Archived: Dean View Residential Home

We visited the service again on 2 July 2014 and found that people's care and welfare had improved and therefore the warning notice was removed.

The purpose of this inspection on 2 September 2014 was to check that the provider's action plan had been implemented. We judged there had been improvements and the service was now compliant with safeguarding people from abuse, management of medicines, staffing, notifications of incidents, and record keeping.

At the time of this inspection there were three people living at Dean View. They were able to understand our questions but could not provide detailed responses. We observed their responses to our questions, and also observed their interaction with the staff.

During our visit to the home, we looked at the care records for people living at the home and spoke with five staff to find if people received the care and support they needed, as agreed in their plan of care. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The service was safe because people's health and care needs were understood by staff who had been suitably trained and supported. In the five months before this inspection new staff had been recruited to fill vacant posts. This had resulted in fewer agency staff working in the home and a more stable staff team who knew the people living there and understood their needs.

The staff we spoke with had received training on all essential topics including safeguarding and understood the actions they must take if they suspected any person had been abused or neglected. Risks to people's health and welfare were understood and managed in line with their assessed needs and measures were put in place to minimise any potential risks. There were monitoring processes in place for all aspects of the care and support people received

Care plans included considerations of the Mental Capacity Act (2005) and staff demonstrated an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

The service was effective because people's health and well-being was promoted. Care plans and records had been reviewed and updated and provided detailed information about all areas of each person's support needs. Staff understood each person's needs and we saw that routines were carried out in accordance with each person's care plan, for example making sure people were offered drinks regularly throughout the day, and making sure medicines and creams were administered at appropriate intervals throughout the day as prescribed.

Is the service caring?

The service was caring because we saw staff communicating in a warm and caring manner. We saw staff asking people for their consent before carrying out tasks. Staff recognised the importance of respecting each person's privacy and dignity when carrying out personal care tasks.

Is the service responsive?

The service was responsive because people's wishes and their likes and dislikes were taken into account. Advice and treatment had been sought appropriately when staff recognised people's needs had changed. We saw evidence of visits and appointments with health and social care professionals. For example a person who had shown signs of ill health recently had been referred to their doctor who had arranged for tests to be carried out.

Staff told us they understood each person's needs. They were able to describe people's care needs, including the medicines they required and how the medicines should be administered. They were able to communicate with each person and understood their requests and preferences.

Is the service well-led?

The home did not have a registered manager. The provider has submitted an application to the Care Quality Commission to de-register the home in the near future. They plan to offer supported accommodation to the people living in the home instead of residential care. New management systems had been put in place in the last five months in readiness for the planned changes. The provider has registered a personal care service known as Exeter Home Care Guinness Care and Support and they intend to offer people living at Dean View care and support through this service. The registered manager of this service was overseeing the management of Dean View at the time of this inspection. Staff told us the management arrangements were working well and there were good systems of monitoring, support and communication in place.

We saw that daily routines were monitored, reviewed and adjusted where necessary. Monthly audits were carried out by the management team. Where problems had been found we saw the provider had action plans in place to address these.

Staff meetings and individual supervision sessions were held regularly. Staff told us there was good teamwork and it was a happy and positive place to work. When team leaders or managers were not present in the home they could easily be contacted by telephone to provide advice or support if needed.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well led?

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

This inspection was undertaken to check that urgent improvements in relation to people's care and welfare had been made , following our previous inspection on 25 April 2014. Three people lived at the home when we visited and we spent time with all three people and looked in detail at one person's care records. We spoke with five staff about their care and obtained feedback from three health professionals who regularly worked with people and staff at the home.

Is the service safe?

The service is safe because people were cared for by a team of staff who had the appropriate skills to support them. Since we last visited, people's care plans and risk assessments had been reviewed and updated. They included much clearer, more detailed care information about people's health care needs and risks and about how to support each person. For example, about how to recognise when a person was anxious and needed reassurance. We observed how staff supported people to remain safe when going into the community, such as by enabling them to cross the road and get on the bus safely.

Is the service effective?

We saw that people were receiving a more effective service. One person said, 'It's much better now'. People were undertaking a wider range of activities and pursuing their interests and hobbies. Staff told us they were trying a variety of new things with people to see what they enjoyed. Staff told us all three people enjoyed a weekly music therapy session and that staff spent more one to one time with each person. They also told us how people were supported to be more independent, and how each person had obtained a bus pass so they could access the community more easily.

Is the service caring?

The service is caring. We observed very positive interactions between people and staff. We saw that care was more person- centred and staff knew about people's needs and how to support them. People were treated with dignity and respect and were offered choices and their decisions respected. Senior staff also told us how people had been involved in the selection and recruitment of new staff to make sure their views were sought and taken into account when employing new staff.

Senior staff told us how they were exploring further training for staff to help people to communicate more independently. For example, providing Makaton training for staff and supplying pictures and symbols for people to help them communicate. They explained this would mean people could become more independent and less reliant on staff to speak on their behalf.

Is the service responsive to people's needs?

We found the service was more responsive to people's needs. Since we last visited, one person's urgent health care needs had been addressed and others had attended routine health care appointments. One person had been referred for a specialist assessment about their mobility needs and was awaiting an appointment. We saw that people's individual appointments and activities were documented in a diary each week, so staff made sure nothing was missed. In care records, we saw more detailed information was documented about people's eating and drinking and staff told us how they were offering people a wider range of healthy food choices such as fresh fruit and vegetables. Staff also monitored people's weight regularly so they were alerted to any significant changes.

