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Archived: Downs Cottage Care Home (with Nursing) Requires improvement

Reports


Inspection carried out on 8 August 2016

During an inspection to make sure that the improvements required had been made

Downs Cottage Care Home provides nursing care for up to 23 older people including people who live with the experience of dementia and other mental health conditions. At the time of our inspection 13 people were living at the home. All required support with personal care and mobility.

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 2008 and associated Regulations about how the service is run.

The inspection took place on 8 August 2016, in response to concerns we had received, and was unannounced. The inspection was planned to be a ‘Comprehensive’ inspection to cover all five key questions about is the service Safe, Effective, Caring, Responsive and Well Led.

At the beginning of our inspection the provider announced that the home would close in four weeks. Due to this we changed to a ‘Focussed’ inspection to check that people would be kept Safe during the home closure. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Downs Cottage Care Home on our website at www.cqc.org.uk.

People were not protected from the potential risk of harm.

People at risk of choking had been given inappropriate food that increased the likelihood of a choking incident. People who should have been on a pureed diet to aid swallowing had been given chopped up burgers, sausages, pasta back, and sandwiches. The registered manager took immediate action to ensure this did not happen again.

There were not enough staff to meet the individual needs of people. The numbers of staff deployed left people at risk of falls unsupported. Arrangements for staff to call on other staff for help in an emergency, such as if someone fell, were inadequate. Staff made reference to sounding the alarm bell to call for aid, but this could not be found on the day of our inspection.

The home had not been maintained to assure peoples safety. The landlords gas safety certificate expired in April 2016, so they could not be certain the gas appliances were safe at the home. Risks to people from the spread of infection had also not been managed in a timely way. A risk identified during a night shift was not dealt with by staff the next day, until we brought it to the provider’s attention. This increased the chance that the infection would spread around the home. The provider took action to alert the appropriate authorities, and have the situation dealt with the day after our inspection.

We identified one breach in the regulations. We met with the provider, and wrote them a formal letter to outline the actions we required them to take to ensure people where kept safe during the closure of the home.

Inspection carried out on 5 April 2016

During a routine inspection

Downs Cottage is a care home with nursing for older people including people who live with the experience of dementia and other mental health conditions. There were 13 people living here at the time of our inspection.

We previously carried out an unannounced comprehensive inspection of this service in June and July 2015. At those inspections a number of breaches of legal requirements were found. We met with the provider to discuss our concerns. We also issued two Warning Notices which required the provider to take immediate action in relation to staff training and the safety of the building.

Since our last inspection we have continued to engage with the provider. We also required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant that the provider had complied with the Warning Notices we had issued.

Since our last inspection, the service had experienced a period of considerable change. Whilst it was evident that the management team had effected improvements to the home, these changes now needed to be embedded and sustained.

The providers focus had been on ensuring staff had appropriate training in first aid and changing the environment of the home to make it more suitable at meeting the needs of the people who live here. This included redecorating areas of the home, and major works such as installing two walk in shower rooms and fitting ceiling hoists to help people with mobility support needs. As such other areas of improvement had been identified, but not wholly implemented. For example, whilst we found that people received appropriate care, the care plans had still not been fully updated to give guidance to staff.

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 2008 and associated Regulations about how the service is run. However the registered manager had been absent from the home a number of times, and the provider’s plans to give management support at the home were not totally successful. Staff had not had the opportunity to have formal one to one meetings with their manager as per the provider’s policies. In addition a senior manager was not always available to support staff. The registered manager returned to work soon after our inspection, so these issues were in the process of being corrected.

We had positive feedback from people and their relatives about their lives at Downs Cottage. One person said, “I am happy here, I don’t think they could do better.” Another told us, “Staff are very nice and take time to talk to me.” A relative said, “I think my family member is well looked after and happy living here.” There was positive and caring interaction between people and staff.

The home was decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid with people’s mobility needs. The home had an airy and homely feel.

People were safe at Downs Cottage because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Staff recruitment procedures were robust to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

People received their medicines when

Inspection carried out on 24 July 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 24 June 2015 when we found breaches of legal requirements. Following this inspection further concerns came to light.

We undertook this unannounced focussed inspection on 24 July 2015 to check the provider had taken appropriate action as a result of the concerns identified in our earlier report and an incident that took place at the home. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Downs Cottage Care Home on our website at www.cqc.org.uk.

People were not protected from the potential risk of harm. The provider had not responded appropriately to ensure the risks to people at danger of heart attack and choking had been reviewed and controls checked to ensure they were keeping people safe. Not all staff had an understanding of current best practice in first aid.

People were at risk of harm in the event of a fire as the provider had not taken action to respond to all the issues raised in Fire Safety risk assessments and reports. People’s bedroom doors did not close fully, so would be ineffective at giving people protection from fire and smoke.

