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Archived: Dean Wood Manor


Inspection carried out on 12 August 2014

During a routine inspection

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at respect and involvement, care and welfare, safeguarding, support for workers and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking to professional visitors and looking at records:

Is the service caring?

We observed staff interacting with people who used the service in a kind and friendly manner. Staff made efforts to ensure people�s dignity and privacy was preserved and their preferences and choices respected.

There were a number of ways in which people were assisted to be involved in the home, including families attending reviews of care, relative�s meetings and regular satisfaction questionnaires. People who used the service were consulted if possible, but many were unable to express an opinion due to the nature of their dementia.

There was no activities coordinator in place on the day of the inspection, but the home was in the process of trying to recruit someone to this position. In the meantime we saw evidence of care workers offering some activities, such as gardening in the new greenhouse and playing ball games. We also saw that there was regular entertainment offered at the home.

We spoke with one person who used the service who said, �Fantastic, no complaints whatsoever�. We spoke with three visitors who were all positive about the care at the home. One person said, �Brilliant, I can�t fault them, he�s well looked after. He�s content and I�m content with him here�. Another visitor told us, �I find them (staff) very obliging, I�ve only to mention something and they see to it�. They went on to say, �I nip in any time and I always find the care is good�. A third visitor commented, �X has settled well and is looked after well�. All felt communication was good and they were informed in a timely way if there was anything they needed to be told.

Is the service responsive?

We saw evidence that assessments were carried out prior to people moving in to the home and care plans were individual and were regularly reviewed to ensure the person's care delivery was still appropriate. We were told that a person had recently been reassessed due to changes in their condition and a more appropriate placement found for them elsewhere. This indicated the home�s responsiveness to changes in need and ability to follow this through to help ensure a good outcome was achieved for the person.

There was evidence that people�s wishes and suggestions had been responded to via residents� meeting minutes, questionnaire analysis and within the care plans.

There was evidence that when audits, quality checks and assessments were undertaken the home responded appropriately. We saw changes had been made at the home in response to a recent home development plan which had highlighted the need for more dementia friendly materials on the walls of the home.

Is the service safe?

There were adequate numbers of staff on duty at the home on the day of the visit.

There were five people at the home who were subject to Deprivation of Liberty Safeguards (DoLS), and the home was working with the local authority to ensure further appropriate authorisations were made in a timely manner. Staff had received training in the subject and demonstrated an understanding of DoLS and the need for the least restrictive measures to be used.

Staff training was up to date and on-going and had been increased over recent months to ensure knowledge and skills were up to date.

Appropriate risk assessments were in place and when incidents occurred we saw the home took steps to minimise the risks of further occurrences. In cases where people who used the service demonstrated behaviour that challenged we saw evidence that this had been addressed with close monitoring, distraction techniques and referrals to other appropriate professionals.

Staff demonstrated a good knowledge and understanding of safeguarding procedures and were aware of how to report any concerns. Policies, procedures and guidance were in place at the home.

Is the service effective?

We spoke with four members of staff who demonstrated a good understanding of their roles and responsibilities. We looked at five care plans which included a significant amount of factual and up to date personal and health information.

There was appropriate signage to assist people with orientation around the home and the main corridor was circular which enabled people to move around freely and safely.

Visitors told us they could visit any time and were always made welcome. Relatives were encouraged to participate in reviews of care and to communicate any concerns or suggestions to staff.

Is the service well-led?

The home had a manager in place at the home, who was in the process of registering with the Care Quality Commission.

A significant number of audits and checks were in place to help ensure consistent standards of care within the home. Home development plans were produced as a response to audits in order to address any shortfalls identified and to continually improve service delivery.

Relatives' questionnaires were completed regularly to ascertain people�s satisfaction with the service offered. There were regular relatives� meetings where people were encouraged to make suggestions and raise any concerns.

Complaints were logged appropriately and the policy was accessible to relatives of people who used the service.

Inspection carried out on 24 September 2013

During a routine inspection

Due to the differing ways in which the people living at the home communicated they were unable to give their views on the outcomes we looked at. We made observations in the dining room during lunch and found that people were being asked respectfully for their choice of meal and drink. People were encouraged to eat and were given reasurance when required. Staff supported people to eat in a dignified way.

Relatives spoken with said "the home is very nice" and " I am always made to feel welcome". Other comments made were " The staff are very nice" " they know what they are doing" and " I know all the staff"

Inspection carried out on 10 October 2012

During a routine inspection

We spoke with two people living at Dean Wood Manor and four relatives. People were complimentary about the care that people received. We were told �Staff are efficient and kind�; �Staff know what they are doing�; "I have found the care staff ensure the privacy and dignity of my relative� and �All staff are good but there are not enough of them.� Several people (relatives and staff) told us that they though there were not always enough staff at the home to meet people�s needs and we have discussed this further in Outcome 13. We found that some people were at risk of receiving unsafe or inappropriate care because their care was not monitored and updated in timely manner.

We found that people were given choices about their care and visitors told us they thought that their relatives were safe from abuse at Dean Wood Manor. Staff received appropriate support and training and people told us staff were competent to undertake their roles.

We were shown an extensive quality monitoring programme. We were told that a new manager had been in post for a few months and was in the process of identifying areas for improvement. The Regional Director for Mimosa (The company that owns the care home) had also identified areas for improvements and some of these had been completed. One relative told us that the environment of the home had improved since the new manager had started working at the home.

Inspection carried out on 26 September 2011

During a routine inspection

�We received a lot of information before choosing this home: The Manager came to see us, she was a great help�.

�I attend the family and friends meetings, the staff do listen to what we have to say�.

�This is a good home; they look after my Wife wonderfully�.

�I am happy how the staff look after my Mother�.

Staff we spoke with told us:

�We have regular meetings, we can make comments on the service, good and bad and we are listened to�.

� The manager is good at actioning any shortfalls identified�

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