Archived: Devonshire Manor

Devonshire Manor is a care home that provides accommodation for up to 15 people who need help with their personal care. At the time of the inspection 9 people lived in the home. Most of the people living in the home, lived with dementia.

People's experience of using this service:

At the last inspection, the provider was rated inadequate and placed in special measures. At this inspection, we found the service had not improved and remained inadequate.

We undertook a focused inspection. A focused inspection was undertaken to specifically check whether sufficient improvements in the safety of the service and people’s care had been achieved and to assess whether the manager and provider now had sufficient oversight of the service. At this inspection we continued to have serious concerns about the safety of the service and its leadership.

People’s risks were still not adequately assessed, and staff lacked clear and sufficient guidance on how to support them appropriately. Records did not show that people received the right support with regards to their nutrition, skin integrity, medication needs and overall care.

Fire safety arrangements remained poor and did not ensure people were protected in the event of a fire. Personal and protective equipment was not being used in accordance with Public Health England guidance to mitigate the risks associated with Coronavirus.

Robust staff recruitment procedures were still not being followed and improvements to the way medicines were managed had not been made to ensure its administration was always safe.

The systems in place to monitor the quality and safety of the service remained ineffective. At the last inspection, the provider and manager did not have sufficient knowledge of the care people needed, or their regulatory responsibilities. At this inspection, this remained the same.

This meant people had continued to be exposed to ongoing risks of inappropriate and unsafe care and poor management.

Rating at last inspection and update:

The last rating for this service was inadequate (published 16 January 2020). After this inspection, the provider completed an action plan to show us what they would do and by when, to improve. At this inspection, the provider not achieved the improvements identified in their action plan. Multiple breaches of the regulations remained and the provider’s rating remains inadequate.

Why we inspected:

This was a planned focused inspection based on the previous rating.

Follow up:

Shortly after the inspection, we referred two people’s care to the Local Authority Safeguarding Team for further investigation. We notified the Local Authority Quality Improvement Team of the ongoing failings of the service. We referred the provider to Merseyside Fire Authority due to the fire safety deficiencies identified at the service. We will work with the local authority and Merseyside Fire Authority to monitor progress.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service will be placed in special measures. ‘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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Devonshire Manor is a care home that provides accommodation for up to 15 people who need help with their personal care. At the time of the inspection 13 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service:

At the last inspection, the provider was rated requires improvement. At this inspection, we found the service had deteriorated to inadequate.

There were no adequate or effective systems in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks.

Risks in relation to people’s care were not properly managed and their care did not ensure their needs and preferences were met. This placed people at risk of receiving inappropriate and unsafe care.

People told us that the food and drink on offer was good. We found however that people did not always receive a diet suitable for their needs. Where people needed help from staff to eat their meals, the support provided was not well organised or person centred.

The Mental Capacity Act 2005 was not always followed to ensure people’s legal right to consent to their care was respected. People’s right to be independent and have control over their own care was not always promoted in the support they received.

People living in the home had little to occupy and interest them. Their social and recreational needs were not adequately supported and most people spent all day watching television.

On the days we inspected, staffing levels within the home were sufficient to meet people’s needs. People told us they felt supported and that staff were kind. Staff recruitment however was not safe and some staff had not received the training and support they needed to do their job effectively.

Records showed that some people had raised concerns over staff conduct but there was little evidence that safeguarding procedures had been properly followed to ensure people were protected from potential abuse.

Fire safety arrangements were not robust. There was no formal fire evacuation procedure and practice fire drills had not been undertaken for some time. Staff members had not received training in how to use the home’s fire evacuation equipment and fire alarm checks had also not been completed for over six weeks at the time of our inspection.

The atmosphere at the home was homely but the management of the service was not open, person centred or motivational. Neither the provider or manager had sufficient knowledge of people’s care or their regulatory responsibilities. The service was not well-led and did not ensure people achieved good outcomes or had a good quality of life.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 17 April 2019). After this inspection, the provider completed an action plan to show us what they would do and by when, to improve. At their recent inspection, the provider had not achieved the improvements identified in their action place. We found multiple breaches of the regulations and the provider’s rating has declined to inadequate.

Why we inspected:

The date of the inspection was brought forward due to CQC receiving concerning information about the service and people’s care.