The provider had not taken all necessary actions to ensure they had addressed the breaches in regulation and we found continued breaches of regulation.

Inspection carried out on 24 June 2015

During a routine inspection

Downs Cottage is a care home with nursing for older people, many of whom live with the experience of dementia and other mental health conditions. The home is an old property with some modifications made to suit the needs of people, for example ramps so people can access the garden, and a stair left to help people get up the stairs. However it has narrow corridors, that make it hard for people that require support to move around, and the inside of the house has not been well maintained. Facilities such as bathrooms are also limited, for example people who live upstairs have to travel downstairs to have a bath or shower, even though they have a bathroom next to their rooms. At the time of our visit 21 people lived here.

This inspection took place on 24 June 2015 and was unannounced

Everyone we spoke with praised the care and support the received from the staff and the registered manager. One person said, “Staff are really good here, they know me and what I like.” A relative said, “The care staff go out of their way to look after the residents.”

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 2008 and associated Regulations about how the service is run.

The home had a 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 did not have the opportunity to be involved in how the home was managed. The registered manager carried out a number of audits to check that a good quality service was being provided, however the provider had not responded or taken action in a reasonable time.

People were not completely safe at Downs Cottage. The home was not clean and maintenance around the home had not been kept up to date to keep people safe. Not all windows had restrictors on them, so there was a risk people could fall out.

Training was not effective at keeping staff up to date with best practice on important areas such as first aid. The examples they gave us on dealing with medical emergencies did not match current best practice guidance, so people may not be supported effectively in a medical emergency.

The service was not based around the individual needs of people. People did not have activities that met their needs and the equipment and environment was not personalised to the people that used it, for example people did not have personal equipment when they needed help to move from one chair to another, and rooms were all decorated the same.

Care and support documents did not look at the person as a whole, for example care plans did not contain information about people’s personal history or personal preferences. They were based on people’s healthcare needs. Records of daily care did not give enough detail to show that people received appropriate care and support.

People were supported to maintain good health as they have access to healthcare professionals when they needed them. However improvements need to be made around people’s access to specialists in mobility to ensure they are receiving the best support to meet their needs.

There were enough staff to meet the needs of the people that live here, however we identified that the deployment of staff around this building should be reviewed, as should the staffing levels at night. There was a stable permanent staff team that knew the people they cared for.

The staff were kind and caring and treated people with dignity and respect.

Before people received care and support their consent was obtained. Where people did not have the capacity to understand or consent to a decision the provider and staff had followed the requirements of the Mental Capacity Act (2005). However we noted that some capacity assessments needed to be reviewed.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards to ensure the person’s rights were protected.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home.

People were offered a choice of food and had enough to eat and drink.

Processes were in place in relation to the correct storage of medicine. All of the medicines were administered and disposed of in a safe way. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People knew how to make a complaint. Feedback from people was that the registered manager would do their best to put things right if they ever needed to complain.

We have identified eight breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 17 September 2013

During a routine inspection

We visited Downs Cottage to look at the care and welfare of people who used the service.

During our visit we spoke with people who used the service; one relative; a visiting GP; a social worker; members of staff and the manager. We also met the provider.

We observed the interactions between staff and the people who used the service. We did this for the people who we were unable to verbally communicate with, or who said they did not want to talk to us when we asked.

We saw that systems were in place to ensure staff worked with the consent of people. One person told us “They never ask me to do something that I don’t want to do.”

People who used the service and relatives had been involved in the planning of care. One person told us “Overall the staff are good. They care for me.” Staff were seen to respond to people's needs. People appeared relaxed and happy.

We saw the house was clean and tidy. People who used the service told us they were happy with the standards of cleanliness.

The manager carried out appropriate checks when they employed staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

People and a relative that we spoke with said they would tell the manager or staff if they were unhappy about anything. They said that they had never felt the need to complain. They thought the manager would listen to what they said and take action.

Inspection carried out on 16, 17 October 2012

During a routine inspection

We made an unannounced visit to Downs Cottage Nursing Home. We looked at the care and welfare of people who used the service.

During our visit we spoke with three people who use the service; three relatives; one visiting social worker; six members of staff, and the deputy manager. We also met the provider.

Due to the communication needs of the people using the service we used an observational tool to assess the care and outcomes being provided to people who we were unable to fully communicate with.

We spent time observing people and how staff interacted and supported them. People told us that “staff were nice” and that they were "happy here." They also told us the food was "nice."

Relatives told us that they were able to visit as often as they liked. One relative told us “staff are very helpful and pleasant.” Another said that “I get answers when I ask questions about care.” A relative also said that “perhaps there could be a little more activity for people.” Someone else said “I don’t think they could do anything better.”

Relatives told us that they could tell staff or the deputy manager if they had any concerns. They also told us that the staff would discuss with them any change in a persons needs or health. A visiting social worker commented to us that a particular person “appears to be getting better since they came here.”

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