Archived: Devereux House

Devereux House is a residential care home for up to 16 people aged 65 and over. 12 people were living there at time of the inspection. The home Is located above a day centre in a residential area of Farnborough. The home has its own lounge/dining room but shares the kitchen and main activity space with the day centre.

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

People received safe care and treatment from trained, caring and compassionate staff. People told us they felt safe living at Devereux House. Staff were able to give examples of how to identify potential abuse and the actions they would take to protect people.

We observed caring and respectful interactions between people and care staff. People and their relatives were very positive about the service. One person said, “It is a homely and welcoming place and the staff are second to none.” Another said, “All the staff are so kind and gentle.”

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 place supported this practice. Risk assessments were detailed and person-centred and gave clear information on steps staff should take to reduce and mitigate risk.

Recruitment processes enabled the provider to recruit staff assessed as safe to work in health and social care with people. Staff were supported to carry out their roles through training, supervisions and annual appraisals. Good team work was encouraged and evident.

People were supported to participate in group activities and take meals in the communal dining area. Staff also respected the wishes of people who preferred to pursue their own interests and have more privacy.

People were consulted about their care and care plans were personalised and up to date with people’s needs and preferences. Staff listened to people’s wishes and responded quickly and appropriately. People were treated with compassion at the end of their lives.

People and their relatives knew who to speak to if they had a complaint to raise. They were confident that if they did raise a concern it would be dealt with immediately. They knew the registered manager very well and felt confident about approaching them at any time.

Quality monitoring systems included audits and observation of staff practice. The provider made regular checks on key aspects of the service and produced written reports and monitored action taken.

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 23 August 2017).

Why we inspected

This was a planned comprehensive inspection based on the rating at the last comprehensive inspection. At this inspection the service remained good.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

We last inspected Devereux House on 11 and 13 January 2016 and found the provider to be in breach of regulations in relation to good governance and fit and proper persons employed. We issued a warning notice for the breach of regulation in relation to good governance. The provider was required to meet the regulation relating to the warning notice by 31 May 2016. During this inspection we found the provider had taken action to ensure the requirements of this regulation had been met.

We served a requirement notice on the provider regarding the breach of regulation in relation to the employment of fit and proper persons. The provider was required to send us an action plan detailing how they were going to make improvements to meet the regulation. During this inspection we found the provider had made some improvements to their recruitment process but there were still some gaps in relation to staff previous employment histories. However, prior to the completion of this report the registered manager had provided evidence to demonstrate that all gaps in staff employment histories had been addressed. In addition the provider had also made improvements to their recruitment documentation to ensure robust processes going forward.

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.

People were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and had access to guidance to help them identify abuse and respond appropriately if it occurred. Staff were able to demonstrate their role and responsibility to protect people.

Risks specific to each person had been identified, assessed, and actions implemented to protect them. Risks to people had been assessed in relation to their mobility, social activities and eating and drinking. Staff were able to demonstrate their knowledge of individual risk assessments and how they supported people in accordance with their risk management plans.

People’s care plans had been reviewed to ensure they included all of the information staff required to meet people’s needs.

The registered manager completed a daily staffing needs analysis to ensure there were always sufficient numbers of staff with the right skills mix and experience to keep people safe. We reviewed staff rotas which confirmed that people had been supported by sufficient numbers of suitable staff to keep people safe. Staff had undergone pre- employment checks as part of their recruitment, which were documented in their records.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the registered manager.

The provider’s required staff training was up to date, including safeguarding people from abuse, moving and positioning, the Mental Capacity Act 2005, fire safety, food hygiene and infection control. This ensured staff understood how to meet people’s support and care needs. Training was refreshed regularly to enable staff to retain and update the skills and knowledge required to support people effectively.

Staff had received individual supervisions and appraisals from their supervisors who completed competency assessments in relation to staff skills such as moving and positioning.

Staff supported people to make as many decisions as possible. People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and deprivation of liberty legislation and guidance.

People were supported to have enough to eat and drink and were provided with a balanced, healthy diet. People were supported to consume sufficient nutritious food and drink to meet their needs, in accordance with their care plans.

Records showed that people had regular access to healthcare professionals such as GPs, speech and language therapists, opticians, dentists and podiatrists. The registered manager had developed excellent links with specialist nurses, particularly the Specialist Community Nurse for Care Homes, who held regular clinics at the service. Staff had benefitted from training and guidance from a range of specialist nurses.

People and where appropriate their relatives were supported to be actively involved in making decisions about the care they received. Staff had developed positive caring relationships with people and spoke with passion about people’s needs and the challenges they faced. Healthcare professionals made positive comments about the positive impact on people’s well-being due to how well staff had implemented their guidance.

People’s privacy and dignity were maintained by staff who had received training and understood how to support people with intimate care tasks. Staff demonstrated how they encouraged people to be aware of their own dignity and privacy.

