Archived: Devonia House Nursing Home

Updated 10 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 unannounced focused inspection took place on the 22 and 23 June 2016 and was completed by two Care Quality Commission (CQC) inspectors.

The team inspected the service against three of the five questions we ask about services: is the service safe; effective and well-led? This is because the service was not meeting some legal requirements.

Before the inspection we reviewed the information we held about the service, including notifications. Providers are required to submit notifications to the Care Quality Commission about events and incidents that occur including unexpected deaths, any injuries to people receiving care, and any safeguarding matters. This enabled us to ensure we were addressing any potential areas of concern.

There were 17 people living at the home at the time of the inspection. We saw or met with the majority of people using the service and we spoke in detail with five people. We spoke with two relatives, and three health and social care professionals; including a GP, nurse specialist and community nurse. We also spoke with the provider and eight members of staff, including the manager; care staff and ancillary staff. We observed how people were being cared for and how staff attended to their needs.

We looked at six people’s care records, people’s medicine records, three staff recruitment records, staff training records and a range of other quality monitoring information.

Updated 10 August 2016

Devonia House is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. The service can accommodate a maximum of 32 people. People using this service may have a diagnosis of, or conditions relating to, dementia.

In December 2015 the provider made the decision to stop providing nursing care at the service as they were unable to recruit and retain nursing staff. This came into effect from January 2016.

As a result of the unannounced comprehensive inspection in April 2015 the overall rating for this provider was ‘Inadequate’. This meant that it has been placed into ‘Special measures’ by the Care Quality Commission (CQC).

At the unannounced comprehensive inspection in January 2016 we found improvements had not been achieved and the overall rating for the service remained inadequate. At the inspection in January 2016 we identified nine continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two new breaches. We found people’s care plans did not contain person specific mental capacity assessments and applications for the Deprivation of Liberty Safeguards had not been carried out appropriately. Care plans were not updated on a regular basis and some sections were not completed or were inaccurate. There were not enough staff to provide support to people who used the service and recruitment practices were not safe. The provider had not taken steps to ensure staff received on-going or periodic training, supervision and an appraisal to make sure competence was maintained. The management of medicines did not protect people from the risk of unsafe care or treatment. Risks were not fully assessed for the health and safety of people who used the service. The provider had failed to monitor the quality of the service to identify issues. People were at risk of harm because the provider’s actions did not sufficiently address the on-going failings.

After the comprehensive inspection in January 2016, the provider wrote to us to say what they would do to meet the legal requirements in relation to the 11 breaches of regulation.

We undertook this unannounced focused inspection on 22 and 23 June 2016 to check that the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Devonia House Nursing Home on our website at www.cqc.org.uk

As a consequence of the inadequate rating for the service, Devon County Council suspended admissions to the service from 27 July 2015 until 13 May 2016. The suspension of placements was lifted by the local authority on 13 May 2016. However an advisory notice remains in place for social care placements, meaning that any social care funded placements to the service had to be agreed by a senior manager within Devon County Council. The service continues to receive considerable support from the local authority ‘quality assurance and improvement team’ and from health and social care professionals. Regular monitoring and support visits had been undertaken by health and social care professionals. We found that despite this support from the local authority the provider was unable to meet the essential requirements and make all of the necessary improvements.

At the time of this inspection the home did not have a registered manager. The service has not had a registered manager since December 2013. However, with the assistance of the local authority, a new manager had been recruited and appointed in January 2016. This manager left the service in March 2016. Another manager was appointed and started working at the service in March 2016 but has since resigned and left the service on 30 June 2016. The provider informed us on that a senior member of the night staff team has been appointed as acting manager temporarily, with responsibility for the day to day running of Devonia House. 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 manager at the time of the inspection demonstrated that they understood some of the shortfalls at the service and had begun to implement systems and processes to improve the service. However due to the limited time they had managed the service and the difficulties they had experienced the action taken had yet to have a sustained impact upon the overall quality of the service. At times people were exposed to avoidable risk.

People’s health, safety and welfare were put at risk because there were not always sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times. Staff did not receive the training they required to be able to fulfil their role effectively. The provider did not have appropriate arrangements in place to manage medicines safely. People were put at risk as a result of poor practice and a lack of staff training in relation to medicines.

People's nutritional needs were not always monitored. Records relating to people's daily dietary and fluid intake were poor. This meant we could not tell in any detail whether people had sufficient amounts to eat and drink.

People were at risk because accurate records were not consistently maintained. There were gaps in people’s food and fluid charts, weight, bowel and repositioning charts. We could not be assured that people’s care needs were being met.

Systems the provider had in place to monitor and improve the quality of the service had not been embedded and were ineffective.

Some people were happy with the care and support they received. Two health care professionals and two relatives provided positive feedback, especially in relation to staff attitude and caring approach. We witnessed some kind and caring interaction between staff and people who lived at the service.

Some care plans had been improved and contained detailed and personalised information about people’s care needs and preferences. However two people did not have care plans or risk assessments in place to ensure staff provided appropriate and safe care and support.

We found improvement in relation to the Mental Capacity Act 2005, which requires providers to ensure safeguards are in place when someone does not have the capacity to make an informed decision about their care and treatment. Some people’s capacity to consent to care and support had been assessed. Applications had been submitted to the local authority in respect of six people where it had been identified that were being deprived of their liberty. However, we found improvement was still needed to ensure everyone’s rights were protected.

During the inspection we identified seven continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk of harm because the provider’s actions did not sufficiently address the on-going failings. There has been on-going evidence of the provider’s failure to sustain full compliance since 2011. We have made these failings clear to the provider and they have had sufficient time to address them.

Due to the concerns found at this inspection, through our legal processes we have told the provider they cannot admit any new service users without the written consent of CQC.