Duncote Hall Nursing Home

Duncote Hall is a residential care home that can provide long and short-term residential nursing care for up to 40 older people, including people living with dementia. At the time of inspection 13 people were using the

service.

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

Improvements had been made since the last inspection. However, these needed to be fully embedded.

Systems and processes to ensure oversight of the service and the care people received was in place but required embedding and reviewing to ensure all information was captured and all risks reduced.

People were protected from harm. Known risks to people had been assessed and mitigating strategies implemented. However, we found a few areas required further improvements. Most unexplained injuries had been investigated, followed up and recorded appropriately.

People received their medicines safely and by trained staff. However, we found not all prescribed medicines had been recorded appropriately. However, we found no evidence of harm to people.

People told us activities were not offered at weekends, and staff at times were slower at responding to needs than expected.

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 the service supported this practice.

Staff were seen wearing appropriate PPE, COVID-19 testing was in place and the service followed government guidance throughout the COVID-19 pandemic.

People were supported by staff who had been recruited safely and who had received the necessary training to complete their roles.

People told us staff were kind, caring and knew them well. Staff respected people’s privacy, dignity and independence. People were involved in their care planning and preferences had been recorded.

People were supported with aspects of food and fluids as required. People had a choice of meals and drinks throughout the day.

Staff worked closely with other professionals such as speech and language therapists, GP’s, commissioners and other health professional.

People, staff and relatives knew how to complain. The management team had requested feedback on the service from people, their relatives, staff and other professionals.

People's communication needs were documented and met. The registered manager had information available in different accessible formats such as easy read, large print or in a different language.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 9 April 2020) and there were multiple breaches of regulation. The provider completed action plans after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Exiting special measures

This service has been in Special Measures since 9 September 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Duncote Hall is a residential care home that can provide long and short-term residential nursing care for up to 40 older people, including people living with dementia. At the time of inspection 17 people were using the

service.

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

Quality systems were not effective in identifying the concerns raised on inspection.

The systems and processes in place to maintain oversight of the service were not effective in ensuring people’s needs were met and that staff had all the information required to provide safe care.

Medicine management system needed to be improved. Medicines had not been administered or recorded

in line with the provider’s policies.

Records of care had not been consistently completed. Audits had not identified the gaps in recording found during inspection.

People who had injuries, bruises or pressure ulcers did not always have these reviewed or treated.

Not all care plans held enough information to ensure staff knew people’s individual care needs and the support they needed to stay safe.

People told us they felt safe and that the staff supporting them were kind.

Staff had been safely recruited and completed an induction. There were sufficient staff to meet the needs of people living at Duncote Hall Nursing Home.

The home appeared clean and well maintained.

After the inspection the manager put in a variety of new systems and procedures to improve the care given, however as these are new we have no assurances of these being embedded into the service.

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 inadequate (published 2 May 2020) the provider was in breach of regulations 10, 12, 17 and 18.

This service has been in Special Measures since 9 August 2019.

At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 March 2020. Breaches of legal requirements were found in relation to dignity and respect, safety, staffing and governance.

Before this inspection we received concerns in relation to documentation recording and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed following this focused inspection and remains inadequate.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Duncote Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider failed to have adequate systems in place to monitor the quality care being provided.

Duncote Hall is a residential care home that can provide long and short-term residential nursing care for up to 40 older people, including people living with dementia. At the time of inspection 23 people were using the service.

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

Quality systems were not effective in identifying the concerns raised on inspection.

Risks to people had not always been assessed and managed appropriately. Equipment had not always been used in line with the needs of the people using it.

Systems and processes were not effective in ensuring the safety of people or the environment.

The environment had areas that were unclean and some areas that were accessible, were unsafe for people.

Medicine management system needed to be improved. Medicines had not been stored, disposed of or recorded in line with best practice.

We found that staff had not been appropriately deployed to ensure people had their needs met in a timely manner. People told us there were not enough staff on shift and that they were made to wait for their needs to be met.

People’s dignity was not always maintained or respected. Personal information was not always stored securely.

Not all care plans held the correct information. Care plans did include people’s choices, and preferences as well as any cultural or religious needs.

People who were at risk of dehydration did not always have their fluid intake recorded. People told us the food was good and the kitchen staff were aware of people’s preferences and dietary requirements.

People told us staff were kind, we saw interactions between staff and people varied. Some staff interacted well with people, taking time to talk to them and explain things, whilst other staff had very limited interactions with people.

People were referred to healthcare professionals as required. Staff supported people to access doctors, dentists and opticians as required. People who had a preferred gender of staff to complete care tasks, had this need met.

Complaints had been dealt with appropriately and within the provider's timeframes. The manager had acted on and completed their responsibilities under the duty of candour.

Staff had been safety recruited and completed an induction. Staff understood their role in relation to safeguarding adults.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 8 October 2019) and there were breaches of regulations in relation to food and fluid, infection control, safe care and treatment, staffing levels, governance, person centred care, respect and dignity, staff recruitment and environmental concerns.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, however the provider continued to be in breach of four regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found breaches in relation to keeping people safe, medicines, infection control, staffing, dignity and respect and oversight of the service at this inspection.

We will update the end section of this report to provide information about CQC’s regulatory response to the breaches found. We will do this once any action has concluded.

The overall rating for this service is inadequate and the service remains in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means we will start processes that will prevent the provider from continuing to operate the service.

For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.

