Deerhurst Care Home

Deerhurst Care Home is a care home that provides accommodation, for 66 people who require nursing or personal care. The service is provided in accommodation over two floors. At the time of this inspection 64 people were living at the home.

We found the following examples of good practice.

People were protected by the homes infection prevention control policies and procedures. Visitor arrangements were constantly reviewed and supported based on government guidelines. One relative told us, “The manager has always kept us fully up to date with constant change. They always manage to keep us calm and confident that they are doing the right thing to protect people”. Prior to any visits people were informed of the procedures they should expect on arrival. People were asked not to visit the service if they displayed any symptoms related to Covid-19 and took a lateral flow test (LFT) before entering. Everyone provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

Each person had been individually risk assessed to ensure visits were person centred. This helped ensure their visits were meaningful whilst maintaining everyone’s safety. Relatives remained supportive and respectful when guidance changed, and new policies had to be implemented. A recent satisfaction survey completed by relatives scored 94 per cent. One relative told us, “This is a fantastic place, I cannot speak highly enough of the support and care to my father. This kindness is also extended to family members. I went to a meeting held for relatives because the manager and staff wanted to know how we were and if we required any support”.

Should there be a Covid outbreak the registered manager had ensured people had access to a nominated Essential Care Giver (ECG). This was usually a family member, but an alternative significant other would be nominated for those who did not have family. Enhanced risk assessments ensured this was managed safely and that all relevant testing and the use of PPE was maintained at all times. End of life visits had also been supported and respected so that people could spend time with those people who were important to them. We read a letter of thanks from a family whose parent had recently passed away. They praised everyone for the care they received and described how ‘eternally grateful’ they were to ‘spend time together, holding hands and to be able to say goodbye in a very special way’.

The emotional wellbeing of people and their families had been supported throughout the pandemic. Contact was maintained through various initiatives. Staff were sensitive to people's feelings including anxiety, sadness and loss. Positive, meaningful activity provision continued, including celebrating special events and trips in the local community. We observed a group activity whilst we were at the home. People were clearly enjoying themselves and there was a happy atmosphere throughout all areas of the home. One relative told us, “My father is in good spirits, he loves it here and there is always lots of laughter”.

The provider and management team were proud of their staff and recognised the difficulties for them during the pandemic. Despite increased pressures and challenges staff continued to work well as a team and support each other. Staff welfare had been considered and supported throughout. The registered manager told us about a recent staff wellbeing week which included alternative therapies such as mindfulness sessions, Indian head massage and Reiki, a Japanese form of energy healing. An independent consultant had been working closely with the registered manager to support emotional well-being and resilience.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. The vaccination programme for people and staff had been well received. The home had various communal areas which helped support and encourage social distancing. Where this was not achievable, for example those people with dementia, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

The housekeeping team contributed to keeping people safe during the pandemic. There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received Infection Prevention and Control (IPC) training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of Personal Protective Equipment and IPC practices.

Deerhurst Care Home is a care home that provides accommodation for persons who require nursing or personal care to 66 older people. The service is provided in accommodation over two floors. At the time of the inspection, 66 people were living at the home.

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

People consistently told us that staff were exceptionally kind, caring and compassionate and health and social care professionals told us staff were exceptional in the way in which they provided care and support.

There was a strong culture of person-centred care. Staff in all roles were motivated to ensure people had the best day possible and all understood how their role and interactions contributed to people's wellbeing. There was a culture of inclusiveness and one which acknowledged and recognised the different needs of people. There was a strong emphasis on encouraging people to maintain independence and respecting people’s privacy.

The environment of the home continued to be exceptionally dementia friendly. Since the last inspection the registered manager had continued to be creative with the environment which people lived in. The changes made had continued to have a positive impact on people’s wellbeing. Staff knew people well and were creative when assisting people to eat and drink. We observed the staff used a range of communication methods to encourage people to eat and drink.

People were encouraged where possible to make their own choices and decisions about aspects of their daily life. Where people lacked the capacity to make decisions for themselves the staff knew what to do to ensure that any decisions made on behalf of the person was made in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People received care that was extremely personalised and responsive to their specific needs and preferences. There was a strong focus on providing meaningful activities which promoted people's physical and emotional wellbeing. Staff had gone the extra mile in ensuring the people maintained and experienced interests and activities that were important to them. People and their relatives described how responsive staff had been to their needs. All levels of the service demonstrated a strong commitment to providing a personalised and holistic service. The registered manager and staff showed a commitment to ensure people's quality of life was optimised and provided emotional support. People were treated as individuals when considering recording any preferences or wishes at end of life.

The registered manager and provider were deeply involved in all aspects of the running of the home and provided their team with excellent leadership. This ensured all staff had the same aim to enable people living with dementia to lead fulfilled lives. The culture of Deerhurst Care Home was exceptionally open and positive. The atmosphere was relaxed and friendly. The registered manager worked in collaboration with other professionals and had undertaken project work within the home. The registered manager shared best practice with other providers and helped to drive improvements.

People were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified. Where risks to people had been identified assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe. People were encouraged to take positive risks to help them live a meaningful life. People received their medicine as prescribed.

