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  • Care home

Archived: Down House Residential Care Home

Overall: Inadequate read more about inspection ratings

Alum Bay New Road, Totland, Isle of Wight, PO39 0ES (01983) 752730

Provided and run by:
Mrs Trina Marie Clack

All Inspections

13 August 2015

During an inspection looking at part of the service

We carried out a focused inspection on 13 August 2015 following information about a lack of staff on duty in the home. This report only covers our findings in relation to this topic.

We undertook an unannounced comprehensive inspection at Down House on 14, 15, 17 and 26 April 2015 at which breaches of regulation were found. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Down House Residential Care Home’ on our website at www.cqc.org.uk’.

Down House Residential Care Home is registered to provide accommodation for persons requiring nursing or personal care. Down House is a residential care home for up to 17 people. At the time of our inspection 6 people were living at Down House some of whom have physical disabilities or are living with dementia. The home did not have a registered manager at the time of our inspection. 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.

Whilst there were sufficient staff to provide people’s care and support needs on the day of our inspection, the provider failed to plan staffing levels effectively. There was no systematic approach in place to ensure sufficient numbers of suitably skilled, experienced and trained staff were available to meet people’s individual needs. The manager had been given permission by the provider to engage agency staff at short notice and therefore was able to demonstrate that staffing levels for the weekend and the following week were sufficient to enable people to have their needs met.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

14, 15, 17 and 26 April 2015

During a routine inspection

Down House Residential Care Home is registered to provide accommodation for persons requiring nursing or personal care. Down House is a residential care home for up to 17 people. At the time of our inspection 10 people were living at Down House some of whom have physical disabilities or are living with dementia.

This inspection was carried out on 14, 15, 17 and 26 April 2015 and was unannounced. At our last inspection in December 2014 we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action and required the provider to make improvements. We issued a warning notice in relation to cleanliness and infection control. At this inspection we followed up on the warning notice and carried out a comprehensive inspection to check whether the provider is meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of inspection the home did not have a registered manager because the previous registered manager had recently left. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

At Down House care is provided on two floors. A lift is available for people to access the rooms on the upper floor. A dining room, and lounge are located on the ground floor, as well as a smaller lounge, known as the snug. The garden was well maintained and people had access to the outside areas.

Care provided at Down House was not safe. People at risk of pressure injury, or of choking, were not cared for appropriately. Some people had behaviour that challenged others and staff were not trained to care for people safely. Risks to people’s health and safety were not assessed and mitigated effectively.

Insufficient staff were available to ensure people’s needs were met. Some staff did not show a caring attitude towards people, and the majority of staff interactions were task focussed and did not deliver individualised care. Staff were not trained to act safely in the event of a fire, and recruitment processes did not ensure staff were suitable to work in the home.

People did not always have access to pain relief when they needed it and medicines were not managed safely. Parts of the home had not been cleaned effectively and the provider and staff did not practice safe infection prevention and control procedures.

Although people did not have any complaints about staff we observed the staff and the provider did not respect people’s confidentiality, and people’s personal health and care needs were discussed in front of other people using the service. Some staff prevented people from moving around the home by placing their mobility aids away from them. People were satisfied with the food but were not always supported to eat and drink sufficient amounts.

People were not involved in the planning and delivery of their care or treatment. People had few opportunities to engage in activities and care staff rarely engaged with people unless it was to assist them to move.

Staff had some knowledge of abuse and how to report it. Staff were not supported to report poor care practice. The provider did not monitor staff practice and take action when this fell short of the standard of care people should expect.

The provider did not monitor the quality of the care effectively or respond to some concerns about the care provided to people using the service. They were not aware of the regulations applicable to the provision of the regulated activity.