Enforcement

We have identified breaches in relation to regulations 9 (person centred care), 11 (Need for consent), 12 (safe care and treatment), 13 (Safeguarding people from abuse and improper treatment), 14 (Meeting nutritional and hydration needs), 17 (Good governance) and 19 (Fit and proper persons employed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service will be placed 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.

Devonshire Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Devonshire Manor offers accommodation for up to 15 people who require support with their personal care. There are 14 single bedrooms and one shared bedroom with communal bathrooms for people to use. At the time of our inspection 12 people were living at the home.

The home had a registered manager who had been in post for approximately one year. 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 our inspection in March 2017 we identified breaches of Regulations 11, 12 and 17. These breaches related to the management of risk, the implementation of the mental capacity act and the governance arrangements at the home.

At our last inspection in June 2018 the service had deteriorated and we identified breaches of Regulations 11,12,13,17,18 and 19. These breaches related to the management of risk, safety of the home’s environment, the management of people’s medication, safeguarding people from the risk of abuse, staff training and safe recruitment of new staff members, the implementation of the Mental Capacity Act and the governance arrangements of the home.

After the June 2018 inspection, the provider submitted an action plan to CQC outlining the action they intended to take to improve the service. At this inspection we found that the provider had taken steps to improve the service. However, on this inspection the provider was in breach of Regulation 9, 12 and 17. This is because the activities available for people and how they were supported to occupy themselves during the day did not always meet their needs or reflect their preferences; information in people’s care plans did not adequality identify the risks present in people’s support and show how these can be mitigated. The provider and registered manager had not used ongoing assessment and monitoring of the service to address these issues and also difficulties between the provider and registered manager and members of staff at the home. It was not clear what strategy or way forward the registered manager or provider had planned to tackle this problem.

There had been improvements in other areas of the home. For example, in the safety of the environment of the home and the quality of the facilities available to people, the safe administration of people’s medication, the addressing of any arising safeguarding concerns and people being consistently treated with dignity and respect.

The home’s environment was clean, well maintained and there were no unpleasant odours. People told us that staff were kind, caring and treated them well. One person told us, “The staff are very kind to me.” Another person said about the staff, “They are kind and patient.” During our visit, we observed many positive and thoughtful interactions between staff and people who lived at the home. One person told us, “I get on well with staff, we have a laugh. They hug me and say good morning.”

During our inspection we noted that there were enough staff to meet people’s needs in a timely manner. However, when we asked people, their relatives and staff, feedback about the usual levels of staff was mixed.

People told us that staff consult with them to learn their wishes and obtain their consent; one person told us that staff listen to them and act on what they say. People were encouraged to make as many choices for themselves as possible. When care planning and supporting people to make decisions the principles of the MCA were being applied. People were treated with respect and their choices and if appropriate their consent was sought before staff offered any care or support. People’s personal records and private and confidential information was appropriately stored to protect their privacy.

People told us that they thought staff members had the knowledge and skills to support them effectively. Staff received support with a programme of ongoing training using computer based e-learning and practical demonstrations. Staff also had regular supervision meetings with a senior member of staff. New staff received an induction into their role with a senior member of staff covering the topics in an induction worksheet. One staff member told us that after this process they felt ready to support people another staff member told us they felt confident in their role.

People were supported with their healthcare needs. There were records that showed that the service worked alongside healthcare professionals and demonstrated times when staff had been proactive in identifying a health concern and raising an appropriate alert.

Each person had a care plan which contained some person-centred information about people and their lives. People’s relatives told us that they were involved in putting together their family member’s care plans. We saw that people’s care plans were regularly reviewed by the person’s keyworker and care staff had signed then to say that they had read the information they contained. Any accidents or incidents that happened at the home were recorded and appropriately responded to and learned from.

People told us they would feel confident raising a complaint with staff, but told us they had not had a reason to. People’s relatives told us that they felt comfortable and would not hesitate to raise a concern.

People’s relatives told us they knew who the registered manager was and they found them approachable. One person’s relative told us, “I have seen an improvement since [registered manager’s name] has taken over as Manager. There are improvements in the home and the staff seem happier.” We found both the provider and manager were pleasant, approachable and receptive to any feedback given.

Devonshire Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Devonshire Manor offers accommodation for people who require support with their personal care. There are 14 single bedrooms and one shared bedroom with communal bathrooms for people to use. A stair lift enables people’s access to bedrooms on the upper floors.

On the day of our visit, there was 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. The manager had been in post approximately seven months at the time of our visit.

