Archived: Dane House Care Home

Updated 16 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 home, and to provide a rating for the home under the Care Act 2014.

The inspection took place on 12 July 2016 and was unannounced. The inspection team consisted of two inspectors, a specialist nurse advisor and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The home was last inspected in March 2015, where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to the maintenance of accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided. The home received an overall rating of 'Requires Improvement' after our inspection on 2 March 2015, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

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Prior to the inspection the provider had completed a Provider Information Return (PIR), this is a form that asks the provider to give some key information about the home, what the home does well and any improvements they plan to make. Other information that we looked at prior to the inspection included previous inspection reports, the local authorities’ commissioner’s report and notifications that had been submitted. A notification is information about important events which the provider is required to tell us about by law. We used this information to decide which areas to focus on during our inspection.

During our inspection we spoke with eight people, two relatives, nine members of staff, two visiting healthcare professionals, the registered manager and the regional manager. We reviewed a range of records about people’s care and how the service was managed. These included the individual care records for eight people, medicine administration records (MAR), five staff records, quality assurance audits, incident reports and records relating to the management of the home. We observed care and support in the communal lounge and in people’s own bedrooms. We also spent time observing the lunchtime experience people had and the administration of medicines.

Updated 16 August 2016

The inspection took place on 12 July 2016 and was unannounced.

Dane House provides accommodation for up to twenty-five older people, some of whom are living with dementia and who may need support with their personal care. On the day of our inspection there were nineteen people living at the home. The home is a large property, spread over two floors, with a communal lounge and a conservatory looking onto a large garden. It is situated in Brighton, East Sussex. Dane House belongs to the large corporate organisation called Four Seasons. Four Seasons provide nursing care all over England and have several nursing homes within the local area.

We carried out an unannounced comprehensive inspection on 13 and 14 March 2014. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 2nd March 2015 we carried out a focused inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection we found that significant improvements had been made, however, we continued to have concerns with the recording of mental capacity assessments, staff’s understanding of Deprivation of Liberty Safeguards (DoLS), the opportunity for meaningful activities for people and involving people in the running of the home. At the inspection on 12 July 2016 we found that significant improvements had been made, however, we continue to have concerns regarding the lack of staff training, knowledge and understanding in relation to the Mental Capacity Act 2005 (MCA) and DoLS. Further areas in need of improvement related to people’s dining experience and end of life care.

People’s consent was gained before staff offered support. One relative told us “They always inform me and ask my consent if needed”. There were good systems in place to assess people’s mental capacity and ensure that any decisions made on their behalf were made in their best interests and with people that were legally able to make decisions. However, there were concerns regarding staff’s training, knowledge and understanding in relation to MCA and DoLS and we have identified this as an area of practice in need of further improvement.

People told us that they were happy with the food and that they were able to choose what they had to eat and drink. Observations showed people being appropriately supported by patient and sensitive staff. However, people’s dining experience was poor. Most people ate their meals in their rooms, whereas others were in the communal lounge. People ate their meals on lap tables in the arm chairs that they had spent most of the day in, this didn’t aid their independence or enable them to orientate to time and place and know that it was time for lunch. The registered manager recognised that this needed to improve and told us that there were plans to redecorate the conservatory area to create a ‘fine dining’ experience for people. This is an area in need of improvement.

One person was receiving end of life care, they were treated with compassion and kindness by staff and their health and physical needs were met. However, there was a lack of holistic care and the person spent their time in bed with minimal stimulation or possessions near to them. People were not asked their preferences in regards to how they wanted to be supported at the end of their lives. The registered manager recognised that this was an area that needed further improvement, they had already made contact with the local hospice and planned to implement advanced care plans for people.

The management team consisted of a registered manager and a deputy manager. A registered manager is a ‘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 home was well-led and managed well. People, relatives and staff were complimentary about the leadership and management of the home and of the approachable nature of the registered manager. One person told us “I can talk to the manager, in the past there was a rapid turnover of staff but this has all changed”. Another person told us “The deputy manager is excellent, they are keen and enthusiastic and will talk to you anytime”. There were quality assurance processes in place to ensure that the systems and processes within the home were effective and ensured that people’s needs were being met and people were receiving the quality of service they had a right to expect.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

Sufficient numbers of staff ensured that people felt safe and their needs were met. One person told us “I can ring my bell for help so that’s how I feel safe”. There were suitably qualified, skilled and experienced staff to ensure that they understood people’s needs and conditions. Essential training, as well as additional training to meet people’s specific needs, had been undertaken and used to improve the care people received. People and relatives told us that they felt comfortable with the support provided by staff. One relative told us “I think some are excellent”. A visitor told us “They must be well trained because they can deal with any occurrence”.

People’s healthcare needs were met. People were able to have access to healthcare professionals and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services.

Positive relationships between people and staff had been developed. There was a friendly and homely atmosphere and people were encouraged to maintain relationships with family and friends who were also able to visit the home. People were complimentary about the caring nature of staff, one person told us “They always have time for a chat and will do anything you ask, I can’t fault them at all”.

People’s privacy and dignity was respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Residents’ meetings enabled people to make their thoughts and suggestions known. People’s right to make a complaint was also acknowledged. The registered manager welcomed feedback and used this as opportunity to develop the service provided. People received personalised and individualised care that was tailored to their needs and preferences. Person-centred care plans informed staff of people’s preferences, needs and abilities and ensured that each person was treated as an individual.