The provider and most staff did not understand their responsibilities under the Mental Capacity Act 2005. Staff did not always seek consent from people who could give it before providing care. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Whilst no-one living at the home was currently subject to a DoLS, we found that the provider did not show an understanding of when an application should be made and how to submit one.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of Special measures in Adult Social Care is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provides a framework within which CQC can use our enforcement powers in response to inadequate care and can work with, or signpost to, other organisations in the system to help ensure improvements are made.

Where necessary, CQC will take enforcement action in response to inadequate care in adult social care services in special measures.

Services placed in special measures are kept under review and, if we have not taken immediate action to cancel registration, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the providers to take at the back of the full version of the report.

27 November and 2 December 2014

During an inspection looking at part of the service

One adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcome we inspected. We also spoke with four staff members, the registered manager and the provider. During this inspection we looked at cleanliness and infection control. We used the information to answer the question we always ask;

Is the service safe?

This is a summary of what we found-

Is it safe?

During our previous inspections in October 2013, and July 2014, we identified the provider had failed to ensure the home was clean. At this inspection we found infection control procedures in the home were not followed by all staff. Parts of the home were not clean. The home's infection control processes were not followed and as a result people were not protected from the risk of infection.

16 July 2014

During an inspection looking at part of the service

We considered all the evidence we had gathered under the outcomes we inspected. We spoke with six people using the service and a visiting health professional. We also spoke with six staff , the registered manager and the provider. During this inspection we looked at outcomes relating to people's care and welfare, cleanliness and infection control, food and nutrition and requirements related to workers employed within the home. We also looked at staff training and support, the home's quality assurance processes and the quality of the record keeping. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is it safe?

People's needs had been assessed and care was delivered to them in line with their needs. Care plans were clear and informative and staff were aware of people's needs and how to meet them. Risks relevant to the individual had been identified and care plans contained guidance on how these should be managed. People had the equipment they required to move around the home safely, and we observed staff assisting people using safe techniques.

The manager was aware of their responsibilities under the Mental Capacity Act (MCA). No applications had been made under the Deprivation of Liberty Safeguards (DoLS) however, the manager was aware of the procedures to follow should this be necessary. People were cared for by staff who understood their human rights. Records kept on people's care were clear and understandable.

Systems were in place to ensure the home was kept clean. However, some of these measures were not effectively ensuring people were protected from the risk of infection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection prevention and control.

Is it effective?

People told us they were happy in the home and their care needs were met. One person said, 'I've everything I need. They [the staff] know what they are doing'. Daily records of care showed people received the care they required which was in line with their care plan. Staff were aware of people's individual needs and provided care accordingly.

Staff training needs were identified and staff had completed training appropriate to their role. Where people had specific dietary or moving and handling needs, we observed these were met. People's individual preferences were known and respected.

Is it caring?

The staff provided support with a caring attitude. They were attentive to people's needs and provided care in a respectful way. We observed staff adapting their communication style to ensure people with hearing or language difficulties were included and their views were known. This enabled people in the home to make choices because staff adapted to their needs.

Is it responsive?

Staff responded to people's needs and external professionals were involved in people's care as needed. Staff had time to sit and talk with people. They provided people with encouragement to eat and/or drink whenever this was needed. Feedback was sought from people on a group, and one to one, basis and this was acted on. Where concerns with staff practice, or the environment had been identified, action plans and supervision discussions addressed these.

Is it well-led?

Staff told us the manager and provider were available to talk to at any time. One staff member told us, '[They] are really approachable. You can discuss anything with them'. The manager carried out audits and checks regularly and ensured concerns were recorded and acted on. Staff practice was monitored and training needs identified and addressed. This meant the quality of the service provided was monitored and improved as necessary.