At our last inspection of the service in March 2017, we identified breaches of Regulations 11,12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk, the implementation of the mental capacity act and the governance arrangements at the home. After the March 2017 inspection, the provider submitted an action plan to CQC outlining the action they intended to take to improve the service. At this inspection we found that the provider had not taken sufficient action to address the breaches we had previously identified in accordance with their action plan. We also identified additional concerns with the management of medication, the safety of the premises, safeguarding people from the risk of abuse, staff training and recruitment. This meant the provider continued to be in breach of Regulations 11,12 and 17 of the Health and Social Care Act with breaches of Regulation 13 (safeguarding people from abuse and improper treatment) Regulation 18 (staffing) and Regulation 19 (fit and proper persons) also identified.

We looked at the care files belonging to three people who lived at the home. We found that people’s risks in relation to their care had not always been assessed. Care plans lacked clear information about the management of people’s risks and where professional advice had been given, care plans had not always been updated to reflect this. We saw that people’s care plans contained some person centred information about their individual needs, wishes and preferences but some of the information about the support people required was generic with the same standard statements made about a number of people’s needs. This aspect of care planning required improvement.

Some of the moving and handling practices used by staff to support people’s mobility was unsafe. One person’s moving and handling needs required further assessment to ensure that the support provided was effective in mitigating the risk of the person falling.

The management of medication was not always safe. People’s medication administration records contained missing signatures which meant it was difficult to tell if people had received the medication they needed on certain days. The stock of medication in the home was not always correct and some medication could not be accounted for. Records showed that the manager had identified similar issues in a number of consecutive medication audits. This indicated that the issues we identified during our inspection were repetitive and had not been adequately addressed.

The home was visibly clean and free from odours during our visit. The home’s electrical installation, fire alarm, fire extinguishers and moving and handling equipment had all been inspected in accordance with legal requirements. We saw that one of the home’s hoists was unsafe to use but staff had not been clearly advised of this. The home’s gas installation had been tested and we saw that remedial work was required to ensure the home’s boilers were suitable for use. The provider had failed to ensure this remedial work was undertaken in a timely manner. The provider’s fire risk assessment was inadequate and the risk of Legionella bacteria developing in the home’s water supply had not been risk assessed or checked. Some of the infection control measures employed in the home such as the handling of soiled bedding or clothing required improvement as they did not meet the infection control standards set out by the Department of Health.

Where people’s capacity to consent to decisions about their care was in question, the Mental Capacity Act 2005 (MCA) had not always been followed to ensure people’s legal consent was obtained. This was discussed with the provider at the last inspection but no adequate action to address this had been taken.

Most of the interactions between staff and people who lived at the home were positive. We observed however that on a few occasions during our visit, people were spoken to abruptly or inappropriately. We discussed this immediately with the manager. We also heard staff talking about people’s needs and care with other staff members in front of the person’s peers and the person themselves. This was not very respectful and did not show people’s right to confidentiality was respected. During our inspection two people’s appointments with the practice nurse were undertaken in the communal lounge in front of others. Whilst people’s appointments were not of a particularly sensitive nature, people were not given the choice of having their needs discussed in private. This indicated that people’s right to privacy was not always promoted in the delivery of care.

Records showed that a number of safeguarding incidents and other incidents of a notifiable nature such as serious injuries had not been properly investigated or reported to the Local Authority or CQC as and when required. Reporting notifiable incidents is a legal requirement of the provider’s registration with CQC.

Staff recruitment was not always robust. Adequate checks on the safety and suitability of staff to work with vulnerable people had not always been completed prior to employment. Employment references were not verified and some staff members had been employed to work at the home before either their criminal conviction check had cleared or before previous employer references had been received by the provider. This meant the provider could not be assured that at the time these staff member were employed they were safe to work with vulnerable people.

We looked at staff training records. We saw that three members had not had sufficient training to do their job role. This meant there was a risk that they did not have the skills, knowledge or competency to provide effective and safe support. Despite this the provider had permitted them to work in the home. Staff had received appropriate supervision in their job role from the manager and staffing levels overall were sufficient to meet the needs of the people who lived there.

People said they got enough to eat and drink and that the food provided was good. Catering staff had information on people’s special dietary requirements and people’s food and drink preferences in order meet people’s needs.

