Archived: Devonshire Court

At our last inspection of the service on 10 and 11 August 2016 the provider was failing to meet four regulations. These related to governance, safe care and treatment, the submission of statutory notifications and safeguarding service users from abuse and improper treatment. This service was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Devonshire Court provides residential care for older Freemasons and their dependants. Prior to our inspection the service had also been providing nursing care for people. The provider had applied to remove nursing care from their registration. This was effective from 6 March 2017. The home is registered to accommodate up to 69 older people and there were 40 people using the service on the day of our inspection visit.

Within the home there are two units providing a specialist service for older people living with dementia. These are Sherwood and Rutland which currently have capacity to support 10 people each. These units have their own lounge, kitchen and dining area. Other accommodation is provided over two floors. There is a large communal dining room, lounge, conservatory, library and activity room. There are also smaller lounges/dining areas throughout the accommodation.

The service had 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 2008 and associated Regulations about how the service is run.

People told us that there were not enough staff to meet their needs. Staff confirmed that in some areas of the home this was the case. The registered manager told us they would review the deployment of staff to make sure people received the care when they needed it.

Staff were aware of how to report and escalate any safeguarding concerns that they had within the service and, if necessary, with external bodies. Safe recruitment practice was followed.

People received their medicines safely. Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were protected from avoidable risks. Risks associated with people’s care were assessed and managed to protect people from harm. The environment was maintained to keep people safe. Regular safety checks had been carried out on the environment and the equipment used for people’s care to ensure that they were safe. Staff understood how to follow these.

Staff had received training and supervision so that they could meet the needs of the people who used the service. Staff told us that they felt supported.

People were supported in line with the requirements of the Mental Capacity Act 2005. Where people were assessed as lacking the mental capacity to make informed decisions, these were made in their best interest on their behalf.

People enjoyed the meals provided and where they had dietary requirements, these were met.

People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. Dignity and respect for people was promoted.

People were supported to remain active and offered opportunities to engage in activities that were of interest and meaningful to them.

People received care that was centred on them as individuals. People’s care needs had been assessed and were reviewed to make sure they continued to be met. Staff had a clear understanding of their role and how to support people who used the service.

People were given opportunities to feedback about the service they received. Action had been taken based on people’s feedback. Complaints were addressed in line with the provider’s policy.

People and staff felt that the registered manager was approachable and action would be taken to address any concerns they may have.

Action had been taken to make the required improvements following our last inspection in relation to monitoring the quality of the service. Systems were in place to measure the quality and care delivered. However these had not yet had time to fully embed to demonstrate that improvements were sustainable. The provider supported the registered manager in their role and monitored the service to make sure that people received care in line with their policies and procedures.

The registered manager understood their responsibilities for reporting incidents or events that happened in the service to CQC and other agencies.

At our last inspection of the service on 2, 3 and 4 March 2016 the provider was failing to meet five regulations. These related to governance, safe care and treatment, statutory notifications, need for consent and safeguarding service users from abuse and improper treatment. We issued the provider with a warning notice in relation to governance and safe care and treatment at the service and told them that they needed to improve. We also issued them with a requirement notice relating to statutory notifications, need for consent and safeguarding service users.

At this inspection we found that the provider had failed to address all of the concerns and we identified further concerns about the governance of the service.

Devonshire Court provides nursing and residential care for older Freemasons and their dependants. The home is registered to accommodate up to 69 older people and there were 54 people using the service on the day of our inspection visits.

At the time of our inspection the service did not have a registered manager. The manager in post was in the process of applying to become the registered manager. They were successful in their application in September 2016. 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.

We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and with one of the Regulations of the Care Quality Commissions (Registration) Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Safeguarding concerns had not been identified and reported appropriately and consistently. People were not supported in a way that ensured that they did not pose a risk to themselves or others.

Where risks had been identified, the actions that should be taken to reduce the likelihood of the risks causing harm were not clear. Where risk assessments were in place there was not always reference to the Mental Capacity Act 2005 (MCA) to promote people’s rights and where people were unable to give their consent, best interest decisions were not always recorded as having taken place.

People could not be sure that they would receive their medicines as prescribed by their doctor. People’s medicines were not always administered correctly and the provider had not taken appropriate action to prevent further errors. Medicines records were not always accurate and systems to check medicines were not robust. Where people required medication to be administered as required, staff had not been given clear guidance about how to undertake this.

The provider had a recruitment policy in place which was followed. We found that all the required pre-employment checks were carried out before staff commenced work at the service. The provider had taken action to ensure people were supported by staff who were familiar to them. Staff had received training to meet the needs of the people who used the service

People’s independence was promoted and staff treated people with dignity and respect. We observed staff interacting in a caring manner with people. Staff knew people well and understood what was important to them. Most people were supported to follow their interests and engage in activities.

The provider had considered their responsibility to meet the requirements of the MCA and Deprivation of Liberty Safeguards (DoLS). Where people did not have the capacity to make decisions best interest decisions had been made on behalf of them in line with the requirements of the MCA. Records relating to best interest decisions were not in depth and it was not always clear who had been consulted.

People enjoyed the meals provided and where they had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. However these were not always effective. People’s health needs were not always met and when outside health professionals had been contacted for support, people’s care records did not make clear what guidance had been given.

