Downlands

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. At the time of the inspection the manager at Downlands had applied to become the registered manager. Shortly after the inspection the application process was completed and they were confirmed as the registered manager. They were present throughout the inspection.

When we completed our previous inspection on 11 April 2017 we found concerns relating to safe care and treatment. This was because risks to people were not always identified, assessed and managed effectively. After the inspection the provider sent us an action plan describing what they had done to ensure compliance with the legal requirements. At this inspection, on 8 May 2018, we found that the provider had followed their action plan, risks were being managed safely and the breach of regulations had been addressed.

People told us they felt safe living at Downlands. One person said, “Help is there when we need it. I never feel worried.” There were enough staff on duty to care for people safely. There were safe recruitment procedures in place and staff received an induction when they started working at the home. People were receiving the medicines they needed and staff demonstrated an understanding of their responsibilities to safeguard people. The home was clean and there were effective systems in place to prevent and control infection. Incidents and accidents were recorded, together with details of what actions had been taken, to prevent a recurrence, where possible. Learning from incidents was used to make improvements at the home.

Staff spoke positively about the training and support they had received. People and their relatives told us they had confidence in the skills of the staff. One relative said, “I am very happy with the staff, they know what they are doing and I feel my relation is in good hands.” Staff supported people to have access to health care services. They reported effective arrangements for working in partnership and advice from health care professionals was included within people’s care plans. People’s diverse needs had been assessed holistically and staff ensured that there was proper consideration of consent before providing care and support to people. People were supported to have the maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were happy with the food and said they had a choice of what to eat and drink.

People were treated with kindness and respect. One person told us, ”I don’t feel rushed, the staff are very respectful and always kind.” Staff supported people to be involved in planning their care. People were encouraged to be as independent as possible and their dignity was protected. One person said, “All the staff are great.”

Staff knew people well and provided care in a personalised way. People’s care plans were reviewed regularly and updated when things changed. People and their relatives knew how to complain and said they were confident that any concerns would be addressed. People were supported to make plans for the end of life.

People, their relatives and staff spoke highly of the management of the home and described the registered manager as, “approachable” and “efficient.” There were effective systems in place to monitor quality and drive improvements at the home. We noted that improvements made following previous inspections had been sustained and were embedded within staff practice.

There was clear leadership and staff understood their roles and responsibilities. Staff described positive communication both within the staff team and with other agencies. Staff meetings were held and staff confirmed their views on developments at the home were welcomed.

The overall rating for the home had improved to Good.

The service had a registered manager. They were on maternity leave at the time of the inspection and the running of the home was managed by the deputy manager who was present throughout the inspection. 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.

At the last inspection in April 2016 we identified a breach of the Regulation in relation to a lack of person centred care. We also identified some areas of practice that needed to improve. The provider sent us an action plan in June 2016 stating that they had addressed these concerns. At this inspection we found that the provider had made improvements and people were being offered more choices and provided with a more person centred service. The provider had met the requirements of the Regulation but there remained some areas of practice that needed to improve.

Some risks to people were not effectively managed. Wound care was inconsistent and risks associated with the environment were not always identified and acted upon. This was found to be a breach of the Regulations.

Staff understood the principles of the Mental Capacity Act 2005 however, there was not a consistent and clear approach to determining whether people had capacity to make decisions about their care and undertaking best interest decisions where needed.

People’s dignity was not consistently respected. A bathroom was being used as a storage area even though it was used by people. At meal times some staff were focused on the task and not on providing a positive experience for the person.

People and relatives knew how to raise complaints and concerns. However, some relatives felt that their concerns were not always listened to.

The provider had systems for monitoring quality in the service and we could see that improvements had been made. However some systems were not effective in identifying and driving improvements.

People told us they felt safe living at Downlands and there were sufficient staff to keep people safe. People received the medicines safely and staff knew how to recognise and report abuse. Staff knew people well and encouraged and supported them to express their views about their care and support. Relatives were able to visit at any time and told us that they felt welcome at the home. Staff had received training and people told us that they had confidence in the abilities of the staff. One person said “They are well trained and I think they all know how to care for me.”

