Background to this inspection
Updated
16 September 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 08 August 2017 and was unannounced.
The inspection team consisted of one inspector, a specialist advisor who was a mental health trained nurse, with significant experience in elderly care and an expert by experience. Our expert by experience had knowledge and understanding of older people residential services and dementia care.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and notifications about important events that had taken place in the service, which the provider is required to tell us by law. We used all this information to help us plan our inspection.
Not everyone was able to verbally share with us their experiences of life at the service. This was because of their complex needs. We therefore spent time observing people and how care was delivered and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
However, we were able to speak with seven people, four relatives, a visiting friend, four members of staff, a senior care staff, cook, business support officer and the registered manager. We also spoke with the visiting operations manager and two healthcare professionals. We contacted health and social care professionals including the local authorities’ care managers, and GP to obtain feedback about their experience of the service.
We looked at the provider’s records. These included five people’s records, which were care plans, health care notes, risk assessments and daily records. We looked at five staff files, a sample of audits, satisfaction surveys and policies and procedures. We also looked around the care service and the outside spaces available to people.
We asked the registered manager to send additional information after the inspection visit, including training records, staff rotas, business plan and some contact telephone numbers. The information we requested was sent to us in a timely manner.
Updated
16 September 2017
This inspection took place on 08 August 2017 and was unannounced.
The Old Downs Residential Care Home provides accommodation and support for up to 41 people living with dementia. It is set within its own grounds in the village of Hartley, close to Dartford, Kent. At the time of our visit, there were 35 people who lived in the service.
There was a new registered manager at the service. The new registered manager started in May 2017. 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.
At our previous inspection on 08 June 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People's medicines were not always managed safely. Appropriate procedures were not followed in managing covert medicines and medicine risk assessments were not carried out. Malnutrition Universal Screening Tool (MUST) records were not always completed to identify adults who are malnourished, at risk of malnutrition (under nutrition) or obese. We asked the provider to submit an action plan by 07 September 2016. However, due to the registered manager leaving her position, we did not receive an action plan.
At this inspection, we found that the provider had met the breach of the regulation.
Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the service. Malnutrition Universal Screening Tool (MUST) records for five people we looked at were fully completed.
There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.
The registered manager had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the service; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the service.
The service had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely.
There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.
Training records showed that all staff had completed training in a range of areas that reflected their job role, such as essential training they needed to ensure they understood how to provide effective care, and support for people.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and the service complied with these requirements.
The food menus offered variety and choice. They provided people with a nutritious and well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs. Both people and relatives told us they were happy with the food in the service.
People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.
People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.
People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.
People’s needs were fully assessed with them before they moved to the service to make sure that the service could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice.
People spoke positively about the way the service was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.