Care plans, as identified by provider’s own audits, did not include sufficient detail about how to support people. People were not always involved in making decisions about their care, treatment and support.

Where people had requested maintenance work to be carried out in their bedrooms this had not been actioned and they had not received feedback about when action would be taken.

The provider did not have robust monitoring of significant events, such as behaviour that challenged, that happened within the home. The providers own audits had not always been effective in identifying faults and putting systems in place to rectify them. The provider had not taken action to address all of the concerns identified at our last inspection.

People using the service and relatives were not clear on who the manager was. People had been made aware that a new manager was in place and had been at the service since June 2016. Staff felt supported by the new manager. Changes in the management team since our last inspection meant that there had been no continuity of management to follow through and implement the action plan to address concerns we raised.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action

to propose to cancel the provider's registration of the service, will be inspected again within six

months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six

months, and if there is not enough improvement so there is still a rating of inadequate for any key

question or overall, we will take action to prevent the provider from operating this service. This will

lead to cancelling their registration or to varying the terms of their 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.

Devonshire Court provides nursing and residential care for older Freemasons and their dependants. The home is registered to accommodate up to 69 older people and there were 59 people using the service on the day of our inspection visit.

The service did not have 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 2008 and associated Regulations about how the service is run.

We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and one of the Regulations of the Care Quality Commissions (Registration) Regulations 2009. You can see at the end of this report the action we have asked them to take.

Safeguarding concerns, incidents and accidents had not been reported appropriately and consistently. Not all accidents or incidents were reported or investigated. Where people displayed behaviour that challenged others, staff had not been given clear guidelines about how to support those people and prevent risk of harm to them and others

People could not be sure that they would receive their medicines as prescribed by their doctor. We saw people’s medicines were not always administered correctly. Medicines were not always stored safely in people’s rooms. Medicines records were not always accurate and systems to check medicines were not robust.

We found that money was stored appropriately but that access to money by people and staff required greater security measures to avoid the risk of people’s money being misused.

There was a recruitment policy in place which had been followed. This ensured that all relevant checks were carried out on staff members prior to them starting work. Some people that we spoke with felt that there were enough staff to meet people’s needs but felt that staff were very busy. The service was relying on a high number of agency staff to fill vacant care worker positions. People told us that not all staff knew how to meet their needs.

Where people were at risk of falls, appropriate assessments of their needs were not always undertaken.

Most risks associated with the environment, care routines and equipment used to support people had been assessed and hazards were identified. Measures were in place to prevent harm. Fire equipment testing had been carried out but not all staff were aware of the action they should take in a fire or how to support people to evacuate safely.

The provider had not ensured that the requirements of the Mental Capacity Act 2005 were being met. Where people were assessed as lacking mental capacity to make decisions for themselves best interest decisions had not been made for them.

People were not always supported to maintain good health. Where risks to people’s health had been identified appropriate measures had not always been put in place to manage the risks. People had access to health care professionals but the records regarding their health care needs were not always clearly maintained

Staff received supervisions and we saw that there was a programme of ongoing training to ensure that they had the knowledge and skills they needed to meet people’s needs. The support that people required to have their needs meet was not always clearly documented. Staff were not always clear on how to record people’s needs or support that they had received. Where people’s needs had changed this was not always clear in their care plans.

We received mixed feedback about whether staff were kind and caring. Most people told us that they were treated with dignity and respect but some people said that they were not. We observed staff interacting in a caring manner with people who were distressed or upset.

People were supported to maintain relationships with people who were important to them. People were supported to follow their interests and engage in activities.

People were not always involved in making decisions about their care, treatment and support.

People told us that they were asked for feedback about how the service was run. Complaints were not always recorded and dealt with in line with the provider’s policies.

There was not robust monitoring of significant events, such as injuries, that happened within the home. The providers own audits had not always been effective in identifying faults and putting systems in place to rectify them

People using the service and relatives were not clear on who the manager was. Staff felt supported by the new management structure.

People who used the service were satisfied that their views were taken into account by the managers and staff at the home. One person told us, 'Staff here are very polite and respectful. I am very satisfied.' A broad range of social and recreational activities were arranged and people told us they appreciated the opportunity to participate in these.

The people we spoke with also confirmed that they were satisfied with the care and support they received. One told us, 'Staff always chat with me, they have got to know me well and look after me well. I am very happy ' I think it is wonderful here.'

The home was clean, tidy and well maintained. The building was decorated and furnished to a good standard and the overall impression was homely and comfortable.

Requests for help or assistance were usually responded to promptly. One person commented, 'The staff come quickly when I need them, I have no complaints at all.'

There were opportunities for people to share their views and comments about the service and if any complaint was made this was investigated and responded to.

People in some instances told us they took part in the activities organised by the service whilst others told us they preferred to spend time in their room, reading, listening to music or watching television. People's comments included: 'I like looking after my plants and my daughter brings in library books for me to read. I also have a newspaper delivered daily.' 'I like to take part in the art and craft sessions, we make all sorts of cards and sell them to raise money. We also make things and display them in the home.' 'I like to go to the poetry readings.' 'I like going to music and movement and the Church service.'

People told us they could eat their meals in the dining room or remain in their room to eat and said they enjoyed the meals. We noted a menu for the day was placed on each dining table and people selected from the menu on a daily basis.

The provider had effective record keeping systems which were fit for purpose.