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

The service 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.

Deerhurst is a care home with nursing care for up to 66 predominately older people. People have general nursing care needs or are living with dementia however the service places greater emphasis on looking after people living with dementia. The home is split into four areas. On the ground floor was the butterfly trail for 10 people and butterfly cottage for 16 people. Both were for people living with dementia but the cottage accommodated people who were more mobile. On the first floor there were two areas, the honeysuckle suite and bluebill rise. The building was a purpose built care home designed around the needs of the older person and in particular those people with dementia or cognitive impairment and physical impairments. There was one passenger lift and three secured staircases which meant all parts of the home were accessible for people with impaired mobility.

There was level access into the home was from the car parking area. There was a courtyard garden within the centre of the home. People were able to sit out in this area in warmer weather. The courtyard was also decorated in one part as a seaside theme and in another part was set up as a sporting area. To the rear of the property there were sensory gardens, a greenhouse and a large caged area for the hens.

Just prior to our inspection the registered manager had received the Inspirational Leader of the Year 2016 in the National Dementia Care Awards. The service had also been awarded the highest level Quality of Life butterfly kite mark. In order to achieve this the service incorporated the five principles of person centred care. These were occupation and purpose, attachment and a sense of belonging, comfort, identity and inclusion.

The registered manager provided good leadership and management for the staff team. The service and staff demonstrated their commitment to care for people with dignity, to further improve and to follow best practice for the care of people living with dementia. They linked with care provider forums ensured people had access to the local community. The service had a good reputation within the local community and also with health and social care professionals.

The service was very well-led and well managed. The service had a robust programme of audits in place to monitor the quality and safety of the service. Action plans were developed where shortfalls were identified so that improvements could be made. The provider continually looked to make things work better so that people benefitted from an improved service. Any planned improvement actions were followed up to ensure they were implemented.

People were looked after with a person centred approach care and where possible had been involved in drawing up their care plans. Knowledge of the person’s history and personality assisted the staff team and volunteers to provide the right support and maintain the person’s dignity and choices. Care plans were well written and provided detailed information about how the person wanted to be looked after and how their care was to be delivered. People were encouraged to have a say about things that mattered to them and to raise any concerns they may have.

People were looked after by staff and volunteers who were kind and caring. The staff met not only their specific care and support needs but also their emotional and social needs. The staff formed good working relationships with the people they looked after but also genuinely cared about them. People told us they were well looked after. We were told about times when the registered manager, staff and volunteers had gone over-and-above what was expected of them to meet people’s social and emotional needs. This had resulted in improved well-being for people. People were able to participate in a range of different meaningful activities, both in Deerhurst and outside of the service.

People were provided with an effective service that met their individual needs. They were encouraged where possible to make their own choices and decisions about aspects of their daily life. Where people lacked the capacity to make decisions for themselves the staff knew what to do to ensure that any decisions made on behalf of the person was made in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with the food and drink they liked to eat. They were provided with choice and given sensitive assistance if they needed help to eat their meals. Where there were risks of malnutrition or dehydration there were plans in place to reduce that risk. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so. Feedback for health care professionals was extremely complimentary. The service had successfully looked after a number of people who had been “difficult to place” because of challenging behaviours.

People were kept safe. This was because any risks to their health and welfare was well managed. The premises were well maintained and staff were trained in how to move people requiring assistance from one place to another safely. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. The management of medicines was in line with good and safe practice.

Staffing levels were adjusted regularly and took account of the number of people being looked after and their care and support needs. The staff were well trained which meant they were able to carry out their roles and responsibilities effectively. Staff were well supervised and supported by their colleagues and line managers. New staff had a robust induction training programme to complete which met the standards of the Care Certificate.

People were cared for in a clean, hygienic environment. We found good standards of cleaning. Bedrooms were checked and were found to be clean and tidy. We observed during that staff were cleaning people's rooms thoroughly.

Shared lounge areas had been decorated to a high standard and lounge furniture was very comfortable and in good condition. People living at the home told us 'The staff are creative' and 'Its home from home here'.

Staff we spoke with told us that they regularly reviewed people's care plans, audited daily record sheets and involved people in the process. We saw evidence of this when we looked at care records.

One person who was visiting their relative told us 'We chose the home because my relative liked it'. They said they were very happy with the home. They told us 'The manager is helpful and approachable and willing to spend time with us and our relative to help with decision making'.

We spoke to a relative who told us 'The care is amazing' and felt that communication with the home was good. They said they felt their relative was given choices and that staff listened. We saw an area of the home that served as a library. There was a large variety of books that people could borrow or buy for a small charge.

The daily records were entitled 'Being with me'. They had sub headings of 'Know me', Hear me' and Support me' reflecting people's past, present and future. This reflected what made a good day, people's routines, likes, dislikes and personal care support.

We saw that the home made appropriate referrals to the local authority safeguarding team and took leadership and advice where needed. Records were maintained of safeguarding alerter forms and correspondence.

One relative commented that "The staff do a good job and know what they are doing' and 'My family member is so much better since moving here".