Danesford Grange Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 40 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We identified language recorded within records was not always respectful. Incident records included descriptions which did not reflect a dignified or person-centred approach when describing people's behaviours and distress.

We observed a person expressing discomfort in a wheelchair which appeared unsuitable for their size and physical needs. Although concerns were raised, records did not demonstrate timely action had been taken to address this. We also observed a person asleep in a position which could compromise comfort and dignity, with no clear evidence this had been assessed or reviewed.
The environment did not always promote dignity. Worn furniture, damaged flooring, cluttered communal areas and poor maintenance detracted from people's overall experience of living in the home.

People told us staff were kind and caring, and we observed positive interactions throughout the assessment. We observed staff spoke to people in a respectful manner and many showed a genuine commitment to supporting people living at the service.

We observed staff responding to people with patience and compassion. The Activity Coordinators showed enthusiasm and promoted engagement, spending time encouraging people to participate in meaningful activities. Relatives also spoke positively about individual staff members and the relationships developed with people living at the home.
 

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People were not always treated as individuals, care planning and service delivery lacked a person-centred approach. Records were on generic templates and we saw standardised risk assessments which did not reflect people's preferences, backgrounds, wishes and care needs.

Care plans contained limited personalised information and, in many cases, conflicting information about people's needs.Generic falls, choking, and bed rail risk assessments provided little detail about the individual or how staff should adapt support to meet personal requirements.

People's preferences were not consistently reflected in practice. For example, records identified preferred foods, drinks and nutritional support. However, these were not always evidenced in monitoring records we reviewed. One service user's preference for smoothies and yoghurts had not been consistently provided. Another person was not offered a suitable alternative when they did not want part of their meal.

Important aspects of people's lives and wellbeing were not always recognised or celebrated. For example, staff were unaware of a significant wedding anniversary for one service user and their family, despite information being made available within records.

Personal Emergency Evacuation Plans (PEEPs) lacked personalised information. Guidance did not always describe how individuals communicated, how they may respond in an emergency or the support staff would need to provide based on their individual needs and behaviours.
 

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.
People were not consistently supported to have choice, control and independence in their daily lives. Care planning focused on tasks, with limited consideration of how people could have control over decisions affecting them.

Care plans lacked detail about what was important to people, how choices should be offered, or how staff should support individuals to remain as independent as possible. Care plans often did not show what people were unable to do and what they could still achieve with support.

People's rights were not always protected. Restrictions, including bed rails and coded door access, were used without clear evidence of decision-making and that consideration of less restrictive options had been explored. Records did not always demonstrate how people's freedom had been balanced against identified risks.
 

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

The provider did not always respond effectively to people's immediate needs. Systems and records did not provide assurance people consistently received timely and appropriate support when their needs changed or when risks increased.

We found examples where people experienced repeated falls, deterioration in skin integrity, pain, nutritional concerns and changes in health conditions. However, care plans, risk assessments and daily records were not always updated to reflect the changes to people’s needs. This increased the risk of delays in responding to emerging needs.

Records relating to accidents, incidents and deteriorating health lacked sufficient detail regarding actions taken, outcomes achieved and follow-up arrangements. Opportunities to review care and adapt support following significant events had been missed.

People requiring regular interventions did not always receive support in line with assessed needs. Repositioning records contained significant gaps, including for people at high risk of pressure damage.
Staff did not always have clear guidance to help them identify timely responses. Care plans contained conflicting information and risk assessments were often generic, reducing assurance staff could quickly identify and respond to changes in people's needs.

The provider failed to demonstrate learning from incidents or concerns. Issues identified during the initial inspection remained present during the follow-up visit, despite assurances improvements had been made.
 

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

The provider had not created an environment where staff were consistently supported, enabled or equipped to deliver high-quality care. Poor leadership, ineffective oversight and a lack of accountability impacted staff performance and service delivery.

Staff spoke positively about caring for people and we observed many staff treating people with kindness and compassion. However, responses were inconsistent and did not always reflect safe or effective care.

Management had reported additional training and learning sessions had been delivered to improve communication and care practices. When requested, no evidence could be provided to confirm these sessions had taken place, who had attended or what impact had been achieved. This reduced assurance staff received appropriate support and development following identified concerns.

Roles and responsibilities were not always clear. During inspection, senior staff demonstrated uncertainty regarding key governance processes. For example, required clinical audits had not been completed and the clinical lead advised they were not aware this was part of their role.

Support systems for managers and leaders were ineffective. The registered manager described challenges within the management team, including adjustments to duties for senior staff.

Staff all showed they cared for people and demonstrated a passion for wanting the best for people. Lack of guidance and support placed restrictions on staff effectively and safely carrying out their roles.