Deansfield Residential Care Home

Deansfield Residential Care Home is a residential care home providing accommodation for to up to 16 people who require personal care. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 14 people using the service.

The home has a communal bathroom and shower room and all bedrooms have a wash basin. People also have access to a communal dining room and lounge.

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

People were protected from the risk of abuse. The provider took a proactive approach to assessing and mitigating risks to people's safety. There were enough staff on duty to meet people's needs. Medicines were received, stored, administered, and disposed of safely. Staff had received appropriate training to administer medication. Staff and visitors wore PPE in line with the care home policy. There were systems in place to identify when things go wrong.

There were clear, person-centred information in people's care plans. People were supported to share their views and make their own decisions about their care. The provider ensured people's privacy and dignity was respected and promoted.

People achieved good outcomes from their care. There were investigations when things went wrong. The registered manager ensured people, relatives and professionals were informed and updated. There was a system to monitor and assess the care provided. Where audits identified errors or gaps, these were followed up and the lessons were cascaded through team meetings. There was a culture of continuous learning and improvement.

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 February 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Deansfield Residential Care Home on our website at www.cqc.org.uk.

Deansfield Residential Care Home is a residential care home providing personal care to up to 16 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 13 people using the service. The home has a communal bathroom and shower room and all bedrooms have a wash basin. People also have access to a communal dining room and lounge.

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

Audit systems did not always identify where outdated documentation was being used to record people’s health needs. This meant that one person’s health need was not escalated when it should have been. A risk assessment was not in place to guide staff how to manage risk related to a clinical need, but quality checks failed to identify this.

People told us they felt safe. Staff knew the types of abuse and understood how to report concerns. Medicines were stored and administered safely, and protocols were in place for the administration of ‘as required’ medicines. People were supported by a sufficient number of competent staff who were appropriately trained and had been recruited safely. Where things went wrong, the provider and manager acted on them to reduce the risk of reoccurrence.

Some governance systems had improved since the last inspection. Safety checks had been improved and contingency measures had been put in place to ensure these were undertaken consistently. Medicines audits were robust and action was taken where errors were identified. Staff told us the manager and provider were supportive and approachable. People and relatives were encouraged to provide input regarding the service which was acted on. The manager and provider were open and honest and understood the duty of candour.

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

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 October 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had improved but still remained in breach of regulations.

Why we inspected

We received concerns in relation to the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remained requires improvement based on the findings of the inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of the report. The provider took immediate action to mitigate the risks we identified at inspection. This included implementing a risk assessment immediately and reviewing documentation to ensure it was up to date and effective. You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deansfield Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the governance of the service at this inspection. Please see the action we have told the provider to take 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.

Deansfield Residential Care Home provides accommodation and personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 16 people. The home is situated on three floors providing bedrooms on the ground and first floor which are accessible via stairs and a passenger lift. People have access to a lounge, dining area and an outdoor space. Bathrooms and toilets are situated near to all communal areas.

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

We found risks relating to the premises not always being safely managed.

Management checks and audits were not always effective at identifying where improvements to safety measures were required and learning lessons after adverse incidents.

Staff managed people's medicines safely, in line with national guidance. People were supported by staff who had been assessed as safe to work with vulnerable adults. People were kept safe from the risk of infection and COVID-19.

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

The manager and staff were clear about their responsibilities. The service worked in partnership with a variety of community professionals to ensure people received any specialist support they needed. Management sought people's views about the service and acted upon them.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made but further improvements were required, and the provider remained in breach of regulation 12 and 17

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deansfield Residential Care Home on our website at www.cqc.org.uk

Enforcement

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 in relation to maintaining a safe environment, taking action to mitigate risks after adverse incidents and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Deansfield Residential Care Home provides accommodation and personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

The home is situated on three floors providing bedrooms on the ground and first floor which are accessible via stairs and a passenger lift. People have access to a lounge, dining area and a pleasant outdoor space. Bathrooms and toilets are situated near to all communal areas.

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

Governance systems were ineffective at identifying and correcting issues at the home.

People could not be assured they would be cared for safely and that their medicines would be stored, administered and recorded appropriately. People could not be assured that lessons would be learnt if things went wrong.

