Archived: Davenport Manor

Davenport Manor is a residential care home providing personal care to 30 people at the time of the inspection. The service is registered to support up to 34 people in one adapted building

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

Risks to individuals, including falls and mobility, were assessed and well managed. People’s choices about how their care was provided were identified and respected. Staff had a good understanding of the management of risks. Health and safety checks in the service had been carried out. People had access to a range of health care professionals, records were kept of any medical interventions or visits. People told us they felt safe. Staff were aware of their responsibilities to raise concerns and whistleblowing procedures. People received their medicines as prescribed. There were safe systems for staff recruitment and there were sufficient staff to meet people’s needs.

Risks to people who used the service, staff and visitors relating to infection prevention and control, and specifically Covid-19, had been assessed and appropriate action taken. The registered manager was promoting good infection control and hygiene practices. Staff had received additional training, including handwashing and use of personal protective equipment (PPE).

People and their relatives were positive about the registered manager, the service, the way it was run and the support they received. Everyone talked about the homely feel. A relative told us, “I absolutely love it. They are so nice. It feels like a family.” We found the registered manager was passionately committed to providing good quality person centred care. Staff we spoke with shared that commitment. There was a range of quality auditing and monitoring. The registered manager and provider had a system in place which enabled them to review any accidents, incidents, safeguarding’s or complaints.

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 19 April 2018).

Why we inspected

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.

The inspection was prompted in part due to concerns received about the assessment and management of risk, specifically falls and mobility and the management of accidents and incidents. 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.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of is the service safe, is the service effective and is the service well led to at least good. At this inspection we found improvements had been made to these areas.

Davenport Manor is a residential care home registered to provide care and support to up to 34 people. The home is situated in the Davenport area of Stockport close to local shops and churches. There is a regular bus service and Davenport railway station is approximately a quarter of a mile away. At the time of our inspection there were 31 people living at the home.

There was a registered manager in post. 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 told us they felt safe and protected from abuse. Staff working in the home had received safeguarding adults training and demonstrated a good understanding of what to do if they suspected a person was being abused or was at risk of abuse.

Medicines were managed safely in line with national guidelines. People were given ‘as required’ (PRN) medicines only when needed. We saw an example where a resident had been displaying difficult behaviour and the resident’s GP commented how the staff at the home managed the person’s behaviour well without relying on excessive medication.

People were encouraged to be independent. During the inspection we observed care staff helping people to do things for themselves where possible. One resident we spoke with told us; “I can do what I want here.” Care records we looked at were written in a way to enable care workers to encourage people to maintain their independence.

People were very happy with the food served in the home. One resident we spoke with told us; “I had pork yesterday and it was beautiful, lasagne today and I ate it all and I’m a fussy eater.” People were involved in creating the menus and were able to request meals that weren’t on the menu if they chose to. Snacks and drinks were available at all times.

People were able to access other healthcare services. A GP visited the home fortnightly and district nurses visited on a daily basis. The GP and district nurse team told us they thought the home provided a good level of care. An optician and a dentist visited the home annually but appointments could be made sooner than this if needed. When people needed to attend hospital appointments and no family members or friends were available to accompany them, the manager told us a member of staff would go with them to the appointment.

People and their relatives were encouraged to personalise and decorate their rooms. We saw rooms where stencils had been put on the wall and resident’s own furniture had been brought in to make the room feel like their lounge as well as their bedroom.

People told us they felt well cared for. A person we spoke with told us; “I have nothing bad to say about it, every one of the staff are superb, I can have a joke and a laugh with them. I was nervous about coming here but quite honestly they were so warm and welcoming.”

Regular meetings were held for people and their relatives to discuss any issues they had and make suggestions for things they would like to do or improvements that could be made to the home.

Members of staff we spoke with told us they felt supported and well trained. They told us they felt part of a team and worked well together to look after people. Regular meetings were held for care staff to discuss quality issues and also to suggest improvements that could be made to the service.

People we spoke with told us they enjoyed the activities in the home but some people we spoke with told us that although there was an activity plan they felt there could be more things for people to do in and around the home. During our inspection we observed the care workers singing with people and playing with a soft ball. We recommended the service review its arrangements for activities.

People’s care plans were detailed and reflected their choices and preferences. We identified some shortcomings in the documentation of discussions the registered manager had held with a person and their relative regarding their care. We recommended the service review their procedure for recording decisions taken during such meetings.

We last inspected Davenport Manor on 13 and 14 April 2015. At that time, we rated the service requires improvement overall and identified breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one regulation of the Health and Social Care Act 2008 (Registration) Regulations 2014. We asked the provider to make improvements in relation to the supervision of staff, provision of person-centred care based on an assessment of needs and preferences, management of medicines, the safety of the environment and governance and monitoring of the service. The provider sent us an action plan to tell us how they would ensure they would meet the requirements of the regulations.

