The Dower House Nursing Home

The Dower House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided.

We found the following examples of good practice.

• People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection.

• Information was easily accessible on arrival, or before visits, to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control. The provider sent out regular newsletters to residents and relatives with clear visiting guidelines and procedures prior to any relatives visiting.

• Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using video calls, weekly newsletters to family members, visiting in the communal garden or through meeting at a window with tables set up either side of the window to ensure social distancing is supported. Each person had access to a telephone in their room and staff were available to support if required. If people had other communication devices staff were available to support. There was the availability of a laptop within the home for people to access if needed. E-mails from relatives were encouraged and printed out for people.

• The provider had implemented socially distanced meetings for people to keep them updated and involved. Group video calling technology was also utilised to include relatives in meetings.

• All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home, alongside having their temperatures taken. Visitors had no contact with other residents and had minimal contact with care home staff.

• Facilities were in place to wash hands for 20 seconds, or to use hand sanitiser, on entering and leaving the home.

• There was prominent signage and instructions to explain what people should do to ensure safety. Plastic or glass barriers were used to help prevent infection but did not restrict people’s access and mobility.

• Admissions from hospital or interim care facilities, and new residents admitted from the community, were isolated for 14 days within their own room.

• People were assessed twice daily for the development of a high temperature (37.8°C or above), a cough, as well as for other signs such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting.

• All staff in high risk groups such as Black, Asian and minority ethnic (BAME) had been risk assessed, and adjustments had been made.

• All members of staff worked in only one care setting, this included part-time and agency staff.

• Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading to other people and staff members.

• Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

• Staff had received training from an Infection Prevention and Control (IPC) specialist.

• A testing scheme for all staff and residents had been implemented, known as ‘whole home testing’. The provider had tests for regular 'whole home testing' as well as tests for any suspected or symptomatic residents or staff.

• Staff wore a fluid repellent surgical mask, gloves and apron when delivering personal care to all people. Use of personal protective equipment (PPE) was in accordance with current government guidelines COVID-19 PPE. We observed staff to be wearing PPE as per guidelines. Disposal of used PPE prevented cross-contamination as it followed local protocols, in particular single use items and how PPE is disposed of safely.

• Communal areas such as outdoor spaces and garden areas were used creatively to help with IPC. The provider had identified a specific outside paved area at the front of the premises to support people to have visits safely with their relatives whilst enabling their rear gardens to be utilised as a safe outside space for people to access independently and safely.

• The provider had encouraged people to provide feedback about their well-being and how they have felt during the pandemic, including anything they had found difficult or any suggestions they had for improving practices.

• Cleaning staff had cleaning schedules, which they were required to complete which included evidence that high touch areas were regularly cleaned. For example, light switches, keyboards, door handles and telephones.

•The provider ensured that current guidance was shared in a timely way with the service. When the guidance was updated the risk, parameters were reviewed, and changes made. This reduced any potential risk of infection.

• Contingency plans were in place to manage ongoing or future outbreaks or other events effectively. The provider collected data and regular reports from the service. This information was analysed and used to inform future incident management and support learning.

• The provider had upskilled and cross-trained staff in various roles to ensure adequate cover was provided in different roles should they have experienced any shortages of staff.

Further information is in the detailed findings below.

The Dower House Nursing Home is a nursing care home providing personal and nursing care to 39 people at the time of the inspection.

The Dower House Nursing Home accommodates up to 43 people, some of whom may have a physical disability or be receiving end of life care. There is access to landscaped gardens and grounds.

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

People were safe and supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw evidence of people’s and their relative’s involvement in care assessments.

Risks to people were recorded in their care plans and staff demonstrated they had a good knowledge of people. People received their medicines safely. The Dower House Nursing Home offered bespoke care and support for people at end stage of life (EOL) and to their families.

People and their relatives were very positive about the food. People were encouraged to maintain a healthy, balanced diet, based on their individual needs and had access to food and drink whenever they wanted.

The home had a consistent staff team who understood the needs of people well. We saw staff upheld and promoted people’s rights relating to equality and diversity. People and their relatives were positive about the quality of care and support people received.

People and their relatives told us that they thought the home was well led and spoke positively about the registered manager and nominated individual. The registered manager and nominated individual carried out numerous audits to ensure the service was effective.

The registered manager was proactive in ensuring they had a visible presence within the home and operated an open-door policy ensuring that any low-level concerns were dealt with promptly preventing escalation. The service was well-led by a management team whose passion and drive to deliver a good service, leading by example, was evident.

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 22 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The Dower House Nursing Home is registered to provide care with nursing for up to 43 older people. There were 41 people in residence on the day of the visit. The building offers accommodation over two floors in single rooms. Rooms are spacious and have en-suite facilities of the person’s choosing. The upstairs is accessed via a lift or staircases. The shared areas of the service are very spacious and comfortable. The garden is large, attractive and extremely well kept.

The service has a registered manager running the service. 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 management team kept people, visitors to the service and staff as safe as possible. They did this by ensuring staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were fully aware of their responsibilities with regard to protecting people in their care and were able to describe how they kept people safe from all forms of abuse. Risks were identified and managed to make sure that any risks to people and others were minimised.

There were unusually high numbers of staff available to ensure peoples’ needs were responded to quickly and they were given safe care. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. Some additional work was necessary to ensure references were robustly verified. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The MCA legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and no one was deprived of their liberty.

People’s health and well- being needs were met by staff who were properly trained and supported to do so. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built strong relationships with people and their families and provided kind and compassionate care. People were supported to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences. However this needed to be more clearly noted in care plans.

People benefitted from a very well-managed service. The registered manager, general manager and provider were described as very approachable. People and staff were comfortable and confident to make their views known and felt they were valued and listened to. The registered manager was very knowledgeable about people’s individual needs. The service made sure they maintained and improved the quality of care provided.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People told us that they were very happy living at the Dower House Nursing Home. Examples of the comments made by people were: 'No faults found' and from a short stay resident; 'I consider I was extraordinarily well looked after throughout, with good food too'.

When we spoke with people they all were able to confirm that they were aware of the comments and complaints procedures, but had never needed to use these procedures. One person said: 'The service is so good here; I would be extremely surprised if there were any formal complaints'. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Regular audits were carried out of the environment, buildings and clinical procedures, this meant that decisions about care and treatment were made by the appropriate staff at the appropriate level.

People told us that they felt safe at the home because of the care they received from the staff. They told us that they had frequent contact with the registered Manager and that they had confidence to raise any issues should any arise. On the day of our inspection we found people received the care and attention they needed in a timely and respectful manner.

People who use the service were given appropriate information and support regarding their care and treatment.

We observed care being provided to people and saw that this was professional and person orientated. We saw staff speak to people in ways that were respectful, calm and confident. We also observed that they did not rush their care and continually paid attention to the person receiving it.

Without exception, people using the service told us that they felt extremely safe and secure living at the home. They told us that they had confidence in the staff and management to ensure that their safety was protected at all times.