16 April 2014

During an inspection looking at part of the service

The purpose of this inspection was to check whether Down House Residential Care Home had complied with a warning notice we served in relation to the care and welfare of people living in the home. We considered all the evidence we gathered under the two outcomes we inspected. We used the information to three of the five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for by staff who were aware of their needs and who had the skills to provide the support people required. People received the support they needed to move around the home. Some people were assisted to use a walking frame or a wheelchair and we saw this was carried out safely. However, risks to people's health, although identified, were not always managed effectively. The manager did not assure themselves that staff were following people's care plans accurately in order to keep people safe. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Robust recruitment processes were not in place or followed. This led to a member of staff being employed who had not been interviewed. Staff had also not been subject to the necessary checks on security and their suitability to work in the home. This posed a potential risk to people in the home. We have taken enforcement action in relation to this and the provider must take action to improve.

Is the service effective?

Arrangements were in place to ensure people were provided with the support they needed. For example, people who needed pureed food received this, and staff were on hand to provide people with support to eat where this was required. People told us they had their needs met. One person said they were 'quite happy with everything'. The manager had ensured people's weight could be monitored when, due to frailty, some people were unable to use conventional scales. However, some risk assessments impacted on people's ability to retain some independence within the home.

Is the service caring?

We observed staff showed a caring attitude towards people. People were encouraged in a kindly manner to participate in a music and singing session and were assisted to do so. Staff ensured people had sufficient to eat at mealtimes and where malnutrition or dehydration had been identified as a risk, staff supported people by offering a variety of different foods.

15 December 2013 and 2 January 2014

During an inspection looking at part of the service

During our previous inspection, which was carried out over two days on 29th October and 7th November 2013, we found the care provided did not meet the individual needs of people living in the home and ensure their welfare and safety. We issued a warning notice which required the provider to become compliant by 13th December 2013. During this inspection we also identified concerns with the way staff were supported, record keeping and the home's quality assurance procedures.

During this inspection we saw some work had been completed on improving people's care plans however these did not yet fully show how people's needs would be met. We also found some staff did not follow procedures to ensure people's health and welfare were cared for following a fall. We observed one person was assisted to move in an unsafe manner.

We also identified some concerns about the training and supervision of staff. Issues identified at supervision had not been addressed effectively and some records kept for supervision were vague and did not demonstrate that a productive conversation had taken place.

In addition we found quality assurance checks were not recorded for checks on medicines and the environment. We also found checks had not identified when furniture needed to replaced or repaired and there was no system in place for the manager to ensure that staff provided the care people required.

29 October and 7 November 2013

During a routine inspection

We spoke with four of the nine people living at Down House. They told us they were content living there. One person said 'it's nice'. Another person told us 'it's okay'. We looked at four care plans and associated records of daily care. These were in a clear format and outlined the tasks of personal care people needed assistance with. However, we found some people were not cared for according to their care plan, and risk assessments were not up to date.

People told us they enjoyed the food. However, we found frozen foods were not stored appropriately or according to published guidance. We also found that whilst there was a variety offered, people were not offered a choice of meal. Some food storage areas were not clean.

The communal areas of the home and people's rooms were clean. However, we found toilets were not clean and there was a lack of personal protective equipment, such as disposal gloves and aprons available in bathrooms.

There were enough staff available to care for people's needs. Staff had completed training appropriate to their role. A complaints policy was in place and people knew how to complain. People told us they had no complaints and the service had not received any complaints.

26 June 2012

During a routine inspection

We spoke with eight of the people who lived at the home. We also spent some time in the home's communal areas observing people and the way they were cared for.

We spoke with health and social care professionals who regularly visited the home. They were complimentary about the way the service met people's needs.

Everyone we spoke with confirmed that people's privacy and dignity were maintained at all times and that people were able to make day to day decisions such as what time they got up and how and where they spent their time. We observed that people were enjoying their lunch time meal. People told us meals were good and that alternatives were provided.

People said that they had no concerns about how their personal care needs were met. They also told us that if they were unwell then staff would contact a doctor for them. We were told that staff were available when people needed them and knew what care they required. People said staff gave them their medications when they needed them.

People and relatives said that if they had any concerns or complaints they would raise these with the manager. Nobody had any concerns when we spoke with them.