• Care Home
  • Care home

Archived: Devonshire House and Lodge

Overall: Requires improvement read more about inspection ratings

Woolwell Road, Woolwell, Plymouth, Devon, PL6 7JW (01752) 695555

Provided and run by:
Harbour Healthcare Ltd

Important: The provider of this service changed. See new profile

All Inspections

27 April 2016

During a routine inspection

The inspection took place on 27 and 28 April 2016 and was unannounced.

Bickleigh Down Care Home (known as Bickleigh Down) is a purpose built nursing and residential home caring for a maximum of 77 people. At the time of the inspection 53 people were living at the service. Bickleigh Down is part of the corporate group Four Seasons (DFK) Ltd. The service is divided into five units, three nursing units and two residential units. Bickleigh Down provides care for older people who may have dementia and physical health needs.

Bickleigh Down Care Home was owned by Four Seasons (DFK) Ltd at the time of the inspection. The service had been sold to Harbour Healthcare Ltd. The new owners were in the process of registering as the new providers during the inspection process. This was due for completion at the end of May 2016.

A registered manager was employed to manage the service locally. 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 last inspected Bickleigh Down Care Home on 4, 5 and 6 March 2015. We asked the provider to take action to ensure the safe management of medicines and accurate records were kept. The provider sent us an action plan detailing the improvements they would make by the end July 2016. At this inspection we found improvements were still required.

Aspects of people’s medicine management were not always safe. We found documentation and care plans did not always reflect what action was taken if people did not wish to take their medicines. We had concerns the procedures in line with the Mental Capacity Act (2005) were not always followed when people required their medicine covertly. Agency nurses did not always know the systems in place for medicine audits, ordering and emergency medicine which some people might require. This had meant some people had been without their medicine for a short period and there might have been a delay in receiving emergency medicine.

There were sufficient staff on duty to meet people’s needs safely however, there was a high level of agency staff which particularly affected the dementia nursing units. This affected the leadership and continuity of care in these units. Agency staff were unfamiliar with the systems and processes on these units and did not know people well.

Essential work was reported promptly to the provider, but not completed in a timely way. This impacted on people’s safety. For example there were problems with the call bell system and with one of the fire doors.

People’s environment was clean and staff followed safe infection control procedures. However, there was a strong smell of urine in the two dementia nursing units. This affected the carpets in the communal areas and some bedrooms. This had been reported to the provider and action had not been taken.

People had risk assessments in place to mitigate risks associated with living at the service however we found particularly on the nursing dementia units some of these had not been reviewed to reflect people’s current care needs.

People’s mental capacity had not always been assessed in line with the Mental Capacity Act (2005) as required. Applications to deprive people of their liberty had been submitted where required. However, some staff did not have a good understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Further training was being arranged for staff following the inspection.

People were asked for their consent prior to being assisted; however some staff were unsure how to manage people who might decline personal care. This had led to the distress of one person. Staff told us they were keen to learn alternative ways to manage this and be creative in how personal care could be provided to meet people’s individual needs.

People’s nutritional and hydration needs were met, but the systems in place did not ensure people always had their preferences met. For example the current system used to deliver food to people from the kitchen to the dementia nursing units meant some people’s choices were not always met as the food was plated up in the kitchen. Staff also told us evening tea was often before 5pm which meant there was a long gap between tea and breakfast. Although night snacks were available for those who were able to ask for these, many people on the dementia nursing units were unable to communicate if they might be hungry.

Staff were recruited safely. People were looked after by staff trained in many areas. Additional training needs identified during the inspection were promptly booked. People were protected by staff who could identify abuse and who would act to protect people. People told us they felt safe living at the service.

People told us staff were kind, caring and compassionate. Permanent staff and regular agency staff knew the people they care for. People knew how to raise a complaint if they had one and there were systems in place to investigate complaints.

There were activity coordinators and a range of social events to support people to remain active and stimulated. Arts and crafts, dressing up days and musical events were held at the service. People's faith needs were met.

People had their health needs met and saw their doctors, opticians and attended hospital appointments when required.

People were supported to maintain their independence for as long as possible. People told us personal care was provided in a way that maintained their dignity; staff knocked on doors before entering people’s rooms, closed curtains and spoke to them and addressed them in the way they preferred.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

4,5 & 6 March 2015

During a routine inspection

The Inspection took place on 4, 5 & 6 March 2015 and was unannounced.

Bickleigh Down Care Home (referred to as Bickleigh Down) is a purpose built nursing home providing residential and nursing care for up to 77 people. Bickleigh Down is part of the corporate group Four Seasons. The home is divided into five units, three nursing units and two residential units. On the days of the inspection 72 people were living at the home. Bickleigh Down provides care for older people who may also have mental health needs which includes people living with dementia.

The service had 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.