Duncote Hall is a residential care home that can provide long and short-term residential nursing care for up to 40 older people, including people living with dementia. At the time of inspection 34 people were using the service.

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

We found evidence of ineffective systems and processes in how the provider delivered and monitored the quality and safety within the service.

Risk to people’s safety and health were not always identified, assessed and managed. Staff did not always follow people’s risk assessments. Peoples personal emergency evacuation plans (PEEP’s) did not always contain the information required for staff to support them safely in the event of an emergency. People did not have appropriate risk assessments for the use of equipment and the equipment was not always used correctly.

The provider did not have suitable systems in place for staff to recognise and report abuse and injuries to people. The provider did not investigate incidents fully.

Safe staff recruitment processes were not followed to protect people from unsuitable staff. Staff recruitment files did not contain all relevant information to demonstrate that staff had the appropriate checks in place.

There were not always enough care staff to meet people's needs. People and staff told us that staff did not have the time to talk to them.

Medicine management system was not effective or safe. Medicines had not been given as prescribed, and adequate medicine stock was not kept.

The Mental Capacity Act principles were not followed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not receive person centred care. People’s care files were not kept up to date and relevant to the person. Information about people’s needs, health conditions, choices and preferences were not always documented. People’s care was not monitored or kept under review.

People’s records were not completed fully and there were gaps in people’s daily monitoring charts.

The environment was not always kept clean and there were no dementia friendly signage on people’s bedroom doors or on walls throughout the building.

People’s dignity was not always maintained or respected. Staff did not always refer to people in a respectful way.

Daily activities were organised which some people enjoyed. However further action was needed to ensure people were not at risk of isolation and lacked meaningful engagement.

People and relatives told us they knew how to make a complaint. There were procedures in place for making compliments and complaints about the service

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 26 February 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of unsafe medicines management. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to food and fluid, infection control, safe care and treatment, staffing levels, governance, person centred care, respect and dignity, staff recruitment and environmental concerns.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People expressed dissatisfaction with the numbers of agency staff employed. Although there were sufficient numbers of staff on duty to meet people’s needs there were not enough permanent staff to cover the assessed number of hours. This meant that a significant number of hours were covered by agency staff. On the day of our visit we saw sufficient numbers of staff on duty to respond to people’s needs swiftly. The area manager told us that on-going recruitment was taking pace and records we saw confirmed this. They also informed us that agency staff used were regular staff who knew people well to provide consistency.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were detailed risk management plans in place to protect and promote people’s safety. The provider followed thorough recruitment practices to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Staff promoted and respected people's cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

More information is in the Detailed Findings below

Rating at last inspection: Good (report published 13 September 2016)

About the service: Duncote Hall is a manor house with an extension built in 1987 in keeping with the original property. All bedrooms have an en-suite facility and there is a large conservatory which overlooks the grounds to the rear of the building. The service provides residential and nursing care for up to 38 older people, including people living with dementia.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was the second comprehensive inspection carried out at Duncote Hall Nursing Home.

Duncote Hall provides care and support for up to 40 older people with a wide range of needs, including dementia care. At the time of the inspection there were 35 people using the service.

The service has 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 and associated Regulations about how the service is run.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Risk assessments were centred on the needs of the individual and any potential risks to people had been identified. We saw that risk management plans had been completed to enable them to live as safely and independently as possible. There were adequate numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe

People had their medicines managed safely, and received their medicines in a way they chose and preferred.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs. People told us and records confirmed that all of the staff received regular training in mandatory subjects. In addition, we saw that specialist training specific to the needs of people using the service had been completed. This had provided staff with the knowledge and skills to meet people’s needs in an effective and individualised way.

Staff sought people's consent to care and treatment which was in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

People’s needs were assessed and care plans gave guidance on how they were to be supported. Records showed that people and their relatives were involved in the assessment process and review of their care. A wide and varied range of activities were on offer for people to participate in if they wished. The service had an effective complaints procedure in place and we saw appropriate systems for responding to any complaints the service received.

Staff enjoyed working at the service and felt well supported in their roles. They told us the registered manager was supportive of them. Quality monitoring systems and processes were to make positive changes and drive future improvement.

We saw that, for example, reference was made to the 'National Care Standards Act 2000' and not to the current 'Health and Social Care Act 2008'. We also saw that there was no contact details for 'The Local Government Ombudsman' or information about the Ombudsman's role if people remained dissatisfied with what action had been taken to resolve their complaint. We did not see any information about the local social services role with regard to receiving complaints from a person funded by them.

When we again visited 'Duncote Hall' unannounced on the afternoon of 4 October 2013 we found that the complaints procedure information had been appropriately and accurately updated and was on display inside the home.

We also saw that the information had been amended in the service user guide. This meant that in addition to being encouraged to complain if people were dissatisfied with their care they were also provided with the up-to-date information they needed.

We saw that people had been provided with the contact details and role of external organisations that may be of assistance in resolving a complaint.

Everyone we spoke with said that they enjoyed their meals and had plenty to eat and drink throughout the day.

We spoke with two visitors who said they were welcome to visit at any reasonable hour. They said they always found the staff to be helpful. One visitor said, "We are always asked if we want a cup of tea. All the staff seem so friendly."

We saw that the communal areas of the home, such as the lounges and access corridors, were clean and well maintained, attractively decorated, and free from odour. We saw that some areas of the home were being routinely redecorated.

The four bedrooms we saw were comfortable, clean, and each person had personalised their room with their belongings.