Is the service well led?

The home did not have a registered manager but day to day leadership at the home had improved. Since we last visited, the provider had increased the management support available to staff working at Dean View and arranged for a senior care worker to be in day to day charge at the home. Staff we spoke with told us things were more organised at Dean View and how they were able to make more decisions. For example, about helping a person to choose and buy their new chair. We saw there were detailed weekly plans for each person who lived at the home, which included a wide variety of activities as well as health care appointments. We were also told about daily, weekly and monthly quality monitoring checks were undertaken to monitor the quality of care people received.

We will visit Dean View again later this year to follow up the five remaining compliance actions set following the April 2014 inspection.

Dean View is one of seven homes run by Guinness Care and Support Limited within Devon area which was due to deregister as a care homes on 28 April and become a supported living service. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. A supported living service aims to enable each person to be as autonomous and independent as possible, and usually involves social support rather than medical care.

Four people lived at Dean View when we visited. We spent a day at the service, met all four people and observed staff interactions with them throughout the day. We spoke with five staff about people's care needs and looked at two people's care records.

Is the service safe?

Following the safeguarding alert the provider took steps to reduce risks and improve care at Dean View. This included transferring skilled experienced staff into the home to support staff and model good practice. Although risks had reduced, some ongoing risks to people's safety and welfare remained. For example, in relation to skin care for two people and to safety concerns about eating and drinking and medicines management for one person. Also, because of the absence of clear, detailed and accessible care records for staff about the care needs and risks of people who lived there.

A multiagency safeguarding process was underway in relation to Dean View to protect people's safety and well-being. On 28 April 2014, a protection plan was drawn up by health and social care professionals and a range of actions agreed with the provider and other agencies to further reduce risks for people at the home. A review of the current care needs and risks for each person who lived at the home was being carried out and the provider had increased night staffing levels at the home.

Is the service effective?

Work was underway at the home to review people's care needs and improve staff skills and ensure care records provided accurate and up to date information about people's care needs and risks. Although people were being cared for day to day, there were some ongoing risks about the effectiveness of the care provided. This included concerns about staff skills related to communicating effectively with people, supporting them to be as independent as possible and to lead fulfilling lives. Also, concerns about staff knowledge and skills related to pressure area care, food and nutrition and managing people's medication.

Is the service caring?

We met with five staff and observed their interactions with people who lived at the home. People seemed content, and we saw staff were caring and treated people with dignity and respect. Staff supported people with personal care and with eating, drinking and everyday living tasks. One person was very unwell the day we visited and staff spent a lot of time supporting this person. They were caring and compassionate towards the person, they comforted and reassured them.

From our discussions with staff and our observations, we found people's care seemed institutionalised and was not very person centred. We observed there wasn't much happening for three of the four people who lived at the home on the day we visited. For example, two people spent most of the day sitting in the lounge sitting with the TV on although most of the time they gazed around the room or stared out of the window. A third person sat in their room all day and only came out for meals and to use the toilet. Two people went to their room after lunch and staff told us all normally, all four people went to bed between six and seven each evening.

Staff did not use any total communication methods to communicate with people although three of the four people we met had limited verbal communication skills. Two senior staff we spoke with told us about work underway to increase people's daily activities, support them to increase their independent living skills and to improve staff skills in total communication.

Is the service responsive to people's needs?

The information in the safeguarding alert showed staff had not been responding to people's needs in a timely way. Once these concerns were identified, a number of immediate actions were taken by more experienced senior staff that went to work in the home. For example, food and fluid charts were introduced to monitor one person was getting enough to eat and drink, urgent health appointments were arranged for two people identified as at risk, referrals to the dietician had been made and people's medication was being reviewed.

However, at the time of our visit, concerns were still being raised about how staff were co-operating with implementing the changes and improvements required. For example, a dietician recommended staff worked with the person to develop a food menu to encourage a person to eat more healthily. We asked a staff member about how the dietician's recommendations were being implemented. They told us staff were discussing food choices with the person and how they would gradually develop the food menu with this person 'as and when'. Their response did not give us confidence the dieticians' recommendations were being implemented with any sense of urgency.

Is the service well led?

The home did not have a registered manager, the post holder left in October 2013 and had not been replaced as part of the planned changeover to supported living arrangements. The provider had notified us of the interim management arrangements. A team leader had been appointed to oversee the three learning disability homes in Crediton who was in daily contact with staff at Dean View. However, there was no senior care worker based at the home and we found people were at risk because the home lacked day to day leadership and decision making. We also found communication within the home was inadequate.

The provider had taken steps to ensure senior experienced staff were providing day to day supervision and leadership at the home. Two senior staff told us they were very aware of the shortfalls at the home and were working hard to address them. One said, 'The staff team needs to be rebuilt from the bottom up'. They went onto say they were not confident that all staff who worked at Dean View had the right skills and competencies to meet the care needs of the people who lived there.

At the time of the inspection, the provider was undertaking an internal investigation to identify what had gone wrong. This demonstrated the provider was taking the concerns seriously, was committed to identifying what had gone wrong and to ensuring lessons were learnt.

We met and spoke with all four people and the three staff on duty supporting them. We found people were consulted about their care and were supported to make informed decisions about their welfare. People's health and social needs were regularly reviewed and monitored. People's medication was managed appropriately by the staff working in the home and there were sufficient numbers of suitably trained staff to meet people's current needs. People were supported to raise opinions about living at the home, including complaints.

The provider met the five outcomes we inspected.