People who lived at the home and their relatives spoke positively about the home and the staff. A health care professional we spoke with also told us that people looked well cared for and that the staff team were approachable and pleasant. People told us that staff were kind to them and treated them well. None of the people we spoke with had any complaints or concerns about the service and no formal complaints had been received by the manager since they came into post. The provider’s complaints procedure however required improvement. It lacked sufficient information on which organisations people could contact in the event of a complaint. The contact details for the provider and name of the manager were also not provided.

Since the new manager’s appointment we saw that they had worked hard to get to know the home, the staff team and the people they cared for. Records showed that they had addressed a number of issues in order to improve the service such as staff attitudes and the day to day practices of staff. Regular staff meetings and resident meetings had been set up to enable staff and people who lived at the home to participate in decisions about the service and to gain their feedback. The manager was at the time of the inspection was in the process of reviewing people’s care plans and recognised that further improvements were still required.

The manager had undertaken a range of quality assurance audits to identify and monitor the quality and safety of the service. These audits were ineffective in identifying and addressing the areas of concern we found during the inspection. The provider was involved with the service but their involvement lacked any effectiveness. They had failed to have clear and adequate oversight of the service which meant they failed to address the breaches identified at the last inspection. Furthermore since the last inspection, the quality and safety of the service had declined further. This demonstrated that the governance systems in place were ineffective and that the provider’s leadership of the service required significant improvement.

Devonshire Manor provides personal care and accommodation for up to 15 people. The home is a detached three storey building in Birkenhead, Wirral. It is within walking distance of local shops and had good transport links. A small car park and garden are available within the grounds. A stair lift enables access to the bedrooms located on upper floors for people with mobility issues. There are 13 single bedrooms and a double bedroom for people who wish to share. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use.

On the day of our visit, there was no 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. At the time of our visit, there was an acting manager in post who assisted with the inspection.

We looked at the care records belonging to five people. We saw that people’s needs and risks were identified but found that risk management information was not always sufficiently detailed or followed, to ensure safe and appropriate care was provided. Records relating to the delivery of care and the management of risk were not always complete. This meant they did not consistently show that people received the care they needed in accordance with their risk management plans. This did not demonstrate that risks to people’s health, welfare and safety were managed appropriately.

Care plans contained some person centred information about people’s needs and preferences but it was limited. Some also contained the person’s life story which helped staff get to know them but not everyone whose file we looked at, had one of these. When we checked one person’s nutritional preferences we found that they had been provided with food items that they had already advised staff they disliked. This did not indicate that this person’s preferences were always respected. When we asked the manager about this, they told us the person had just recently started to eat these food items.

On the day of our visit, we identified issues with the safety and cleanliness of the premises that had not been picked up and addressed by the acting manager or the provider. We spoke to the acting manager and provider about these issues and they acted on them immediately however, it should not have taken CQC inspectors to point these things out before anything was done. Safety certificates were in place for the gas, electric and fire alarm systems and the equipment used within the home.

We found that where people had mental health conditions that sometimes impacted on their ability to make specific decisions, capacity to consent was not always assessed in accordance with the Mental Capacity Act 2005. Some people’s right to choose for themselves and take informed risks was not always respected.

Staff recruitment was satisfactory but we spoke to the provider about the systems in place to respond robustly to information received about staff once they were employed. We found that staffing levels were sufficient to meet people’s needs and everyone we spoke with told us that staff came quickly when they needed support. Staff received training to meet people’s needs and received appropriate support in their job role.

Medicines were managed safely and people received the medicines they needed. When people became unwell or required the support of other healthcare professionals this was organised accordingly so that people received the help they needed.

People told us they felt safe and it was clear they thought highly of the staff team. They said that the staff were kind, caring and looked after them well. Relatives we spoke with were also positive about staff at the home. We saw that staff supported people in a pleasant and patient manner. It was clear that people were relaxed and comfortable with the staff that supported them.

People comments about the food and drink provided at the home were positive. They told us they had a good choice of what to eat and drink. People were observed to enjoy the social activities on offer and during our visit participated in a sing-along, a nail pampering session and a game of bingo. This promoted people’s emotional well-being.

Safeguarding and accidents and incidents were recorded and responded to appropriately.

The provider has a range of audits in place to monitor the overall quality and safety of the service but these were not always effective. They had not identified the environmental hazards we found during our visit. They had not picked up on the lack of adequate risk management information or poor record keeping in relation to people’s care and they failed to ensure people’s right to consent to their care was obtained by following the Mental Capacity Act 2005. This did not demonstrate that the governance systems in place were adequate or that the service was always well –led.