Rest Home. One person said, “I get anxious sometimes but staff know how to calm me down, I feel safe here.”

• Risks to people were assessed and managed. Staff understood how to recognise and report safeguarding concerns. There were enough staff on duty and they had the knowledge and experience they needed to care for people safely. People received their medicines safely and there were systems to prevent and control infection. Incidents were recorded and changes were made to prevent further occurrences.

• Staff had received the support and training they needed to care for people’s needs. Staff described effective communication and good team work. Assessments and support plans guided staff in how to support people. People told us they enjoyed the food provided. One person said, “We have a choice and there’s plenty to eat and drink.” People were supported to access health care services when they needed them. 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 said that staff were kind. One person told us, “They are all very caring and helpful.” Staff knew people well and had developed positive relationships with them. People were supported to express their views. Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

• People were supported in a person-centred way. Staff recognised changes in people’s needs and responded in a timely way to seek advise from health care professionals. There was a robust system for managing complaints. People told us they felt confident that any issues would be addressed.

• People and staff spoke highly of the management of the home. One person said, “The manager is doing a first class job.” There was visible leadership and staff understood their roles and responsibilities. Management systems were used to monitor and improve the quality of care. People and staff said they felt included in developments at the service and told us their ideas and views were welcomed. Staff worked effectively with other agencies.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good- 29 June 2016

Why we inspected: This was a planned comprehensive inspection.

Follow up: Ongoing monitoring.

The care home is situated in central Hove near to the Town Hall and local shops. Bus services are frequent and can be accessed at the end of the road. The building is comprised of two Victorian houses that have been linked internally to provide accommodation spread over five storeys. The floors are connected by stairs and there are bathrooms on each floor. Some people living at Davigdor Lodge have lived there for many years.

The home had a new manager who had been in post for just over three months. They were going through the process of becoming registered with CQC and at the time of the inspection they were not yet registered. Shortly after the inspection they were confirmed as the 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 spoke highly of the home and said that the Provider, the manager and the staff were all approachable and friendly. However, some aspects of care were not consistently effective. Where people had been assessed as being at risk of malnutrition and poor hydration records were not consistent and clear for staff to follow. This meant that people were at risk of not getting the support they needed with eating and drinking and the risk was not effectively monitored. This was identified as an area of practice in need of improvement.

Staff were working within the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. However staff understanding of their responsibilities with regard to this legislation and guidance was inconsistent. This was identified as an area of practice in need of improvement.

People told us they felt safe living at Davigdor Lodge one person said, “The staff make sure we are all safe here.” Risks to individuals were assessed and managed and staff were clear about their responsibilities to keep people safe and to report any suspected abuse. People received their medicines safely from trained staff. Medicines were stored and managed appropriately.

There was a robust recruitment process in place and there were sufficient staff on duty to meet people’s needs. Staff told us they were well supported with regular supervision and team meetings. They said they had access to good training and they could ask for help at any-time. People were supported to access health care services when they needed to. One person said, “The staff make sure I don’t miss my appointments with the psychiatrist, and the nurse.”

People told us they enjoyed the food at Davigdor Lodge and people’s individual dietary needs and preferences were considered. One person said, “They are very helpful, if you fancy something different they will make it for you.”

People told us that staff were caring, and respectful and that they were happy living at Davigdor Lodge. One person said, “I enjoy living here, we have made it into our own home.” People’s privacy and dignity were respected. Staff knew people well and involved them in decisions about their care and support. A staff member said, “We ask people what they want, how they need us to support them and what we can change to support them better.”

Care and support plans were personalised and reflected people’s preferences. Staff were in the process of reviewing all the care plans to ensure that information was up to date and accurate. People were supported to follow their interests and had access to a range of activities. Staff were focussed on ensuring that people received care and support that was personalised to their needs. People knew how to complain and said they felt comfortable to do so.

People, staff and visiting professionals spoke highly of the management and provider. There was an open culture and people and staff were encouraged to provide feedback about the service and to contribute their ideas about how it could be improved. The provider had systems in place to monitor care and analyse care provision. They used quality assurance methods to identify changes that were needed to improve the service.