People did not have detailed care plans and risk assessments which meant staff may not have the information to support them safely. Checks to ensure staff training had been embedded were ineffective which meant they might not be supported in a safe way.

People could not be assured they would receive person centred support as care plans lacked detail about the people they were written for. People may not receive information in a format they understand.

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

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

Rating at last inspection and update

The last rating for this service was inadequate (published 20 May 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about lack of leadership, poor management of people's medicines and poor risk management. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report

Enforcement

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 in relation to regulation 12, safe care and treatment and regulation 17, good governance at this inspection.

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 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.

Deansfield Residential Care Home provides accommodation and personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

The home is situated on three floors providing bedrooms on the ground and first floor which are accessible via stairs and a passenger lift. People have access to a lounge, dining area and a pleasant outdoor space. Bathrooms and toilets are situated near to all communal areas.

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

People could not be assured they would be protected from the risk of potential abuse, as the provider was unable to demonstrate staff would have the skills and knowledge to recognise abuse and act on it and we were unable to discuss this with staff. Risk assessments were ineffective to ensure people received care and support safely. People were not supported by skilled staff to take their prescribed medicines and they did not always receive their treatment. People could not be confident there would be enough staff to support them during the night-time. Infection, prevention and control measures were not effective to ensure people would not be placed at risk of contracting avoidable infections. Lessons were not learnt when things went wrong and continued poor practices placed people at risk of potential harm.

The provider did not have a registered manager in post. Hence, there was no leadership to empower staff and to promote good care practices. Quality monitoring systems were ineffective to ensure people received a safe and effective service.

People and staff were not actively involved in developing the service and the provider did not engage with other professional agencies to improve the quality of the service. There was no evidence of innovation to improve the service in a timely manner.

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

Rating at last inspection and update

The last rating for this service was good (published 23 August 2021).

Why we inspected

We received concerns in relation to the lack of leadership, poor management of people’s medicines and poor risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to regulation 7, Requirements relating to registered managers, regulation 12, Safe care and treatment, regulation 12.3, Vaccinations as a condition of deployment, regulation 17, Good governance and regulation 20 Duty of candour, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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 of 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.

Deansfield is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 people. The home is a large rural property with bedrooms on both the first and ground floor. People have access to a shared lounge and dining area as well as a large garden. Many of the people residing at the home are living with dementia.

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

Governance systems were still being embedded and the provider was working to ensure they had up to date and accurate information about what work was required. This included monitoring care practice and reviewing people’s care plans to ensure they had been updated.

People felt safe in the home and risks within the property were assessed. People were supported by enough staff although, there had been recent pressure on the team following a recent staff turnover. The provider was in the process of recruiting new staff. People received their medicine on time, and we were assured by the infection, prevention and control measures in place.

People had access to food and drink throughout the day and staff were trained to support people’s needs. People were supported to access health appointments and there was communication with other agencies when needed.

The environment was homely. However, improvements had been highlighted by the provider and plans were in place for the replacement of some furniture and the redecoration of some areas of the home including, replacing some of the flooring.

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

Staff told us they were positive about the future; acknowledging the past few months had been somewhat difficult. Staff were being mentored to understand and be able to implement the provider policies and procedures and this was contributing to the development of the service and its ability to learn lessons when things went wrong.

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 Outstanding (Published 7 June 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the impact of changes to the management of the home. A decision was made for us to inspect and examine those risks.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff were adhering to personal protective equipment (PPE) guidelines and social distancing.

The service has two Infection Prevention and Control (IPC) link staff, who regularly met with the Clinical Commissioning Group (CCG) IPC Lead.

The service was using technology to enable families to keep in touch and was flexible around when families contacted the service to speak with people living in the home via facetime or the telephone.

Staff wellbeing was discussed during supervision and staff had access to support, help and advice through the local authority.

The owner had ordered a garden room for delivery at the end of February 2021. This was a cabin with Perspex dividing the room, which will enable safer visiting when allowed. People living in the home will be able to see and speak with their relatives in a safe environment, reducing the risk of transmission of infection.