During the previous inspection on 16 and 17 July 2014 we asked the provider to take action to improve aspects of people’s care and how they managed infection control. The provider sent us an action plan informing us of the improvements that would be made in these areas. They told us all improvements would be met by 31 October 2014. We found this had been completed.

During this inspection we found concerns with the management of medicines. We found there problems with the storage and recording of medicines. We also had concerns about the records kept in people’s rooms which monitored aspects of their daily care needs such as how much they had eaten and drank during the day.

The environment was clean and clutter free. Staff carried out regular infection control audits to monitor this area. However we found the service was not familiar with the Department of Health guidance related to the use of hoist slings and invasive equipment such as catheters. A recommendation has been issued.

People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People’s life histories, disabilities and abilities were taken into account, communicated and recorded. This helped staff provide consistent personalised care, treatment and support. A specialised dementia care programme, PEARL (Positively Enriching and Enhancing Residents’ Lives), was used to promote and improve an individualised approach to people’s care and experience. Care plans were comprehensive and detailed but the current format made it difficult to find information quickly. The provider was in the process of implementing a new care planning tool to improve care planning.

People’s risks were managed well and monitored. There was a culture of learning from mistakes. Accidents and safeguarding concerns were managed promptly. Investigations were thorough and action was taken to address areas where improvements were needed. There were effective quality assurance systems in place. Accidents were appropriately recorded and analysed but we found the monitoring of falls at the service could be improved.

People were encouraged to live full and active lives. Two activity staff provided a wide range of activities for people to participate in including coffee mornings, baking and singing. People were able to visit the local area with staff support or with their families. Activities were meaningful and reflected people’s interests and individual hobbies where possible. Creations from Valentine’s Day were visible in the home and there were plans for a dog show in April.

People, friends, relatives and staff were encouraged to be involved and help drive continuous improvements. Residents’ meetings enabled people to contribute to developments within the service and newsletters kept people informed. This ensured positive progress was made in the delivery of care and support provided by the home.

People knew how to raise concerns and make written complaints. People told us concerns raised had been dealt with promptly and satisfactorily. Any complaints made were thoroughly investigated and recorded in line with Four Season’s own policy. People felt able to approach the registered manager and staff and informally discuss any worries.

During the inspection people and staff were relaxed and there was a calm and pleasant atmosphere. People who were able to communicate with us said they felt safe. People had lockable facilities to keep their belongings safe. We observed people’s care was safely delivered and their human and legal rights respected. Staff saw their roles as “Protecting vulnerable adults, making sure they are safe.”

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made or in progress. Advice was sought to help safeguard people and respect their human rights. Staff had undertaken training in safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by suitable staff. Safe recruitment practices were in place and records showed appropriate checks were undertaken before staff began work. Staff received a comprehensive induction programme. Sufficient staff were on duty to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. The provider was taking creative steps to recruit registered nurses which would reduce the use of agency staff and improve the continuity of care for people at Bickleigh Down.

Staff described the management to be very open, supportive and approachable. Staff talked positively about their jobs. There was good communication with staff through one to one’s with their unit managers, staff meetings and newsletters. These helped look at staff development and keep them updated with changes.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

16, 17 July 2014

During a routine inspection

Two adult social care inspectors and a pharmacist inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We also looked into information of concern we had received prior to the inspection. This information alleged there were not sufficient staff on duty to meet people's needs. On 16 July and 17 July 2014 we found no evidence to support these allegations.

As part of this inspection we spoke with five people who lived in the home, one relative, the Acting Regional Manager, the Deputy Manager, seven staff and one visiting healthcare professional. We reviewed records relating to the management of the service which included eight care plans, daily care records, medication records, and quality assurance records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The environment was not clean and hygienic. The service did not have systems in place to ensure that people who lived in the home, staff and visitors were protected from the risk of infection. Medicines were administered safely. We watched some medicines being given to people at lunchtime, and we saw that they were given in a safe way. There were enough staff on duty to meet people's needs. During our inspection we observed staff spending time talking with people. This meant the service had ensured staff were able to spend time caring for and engaging with people. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deputy Manager told us the service had recently submitted nine applications. One had been declined, one had been granted and the others were waiting for a decision. Proper policies and procedures were in place. The Deputy Manager knew when an application should be made, and how to submit one.

Is the service effective?

Five people who used the service told us they were happy with the care they received. Comments included 'They look after me very well' and 'I'm very happy with the care provided'. People's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan. We looked at eight care plans. We found that five care plans were detailed and had been reviewed regularly. However, the other three care plans did not contain all of the information needed. This meant that people were not protected against the risks of inappropriate care or treatment.

Is the service caring?