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at. At this inspection, we spoke with nine of the people who lived at the service and two care staff. We also spoke with the manager and service provider.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans had been reviewed and were up to date. However, we found that people were not protected against the risks of unsafe and inappropriate care. This was because some areas of people's care plans were not sufficiently detailed. This meant that there was insufficient guidance to allow staff to deliver safe and effective care that reflected the support required in people's assessed needs. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. Although some communal areas and the exterior of the service had recently been redecorated, we found that other areas required repair, renewal and redecoration. One person told us 'They have done a lot, but there is still a lot to do'. People were not cared for in a safe and suitable environment because there was insufficient planning and activity to ensure that maintenance and remedial work was carried out when needed. A compliance action has been set for this and the provider must tell us how they plan to improve.

We looked around the service and found that some areas were not properly cleaned and were unhygienic. People were not protected against the risks of exposure to infection, because adequate cleaning had not taken place. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff files contained all of the information needed by the Health and Social Care Act. We found that the shortfalls highlighted at our last inspection had been addressed. This showed that the service had effective selection and recruitment procedures in place.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us they were happy living at Davigdor Lodge Rest Home. One person told us 'It suits me here, I'm happy as I am'. We saw that health care needs had been reviewed and specialist care needs, such as particular dietary requirements, had been identified and put into practice.

Is the service caring?

Care records contained personalised information which helped staff to know the people they supported. People told us that the staff treated them well, were kind and friendly. They said that their privacy was respected and their independence was encouraged. One person commented 'I'm involved in my care as much as I want to be. I can always find staff it I want to talk about anything'. We saw that staff interacted well with the people that they supported and people appeared content.

Is the service responsive?

People's needs had been assessed before they moved to Davigdor Lodge. This meant that the service had the skills and facilities to meet their identified needs. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. Regular monitoring of people's health, associated risks and their social needs identified when particular measures were required to help keep people safe. We saw that, when identified, such measures were put in place. This meant that the service was responsive to people's individual needs.

Is the service well-led?

The service had quality assurance systems intended to monitor and improve the service provided. However we identified shortfalls in infection control measures, care planning and the maintenance of the premises. This demonstrated that audit processes were not effective at this time because they had not identified the shortfalls highlighted. A compliance action has been set in relation to the quality assurance systems and the management of risks. The provider must tell us how they plan to improve.

People's needs were assessed in detail before they moved into the home. A standard risk assessment was developed for each person, with any risks identified as medium or high leading to a support plan to manage the risk. Different parts of people's support plans cross-referred as appropriate to their mental health support plan. There was evidence of close liaison with care coordinators based in the community and care records included people's care programme approach plans.

People told us they were well aware of their support plans and felt involved in agreeing and reviewing them. A person living in the home told us 'I feel in control of my life.' However, support plans did not show that all restrictions on activities were fully agreed with people, for example where particular arrangements were made to assist management of personal monies. Some support plans lacked specific information to guide staff.

The service identified that the ageing of people in the home meant physical care and mobility needs were becoming more acute for some people. A wet room had been provided for people who found use of a bathroom too difficult. The home liaised with health professionals in the community. People benefited from six-monthly reviews with their GP.

Training records showed all staff undertook annual refresher training in understanding indicators of possible abuse and how to use local safeguarding procedures. Where people were assessed as posing risks of self-harm, suicide, self-neglect or behaviours others could experience as difficult, risk management strategies were in place.

A person living in the home told us they liked the certainty of how their medicines were administered and they saw how staff recorded what they gave. All members of the care staff received training in handling medicines. There was a monthly audit of medicines handling and lessons were learnt and acted on when rare medicine errors occurred.

We looked at the recruitment records for three staff members who had been recruited in the year prior to our visit. They did not demonstrate that all vetting procedures were completed before people started to work unsupervised in the home. We are asking the provider to take action to ensure recruitment procedures are made safe.

The management were well informed about how people experienced the service. As well as plentiful informal conversation within the daily life of the home, arranged meetings took place for people who lived in the home. There was evidence matters affecting the home were discussed widely and the views of people living in the home, and staff, influenced how the home was run.

All the staff that we spoke to had formed close professional relationships with the people who used the service. The premises were clean and the atmosphere was relaxed and homely. The deputy manager told us 'I tell the residents here that it is their home. We work for them. I believe in positive risk taking and the residents should do what they want to do as long as we manage the risk'.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us 'The staff are very good. They always pop in to see if I'm alright. They are always helpful. I can't complain'. Another person told us 'The staff always do their best for me. I'm very happy here'.

Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us 'We provide a good level of care. We try and meet all the residents' needs in every way. I look at the care plans on every shift I do. I read all the notes and handover notes'. Staff we spoke with felt supported in their role and understood the signs of abuse and how to raise any safeguarding concerns.