Archived: Dene Holm

Dene Holm is a residential care home providing accommodation and personal care to up to 47 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 38 people using the service.

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

Although the feedback from people living at Dene Holm and their relatives was mainly positive, we found systems to monitor people’s safety and well-being were not robust. Risks were not always identified and acted upon. Accidents and incidents were not effectively reviewed and monitored to minimise the risk of them happening again. Safeguarding concerns were not consistently shared with the local authority and The Care Quality Commission (CQC) to enable thorough investigation. Systems to monitor people’s medicines were not robust which meant people may not receive their medicines as required.

People were not always supported by sufficient, skilled staff. Due to staff shortages the provider employed a large number of agency staff who did not know people and the routines of the home as well as more permanent staff. Staff did not have comprehensive and accurate guidance around people’s care needs as records were not updated regularly and contained contradictory information. The environment was not set up to meet the needs of those living with dementia and areas of the home were in need of refurbishment. This resulted in some areas being difficult to clean.

People’s health was not always managed well, and people experienced delays in referrals to healthcare professionals. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There was a lack of activities, and people who were cared for in their rooms were at risk of social isolation. People had limited opportunities to go out unless supported by their family or friends.

Systems to monitor the quality of the service people received were not effective. Action plans lacked detail and timescales for completion were not met. Audit systems were not robust and did not identify concerns. The provider did not have adequate oversight of the service and did not ensure staff in positions of responsibility had the induction, training and support they required.

People told us they enjoyed their food although people’s dietary needs were not always managed well. People and their relatives told us that staff were kind and caring in their approach. Permanent staff knew people’s needs well and individual interactions with people were pleasant.

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 13 December 2017)

Why we inspected

The inspection was prompted in part due to concerns relating to safeguarding, management of risk, staffing and provider oversight of the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found further serious concerns. The scope of the inspection was widened to include all key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches at this inspection in relation to the management of people’s safety, the reporting of safeguarding concerns, the care people receive, consent, records how complaints were responded to and the governance of the service. You can see the action we took at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Abbeyfield Dene Holm is a care home. The service provides accommodation, care and support for up to 47 older people who do not have nursing needs, but some of whom are living with mild to moderate dementia. At the time of our inspection there were 38 people using the service.

At the last Care Quality Commission (CQC) inspection on 2 November 2015, the service was rated as Good in all of the domains and had an overall Good rating.

At this inspection we found the registered manager and provider had consistently monitored the quality of the service to maintain a rating of Good.

The registered manager had been in post since December 2015. 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 environment was clean and had a number of design features which benefitted people living with dementia including themed areas, and clear signage.

People continued to be safe at Abbeyfield Dene Holm. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced. There were systems in place to support staff and people to stay safe.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

There continued to be enough staff to keep people safe. The registered manager had appropriate arrangements in place to check the suitability and fitness of new staff. Staff received training and supervision to help them to meet people’s needs effectively.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Staff encouraged people to participate in activities and socialising, follow their interests and maintain relationships with people that mattered to them.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

Medicines were managed safely and people received them as prescribed.

Staff showed they were caring and they treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs.

The provider had taken steps to meet people’s cultural needs by ensuring there were staff available that was able to speak their first language and by supporting people to access local amenities that supported particular ethnic and cultural groups.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People and staff were encouraged to provide feedback about how the service could be improved. Changes and improvements were made that people wanted. Records continued to be comprehensive and person centred.

The registered provider notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the manager had an on-going and effective improvement plan for the service.

The registered manager provided good leadership. They checked staff continued to focus on people experiencing good quality care and support.

Further information is in the detailed findings below

The responsive follow up inspection was carried out by one Inspector, who visited unannounced on the 3 and 7 July 2014. During the visits we met and talked with people that used the service and their relatives/representatives, the providers, the newly appointed manager, senior care staff, care staff, and domestic staff. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

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

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We looked at four people's individual plans of care and saw that they had individual risk assessments in place to identify potential risks and to show how these could be avoided or minimised. We saw that the assessments had been reviewed, and provided directions for staff to follow. This meant that there were on-going procedures in place to maintain people's safety.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as dementia awareness. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

Equipment at the home had been maintained and serviced regularly. We found that people that used the service were protected from infection because the provider maintained appropriate standards of cleanliness and hygiene.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as 'The staff are good, I have nothing to complain about'.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The service was well-led. A new manager had been appointed and had just started work at the home. They were experienced in working in the care profession, and had been registered as a manager with the Commission at a previous employment.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

As part of our inspection we spoke with people who used the service about the care and support they received. Some people who lived in the home had dementia and were not able to tell us their views; we therefore used different methods to help us understand people's experiences of the care provided, such as the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Most of the people we spoke with told us that they were comfortable in the home. Comments included "I'm fine here", "The food is very good" and "I like it here". We observed some positive engagements between staff and people who used the service, although the interactions were for short periods of time.

However, we found concerns that people's care and support needs had not been assessed correctly in order to help staff provide safe care. We also found that people were at risk because the service had not taken the appropriate action in order to reduce the risk of people's health from deteriorating.

People we spoke with said they felt "Safe" in the home. However, we found concerns that that the service had not always followed the correct procedures with regards to reporting concerns to the appropriate authority for investigation. We also found that not all staff had received up to date training or guidance with regards to identifying and reporting safeguarding concerns.

During our inspection we noted a strong odour of stale urine in different areas of the home. We saw that the hygiene and infection control practices followed by staffed were not appropriate to prevent the risk of infection.

We found that the number of people living in the home and people's dependency level had increased. However, the number of staff to provide care and support had not increased in line with people's additional needs. This meant that the appropriate steps had not been taken to ensure that there were a sufficient number of suitably qualified, skilled and experienced staff employed in order to meet people's needs.

We found that the provider had taken action to address concerns around respecting people's privacy and dignity. We also found that people had received care that met their health needs.

However, we found that improvement was still required with regards to staffing levels in order to meet people's social needs.

People told us they "Enjoyed" living at the home. One person said "I couldn't ask for any more". We saw that people had been involved in their care but found concerns that their privacy and dignity was not always maintained.

We saw that the service had completed risk assessments for people who lived in the home to help staff maintain people's safety and wellbeing, but found concerns that the care and support that had been specified was not always delivered. We also found that some risk assessments had not been reviewed following a change in people's health needs to help minimise the risk of their health from deteriorating further.

Staff told us they felt "Supported". However, we found concerns around the training and competency for some staff who provide specialist care to people. We also found concerns that there were not enough staff to meet the individual needs for people living in the home.

We were informed of a safeguarding matter, in that a concern had been raised. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. There was evidence that the relevant authorities had been informed. The overall review of this matter was not yet concluded.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with seven people who used the service. They told us that they were happy with the care and support that they received. They tall old us the staff were kind and caring. One person said, "The staff are lovely and they can't do enough for you". Another person said "The home is easy going and I am happy with the care".

People we spoke with said that they enjoyed their meals. One person said, "The food is very good" and another person said, "I can choose the meals, which I like". We observed that people were invited to choose their meals which were described to them. People we spoke with said that staff was always available to support them. We observed many positive interactions between staff and people. We observed staff taking time to respond to people's requests and staff respected their right to make choices.

People who used the service said that staff were always available to assist them. We observed that staff took time to listen to people and engaged in conversation with them.