Derham House

Derham House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide accommodation for 64 people who require nursing or personal care. Bridge unit provides nursing care whist Foxhall unit also known as "Memory Lane" provides dementia care. On the day of our visit there were 57 people living at the service.

There was a registered manager in place. 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 they felt safe living at the service and staff understood their responsibilities to protect people from the risk of abuse. Risks associated with people's care were identified, and there was sufficient guidance for staff about how to keep people safe.

The registered manager and staff understood when and how to support people’s best interest if they lacked capacity to make certain decisions about their care. Staff had received training about the Mental Capacity Act 2005.

People were supported with their meals to ensure they received food and drinks they liked to help keep them as healthy as possible. They received their medicines as prescribed and medicines were managed safely. There were systems in place for the monitoring and prevention of infection.

There were assessments undertaken and care plans developed to identify people’s health and support needs. People were encouraged to make decisions about their care and support and the service ensured that information was provided to people in ways they could understand.

Staff received training in a variety of areas to ensure they had the skills to meet people's needs. They were supported through supervision and appraisals.

Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Staff had developed good relationships with people who used the service.

The registered manager had regular contact with people using the service and their representatives. They welcomed suggestions on how they could develop the services and make improvements.

Regular audits were carried out to monitor the quality of the service and drive improvements.

Derham House is registered to provide accommodation for 64 people who require nursing or personal care. Bridge unit provides nursing care whist Foxhall unit also known as "Memory Lane" provides dementia care. On the day of our visit there were 62 people living at the service.

During our visit, there was a registered manager in place, who had already handed in their notice of resignation. 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. A few days after the inspection we received a notification to confirm that the registered manager had resigned.

People told us they felt safe living at Derham House. There was an on-going safeguarding case which had been reported and was being dealt with by the appropriate authorities. Staff had attended safeguarding training and were aware of the accident and incident reporting procedures in place.

There was a complaints procedure which was known by people their relatives and staff. Complaints were monitored monthly and investigated and resolved in a timely manner with the exception of two ongoing complaints.

Staff were supported by means of regular supervision and training. Staff had recently undergone refresher end of life training and were able to explain lessons learnt from recent end of life care.

People told us they were treated with dignity and respect by staff who were polite and caring. We observed staff encouraging people to maintain their independence.

There were shortfalls in the way in which some mental capacity assessments, Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) and bedrails risk assessments were completed.

Care plans mostly reflected people's holistic needs. However, we found repositioning charts did not always specify how often people needed to be repositioned in order to reduce the risk of developing pressure sores.

The service was not always well led. Some records were not always accurate or up to date to reflect the care needs or the care delivered. These were mainly fluid balance charts and food charts which although we could see care being delivered it was not always recorded.

Derham House is registered to provide accommodation for 64 people who require nursing or personal care. The services in divided into two units. Bridge unit provides nursing care whist Foxhall unit also known as “Memory Lane “ provides dementia care. On the day of our visit there were 57 people living at the service two of whom were currently admitted in hospital.

At the time of inspection the manager had been in post for three months and was in the process of registering to be the registered manager. A few days after the inspection the registration had been successful. 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 they felt safe living at Derham House and that they were treated with dignity and respect. We observed staff being polite and noted they were knowledgeable about people’s likes and dislikes.

Risks to people and the environment were assessed regularly with clear steps to mitigate the risks identified in order to protect people from avoidable harm. Staff had attended safeguarding training and were aware of the procedure to follow in the event of witnessed or alleged abuse.

Care plans reflected people’s current needs and were reviewed as and when their condition changed. We made recommendations about record keeping as some records such as pressure mattress settings, topical medicines administration records and do not attempt resuscitation records were not always completed fully.

Medicines were managed safely by staff who were regularly checked to ensure they were still competent.

People were supported to maintain a balanced diet and were offered meals that suited their individual preferences.

Staff were supported by regular training, meetings, appraisals and supervision. They underwent comprehensive recruitment checks before they started work and had a probation period before they became permanent staff.

Staff were aware off their roles and responsibilities in relation to the mental capacity act and could demonstrate how they would act in people’s best interests.

People told us they were able to complain should the need arose and that they felt their issues were listened to and resolved by staff.

The premises were kept clean and were in the process of refurbishment.

There were effective systems in place to ensure that the quality of care delivered was monitored and improved.

The values and the vision of the home were known by staff and aimed to ensure person centred care was delivered.

People were protected from unsafe or unsuitable equipment because the provider ensured equipment provided was properly maintained, suitable for its purpose and used correctly. There was enough equipment to promote the independence and comfort of people who use the service.

There were effective recruitment and selection processes in place. People said they were satisfied with the skills of the staff. One person said "The staff are very good, they know what they're doing." Appropriate checks were undertaken before staff began work.

The service took appropriate steps to bring the complaints system to people's attention. People said they had not had cause to make a complaint. There was an effective system in place for managing complaints.

Most people felt that they were treated with dignity and respect and we observed this to be the case. We also saw that people were asked if they were happy to be supported with personal care by staff of a different gender and that staff were aware of their wishes and respected these.

Staff received the training and support that they needed to carry out their duties and to care for people who used the service. One member of staff told us 'there is a lot of training and recently there was some very good training for working with people with dementia. Therefore we have now arranged for more staff to do the training." They told us that during meetings they talked about how best to support people.

We found that the manager and the provider monitored the quality of the service via visits and audits and that steps were put in place to address any issues or shortfalls that were identified.