People spoke highly of the activities provided. Plans to develop a more person centred approach to providing meaningful occupation for people were in progress.

People spoke highly of the food and said that they were able to make choices about what they had to eat. People received enough to eat and drink and risks associated with nutrition were managed effectively. People were supported to access the health care services that they needed.

Staff morale was good and they had developed positive relationships with the people they were supporting. People told us they were happy living at the home.

We identified one breach of the regulations. You can see what actions we have asked the provider to take at the end of the full version of this report.

Downlands provides nursing and personal care and support for up to 23 older people or people with a physical disability. The service offers long term and respite care. At the time of inspection there were 19 people living at the service. People were mostly older with complex needs or physical frailty requiring personal care and nursing support with all activities of daily living. Accommodation is provided over three floors, in single rooms with en-suite facilities to all bedrooms. The service is located on a main road in a residential area, close to transport links to local shops, the seafront and the city centre. The provider, Beaumont Nursing Home Limited, has another service in Northamptonshire.

The service had two registered managers. This is because one of the registered managers had stopped managing the service but had not submitted an application to CQC to cancel their registration. The current registered manager in post was present throughout the inspection. 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. Downlands registered with CQC on 3 February 2015 and has not been previously inspected.

Individual preferences were not always respected for example people were not supported to get up or go to bed at their preferred time. People told us that the food was good but they were not offered a choice at meal times. On the day of inspection everyone was served the same menu item even though two people told us they did not like this menu item. There was a four week menu in place but it was not displayed and suitable alternatives were not routinely offered to people. This meant that care was not always person centred as people’s preferences were not respected.

Staff did not always act in accordance with the Mental Capacity Act (2005) (MCA). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the support they receive. One person who was thought to lack mental capacity did not have a mental capacity assessment or sufficient detail in their care plan to support a decision made on their behalf to use bed rails and we identified this as an area that needs improvement. Staff were aware of those people with a DoLs authorisation the details of which were stored alongside the care plan in their individual records.

There were regular Infection Control and Medication Audits which demonstrated improvements but other systems to assure quality and drive improvements to the service were limited or informal. Relatives and residents surveys had taken place but people and relatives told us they did not feel confident to express their concerns or preferences and we have identified this as an area that needs improvement.

Staff understood their responsibilities in relation to keeping people safe from harm and there were sufficient staff on duty to meet people’s needs.

The management of medicines was safe. People received their medicines correctly and on time. A person said, “I can get pain relief when I need it, I will ask staff.” There was clear guidance and information provided to staff to support them to administer medicines safely.

Individual risk assessments were in place to ensure that people’s health needs were appropriately managed and these were updated regularly and in accordance with any guidance from health care professionals. Planned care accurately reflected care delivered. There was a system in place to monitor accidents and incidents. The environment and equipment was managed through regular checks and servicing and there were emergency plans in place for the service and individuals.

People with difficulties eating and drinking for health reasons were identified and supported by timely referral to health professionals such as Speech and Language Therapists. Any recommendations made by health care professionals were detailed in individual care plans and followed by staff.

There was a training plan in place and staff said they felt supported. Staff told us that they received regular supervisions, competency checks and observed practice. The nursing staff we spoke to were knowledgeable and experienced in the care of people with complex nursing needs.

Relatives described staff as, “Kind and friendly.” One person said, “Yes, they are nice to me, they (staff) help me.” Staff were genuinely interested in people and were caring and kind in their interactions with them. Staff took time to encourage people to join in activities that they knew they would enjoy or to make it possible for people to attend an event despite their limitations. Staff took care to maintain people’s privacy and dignity whilst supporting them.

There was an activity plan in place and activities were planned according to the interests and preferences of people living at the service. There were activities going on throughout the day ranging from individual chats to group activities. People were supported and encouraged to attend those activities they enjoyed and staff made an effort to ensure that those who preferred not to join in group activity were not isolated.

There was a complaints process in place and all complaints had been responded to appropriately and within a reasonable time frame.

The registered manager and other staff were active in the local health care community. They met regularly with local care home managers and activity staff to keep up to date and share best practice. The provider also worked with other agencies such as the Alzheimer’s Society and the Blind Society to support people who were at risk of social isolation.

We identified a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.