People we spoke with were positive about the home and the staff. Comments included 'They're all brilliant here' and 'The staff are very good.' We spoke with a visiting healthcare professional who told us 'staff seem very caring'. We observed that staff were patient when assisting people with their mobility, food, and medication. On one occasion we observed a staff member chatting with a person about dolls. The person clearly enjoyed the conversation and both of them were laughing. This showed that staff were professional and respectful to people living in the home.

Is the service responsive?

People's needs had been assessed before they started to receive care. The service carried out an assessment to ensure it was able to meet people's needs. During the inspection we saw that one staff member was taking a person to hospital as they had concerns about the person's condition. However, we also found evidence that the service had not promptly sought professional advice for another person.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff we spoke with told us they felt well supported and had regular meetings with the Registered Manager. They told us they were able to approach the Registered Manager at any time. The provider had an audit programme in place to ensure that a number of areas were looked at during a 12 month period. We identified shortfalls relating to infection control. No action had been taken to rectify these. The service's quality assurance systems had not identified the shortfalls relating to care plans and treatment.

10 October 2013

During an inspection looking at part of the service

We carried out an unannounced inspection to follow up on concerns we had recently received about aspects of people's care and to follow up on compliance actions from our previous inspection in July 2013.

We found people had their needs assessed and their risks identified. The people we met appeared content. We found staff understood people's needs well and were looking at ways to improve the experiences of people with dementia related conditions.

Staff told us they felt supported in their roles and had good training. We found that progress had been made since our last inspection and staff were receiving one to one supervision from their manager and a process had been started to ensure staff received an annual appraisal. These methods of review supported staff to develop their practice and maintain good standards of care at the home.

24, 25 July 2013

During a routine inspection

As part of our inspection we spoke with ten people who lived at Bickleigh Down Care home, nine relatives, ten staff members and looked at eight care records and seven staff files.

People told us "The girls are brilliant" and "...they're doing a good job." The staff we met told us how much they enjoyed their jobs and we observed staff that were respectful in their interactions with people and knowledgable about the people they cared for. We found people had an assessment of their needs prior to coming to live at Bickleigh Down Care home and their needs were incorporated in to a care plan.

We found there were systems in place to monitor infection control and the home was clean and tidy. The provider was recruiting for additional cleaning staff. We met a committed housekeeper who was keen to establish a robust schedule to maintain a clean, hygienic home.

We spoke with staff who felt supported in their roles, able to talk to the unit managers if they had questions and had undertaken training to support their development needs and enable them to provide high quality care with confidence. We found a system for supervisions and appraisals needed to be developed.

People told us, "If I had a complaint I'd talk to the boss!" We found there was a policy and process in place for people and staff to make a complaint and this was evident at the entrance to the home. Complaints were dealt with promptly and feedback given to the complainant and to staff.

18 December 2012

During an inspection looking at part of the service

We carried out an unannounced inspection on 18 December 2012 to follow-up on the compliance actions set at our previous inspections. We saw that during our visit improvements had been made. We spoke with 10 people living at Bickleigh Down, a relative and 10 members of staff, which included the unregistered manager, deputy manager and the chef. We looked at six people's care records in detail and a random selection of medication charts on the various units.

People we spoke with who lived at the home said that their care and welfare needs were being met.

Care files demonstrated that relevant assessments had been completed from pre-admission through to ongoing reviews of care and showed the involvement of other health and social care professionals and the contacting of relatives when a person had a fall.

Everyone said that they felt safe and that their possessions were in a safe place. People knew who to speak with if they had a concern and cited the manager or a close relative.

We looked at a random selection of medication charts on the various units. We found that the main medication charts were signed and the corresponding cream charts had been completed in people's bedrooms.

Staff we spoke with informed us that staff morale had improved over recent months and that the management structure was more robust, which meant that people's needs were being met in a timely and organised manner.

13 September 2012

During an inspection in response to concerns

We carried out an unannounced inspection on 13 September 2012 to follow up on concerns raised about continence care management, falls reporting and low staffing levels within the home. On the day of our visit we were told that there were 66 people living at Bickleigh Down. We spoke with two people living at the home, three relatives, five staff members, and specifically looked at one person's care file.

We spent time with the unregistered manager, who had been in post for four weeks. They explained that since their appointment, they had observed issues within the home relating to the running of the home and low staffing levels. They were in the process of dealing with these issues by means of meetings with unit managers and registered nurses and through additional recruitment of staff.

Comments from people living at the home and relatives included: 'there's not enough staff, all it takes is for two staff being needed to assist someone and then everyone else is left unattended' and 'the staff are really caring and work hard, there's just not enough staff.' A person who had recently moved to Bickleigh Down told us, 'one night the staff were pushed, someone was always calling for the nurse.'

26 July 2012

During a routine inspection

We carried out this inspection as part of a programme of scheduled inspections, intending to follow up the compliance actions set at our last inspection (April 2012). We made an unannounced visit to the home on 26 July 2012 as part of the inspection.