The management team were committed to ensuring people were involved as much as they were able to be in the planning of their own care. Staff reviewed people’s needs and risk assessments monthly or more frequently when required to ensure that their changing needs were met.

The registered manager sought feedback in various ways, including provider surveys, visitor’s questionnaires and trustees visits, which they used to drive continuous improvement in the service. Since our last inspection there had been no complaints raised. People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs.

The registered manager and management team inspired staff to deliver good quality care to people living at Devereux House. Staff were able to tell us about the values of the provider and we observed staff followed these in practice. The registered manager was highly visible within the service and readily available to people and staff. The registered manager and senior staff had developed and sustained an open and positive culture in the service, encouraging staff and people to raise issues of concern with them, which they always acted upon.

The registered manager had established systems and processes that enabled them to identify and assess risks to the health, safety and welfare of people who use the service and to ensure compliance with legal requirements. The provider had maintained accurate, complete records in relation to people, including a record of the care and treatment provided and decisions taken. The provider’s audits of medicines management, staffing needs analysis, staff recruitment, accidents and incidents and care records enabled the provider to identify and assess risks to the health, safety and welfare of people and take appropriate actions to improve the service..

We last inspected the home on 14 November 2013 and found the provider was meeting all of the requirements of the regulations at that time. We did however, report that the provider might find it useful to note that their system of internal auditing did not include follow-up actions plans and that people's risk assessments were not being kept up to date.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service is required by a condition of its registration to have a registered manager. The manager had been in charge of the home since June 2015 and had started the process to become registered with CQC following our visit.

At the time of our visit a full and effective governance system to monitor the quality of the service and identify the risks to the health and safety of people was not in place. The manager and Board of Trustees monitored the quality of service people received through monthly visits and meetings However, we could not see that these systems were effective in ensuring compliance with the regulatory requirements. Systems currently in place had not identified the areas of concern we found during the inspection so that action could be taken to improve the quality of care and ensure the safety of people.

The required pre-employment information relating to care workers employed at the home had not always been obtained when care workers were recruited. The provider did not ensure that safe recruitment practices had been followed to ensure staff were suitable for their roles.

Staff were able to demonstrate their understanding of the risks to people’s health and welfare and people told us they received care that met their needs. Risks associated with people’s care and support needs had been identified and guidance provided to help staff protect them from harm. However, people’s care records were not always sufficiently comprehensive to ensure staff who were new to the location would have all the information they required to enable them to meet people needs, wishes and preferences.

Staff had received training to support them to effectively meet the individual needs of people. Even though staff felt supported they did not always receive supervision (one to one meetings with their line manager) to ensure they maintained the skills and knowledge needed to meet people’s needs effectively. We have made a recommendation about staff supervision.

People and staff spoke positively about the manager. They felt she was approachable, listened to them and asked for their views. People felt involved in their care. People were supported with activities, and enjoyed time spent with staff.

People were treated with kindness, compassion and respect. Staff promoted people’s independence and right to privacy. The staff were committed to enhancing people’s lives and provided people with positive care experiences.

People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain. The provider was using learning from a complaint to review whether adjustments to the service could be made so that, in the future, people could continue to live in the home once they had developed dementia.

People received their prescribed medicines when needed and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.

There were enough staff to meet the needs of the people that lived here. People were positive about the staffing levels and said they received support quickly when they needed it.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. Staff sought people’s consent before they provided their care and support. All of the people were able to make decisions about their care and no one was being deprived of their liberty.

People and staff’s views about the management of the service were positive. The manager had promoted a culture that put people at the centre of the work they did. The manager and Chairman of the Board of Trustees had become aware of some shortfalls in the service and were taking action to improve the health and safety arrangements and update the home’s policies and procedures.

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

We found that people were always asked for their consent to care on an ongoing basis. People told us that staff always asked their permission before they offered them care. We found that there were no clear procedures in place for assessing a person's mental capacity.

We found that, overall, people were satisfied with their level of care, and that the provider had an effective system in place for assessing, managing and reviewing people's needs One person said 'they spoil us rotten here'.

We found that staff were trained in safeguarding people from abuse and able to report any incidents of abuse without fear of recrimination from their employer. The people we spoke with said they felt safe from harm.

We found that there were appropriate staffing levels in the service and that staff were qualified for their work. People told us that staff responded quickly to requests for help.

We found that the provider obtained regular feedback from people on the quality of the service, and had systems in place to conduct regular audits and assessments of the whole service. The people we spoke with said that staff members were always asking if they were OK and if they wanted anything.

We found people were offered choices and their likes, dislikes and preferences had been taken into account when planning and delivering their care. We found the service had completed detailed risk assessments for people which included detailed action plans for staff to follow in order to minimise risks.

We saw the service had a safeguarding policy in place and staff knew the procedure for reporting possible abuse. We saw the service had procedures in place to ensure medicine was ordered, stored, administered and disposed of safely. The service also had procedures in place to ensure all necessary checks had been performed before staff began work.