At this inspection we found the provider had implemented their action plan and had made improvements in a number of areas. However, we identified three breaches of the regulations. These were in relation to the safety of the environment, working within the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, good governance and keeping accurate records of care. You can see what action we told the provider to take at the back of this report.

We made five recommendations. These were in relation to reviewing guidance and procedures in relation to the administration of medicines, the use of surveillance in care homes, recruitment procedures, assessing staffing levels and the provision of activities.

Davenport Manor is a residential care home registered to provide care and support to up to 34 people. The home is situated in the Davenport area of Stockport close to local shops and churches. There is a regular bus service and Davenport railway station is approximately a quarter of a mile away. At the time of our inspection there were 31 people living at the home.

There was a registered manager in post. 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.

The provider had not taken adequate steps to ensure the environment was safe for people living at the home. We found window restrictors in place to prevent potential falls from height were not sufficiently robust. The provider had not ensured timely action had been taken to address concerns raised following an electrical safety inspection. We received evidence shortly after our inspection that these shortfalls had been addressed.

Staff told us they had sufficient time to complete all their duties. Staff told us there were sufficient numbers of staff to meet peoples’ needs, and people living at the home confirmed they did not have to wait long if they required any support. Staff told us night shifts could sometimes be hard work but that the on-call manager would provide support if required.

Medicines were managed safely, and staff we spoke with demonstrated a good knowledge of requirements in relation to peoples’ medicines. There were no clear instructions for staff to follow in relation to the administration of ‘when required’ medicines. However, our discussions with staff showed they were aware when to give these medicines and what they were for.

There were no vacancies for care staff at the time of our inspection, which meant care was provided by a consistent staff team. People told us they liked and got on with the staff. Care staff knew people well and were able to talk with us in depth about peoples’ needs and preferences.

Care plans were reflective of peoples’ current needs and had been reviewed regularly. Staff were aware of the guidance contained in care plans.

We received positive feedback from GPs who regularly visited the service, who told us staff followed their guidance and sought advice when required. We saw a variety of health professionals had been involved in peoples’ care, and that referrals were made if health concerns were identified.

People were positive about the food and drink provided. However, peoples’ intake was poorly monitored and there were significant gaps in these records. The issue in relation to the monitoring of nutrition and hydration had been recently raised by the provider and had been raised in a previous CQC inspection. Whilst measures had been identified to improve recording; these had not been wholly effective at the time of our inspection. We found daily records of care were sometimes lacking in detail.

Although actions had been taken to ensure feedback from people using the service and other stakeholders was received and analysed, we found continued shortfalls in the systems in place to monitor and improve the quality and safety of the service. For instance, there were no formally recorded medicines audits, and audits of the environment had not identified the issue with the window restrictors.

The registered manager was visible and accessible to staff, relatives and people living at the home. We saw frequent interaction between relatives and the registered manager, and relatives told us they were confident to approach the registered manager or a staff member with any concerns they might have. Staff told us they felt the service had improved since the return of the registered manager following a period of absence. They were consistently positive about the registered manager’s support and leadership of the service.

The provider was not consistently working within the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider could not demonstrate that adequate steps had been taken to assess whether people should be given medicines without their knowledge (covertly). The approach taken towards the application for DoLS also meant there was a risk some people would be deprived of their liberty without proper authorisation being in place.

We saw some ad-hoc activities taking place during the inspection. We received a mixed response from people when we asked whether they had enough to keep them occupied. Staff told us they would like more time to be able to support people with activities or the support of a dedicated member of staff for activities.

We checked the cleanliness of a number of rooms and bathrooms at the home and found them to be all clean, tidy and well presented.

The cleaner we spoke to told us that they had recently completed a 12 week course on cleanliness and infection control, which they said they had found very useful.

We looked at 17 sets of daily records. We saw that they were completed to a higher standard than when we last checked them. We could not find any significant gaps in them.

People we spoke to told us that they had some input into the care and welfare of their relatives. One person told us; "My father is well looked after as far as I can tell on my visits. He appears to get on well with staff. Staff ring us if there is a problem with his health.'

We spoke to a healthcare professional who was visiting the home. They were complimentary about the staff and the care they provided. They told us; 'I have no concerns about the home, apart from the lack of activities.'

All the residents we spoke to were complimentary about the food. We were told; 'I don't really want to talk today, but this is very good for me. Carers are good and so is the food. In fact couldn't be better.'

The staff we spoke to told us that there was effective team work in place. They told us that the registered manager was approachable and helped keep morale high.

We saw that records kept within the home were poor in many areas. The care plans that we looked at showed many instances where dates had not been recorded on a variety of assessments that had been completed.