We spoke with four people living at the service, obtaining their views of the service. We met others who were not able to give us their views because of their frailty or needs due to dementia. We observed some of the support these people received from staff, to get a better understanding of their experiences. This included using a tool called a Short Observational Framework for Inspection (SOFI), which helped us make judgments about the care people experienced at the home. We also spoke with a visiting relative, six care or ancillary staff, and the home's interim manager.

We observed that people expressed their views and were involved in making decisions about their care and treatment. Complaints were fully investigated and resolved, where possible, to the satisfaction of the individual concerned.

We saw that staff took people's views into account, such as where they wished to spend their time, giving people time to make decisions and supporting them practically to achieve what they decided. Staff communications we heard, with people they were assisting, were respectful and friendly.

One person said to us, 'I am OK here...the staff look after me.' We saw that people received the care planned for them. One person was assisted to change their position regularly to prevent harm from immobility and pressure, for example. Others received support to eat and drink enough. However, there were some inconsistencies in record-keeping which meant there was a risk that people might not be fully protected from unsafe or inappropriate care.

People's independence was promoted in the planning of their care, and also through the use of aids and adaptations. Their environment was clean and fresh, being maintained so as to look homely and in a good state of repair.

21 June 2012

During an inspection in response to concerns

We (the Commission) carried out this inspection after receiving information that suggested the home was not compliant with regulations relating to safeguarding people, support for staff, and medication management. We made an unannounced visit to the home on 21 June 2012 as part of the inspection.

Some information we received related to the night shift so we arrived at 4am to observe care, speak to night staff and look at various records. People we met had needs due to dementia. This affected their ability to tell us their views of the service they received so we also observed some of the support they received from staff, to get a better understanding of their experiences. The home's peripatetic manager and a unit manager arrived at 6am approximately, and provided us with more information. The home did not have a registered manager though recruitment for this post was underway.

All but one person we saw interacting with staff were at ease with the staff. One person was agitated when approached, and we saw their care plan included full information about this, including how staff were to support them. People were not prevented from being up in the night if they wished to be. Someone who called out at intervals was reassured by staff who went to them, and others who were up were assisted by staff when they needed support. One person told us they liked where they lived because it was quiet and they could keep their own routine.

People's welfare was promoted because staff had consulted other relevant professionals in order to meet people's needs in an individualised way and safely. This included their medication needs. Action was also taken to safeguard people's rights, such as through best interest decision-making processes if they did not have the mental ability to make certain decisions themselves. However, sometimes there was a lack of evidence to show that some actions had been carried out to safeguard people as much as possible. Also, the service's systems for ensuring safe management of people's medications were not always robust enough to achieve this.

7 March 2012

During an inspection looking at part of the service

We carried out an unannounced visit to Bickleigh Down on Wednesday 7 March 2012. We met and spoke with eight people living at the service. We also spoke with relatives, care and ancillary staff, a regional manager for the company and an interim manager.

The atmosphere within the home was relaxed and friendly, with people spending their time as they wished. People told us that the staff respected their privacy and dignity, and helped them to retain as much independence as possible.

All of the eight people we spoke with during this visit told us they were happy with the care and treatment they received at Bickleigh Down. One person told us told us, "Staff are so kind, even though they are always busy".

We asked people whether staff had discussed and asked them for their consent to the care that they were being given. None of them could confirm that they had been asked but all said that they were happy with how their needs are met.

A relative of a person who lived at the service told us they had not been given any information about, and not been involved in, care planning for their relative. However, they said they were kept informed of any changes in their relative's health needs and that staff 'Are all very good and kind'.

People told us that they enjoyed the meals served at Bickleigh Down and that meal times were pleasant and sociable.

All the people we spoke with during our visit told us they were well cared for by the staff and that they felt safe. We asked people if they found there were enough staff on duty at all times to support them each day. The majority of people told us that in their opinion there were, and that they did not have to wait for long periods for staff to respond to requests for support if they called or rang their bells. One person felt that staffing levels could be improved and that in their experience it wasn't always easy to find staff.

During the inspection we observed the care provided and read a range of documents used to plan and evaluate care. Overall we found that the majority of people were experiencing good outcomes at the service and people were supported by caring and friendly staff.

6 October 2011

During a routine inspection

The people we spoke to at Bickleigh Down were all happy with the care and treatment they received. They said they were happy with how they were looked after by the staff.

One person told us told us they were 'very happy living here'.

All the food served to the people was prepared at Bickleigh Down. People told us how much they enjoyed the food.

All the people we spoke with during our visit told us they were well cared for by the staff and that they felt safe. People told us that they knew how to complain if they were unhappy and we saw people raising issues verbally with staff.