At the start of the pandemic, a decision was made for staff to move into the cottage on site to reduce the risk to people living in the home. Shift patterns were altered and staffing levels increased. This was done to reduce to risk of staff catching Covid-19 and bringing the infection into the home.

People’s experience of using this service:

People felt safe and care and support was of a very high standard.

People were very satisfied with the quality of the service provided and feedback from relatives, visitors and health professionals was exemplary.

People received their medicines as and when they needed them.

Risks to people were monitored and procedures were in place to help keep people safe.

People were protected from the risks associated with the control and spread of infection.

Staff understood the importance of ensuring people's rights were understood and protected. Individuality was celebrated.

People's health care needs were monitored and responded to promptly with cooperation and support from health care professionals.

There were sufficient staff to meet people’s needs flexibly. Staff felt very well supported and trained.

Support was very personalised to meet individual’s individual needs.

People told us staff fully understood their needs and were extremely kind and caring.

People were confident that complaints would be addressed and they could talk to the management team about anything.

Quality checks and audits enabled the registered manager to ensure improvements were made and excellent quality standards were maintained.

People received excellent support at the end of their lives.

The management of the service was innovative and inclusive. New initiatives were developed and tested to drive continuous improvement.

The service had excellent community links.

Rating at last inspection: The service was rated Outstanding at the last inspection in September 2015.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Deansfield is registered to provide accommodation and personal care for a maximum of 15 older people. On the day of the inspection 15 people were living at the home.

The home had a registered manager in post who was present for the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Clear guidance was in place and staff knew how to report any concerns about bad practice. Staff were trained in protecting people from harm. Risks were managed to keep people safe while promoting their independence. Care was regularly reviewed with people and their representatives where appropriate to reflect people’s changing needs. People were supported by sufficient numbers of staff so that their needs as individuals were met and their preferences respected. The provider believed that people should receive care and support that was not rushed or task focused. People were valued and their views and opinions were always sought.

Staff were recruited following a robust recruitment procedure and there were clear expectations from managers about work performance of staff. People received their medicines safely and as prescribed. Staff were trained in the safe handling and administration of medicines and their competency was regularly assessed.

The provider was committed to creating and developing a skilled workforce. People spoke highly about the skills and attitude of the staff team. Staff were supported through one-to-one meetings and annual development reviews to reflect on their practice and to look at ways of developing themselves by identifying future learning needs.

The registered manager and staff understood how to protect people’s human rights and worked within the current legislation to do this. People had regular access to healthcare professionals to monitor their wellbeing such as doctors, district nurse, chiropodists, dentists and via the memory clinic. We saw staff acted swiftly to engage the support of healthcare professionals where people needed specialist advice and assessments. The provider ensured the correct equipment was in place if people’s needs had changed in order not to place people and staff at risk.

Everyone we spoke with was happy with the care they or their loved one received. Staff knew people well and had positive relationships with them. The registered manager ensured that staff fully understood people’s needs before they were admitted to the home. Visitors were made welcome and people were supported to keep in contact with people who were important to them. People felt their dignity was promoted by staff and that staff were respectful and polite to them at all times. The service provided home cooked food and meal times were made a relaxed sociable experience for people and their families who chose to eat with their loved ones.

The provider and staff supported people in a number of creative ways to lead a fulfilling life when they went to live at Deansfield. Their commitment and determination to promote people’s quality of life was recognised in everything people told us and our observations. People told us they were able to raise any concerns they had and felt these would be acted on by the registered manager. The provider had a system to deal with any complaints.

There was strong leadership at the home which provided staff with drive and enthusiasm and ensured that there was regular evaluation of the work they carried out. The management team fully involved people and put them at the heart of everything that took place at Deansfield. They included staff and relatives in evaluating what they did and were keen to continually develop the home. The registered manager and provider were both experienced health and social care professionals who believed in focusing on individualised care and ensuring a good quality service. Staff told us they felt supported by the management team and considered the home was well managed. The provider had made sustained improvements over time and had been awarded “care home of the year” from Shropshire Partners in Care (SPIC). SPIC is a not for profit organisation committed to maintaining and improving standards by providing training, advice and guidance for care providers, managers and their staff, for the benefit of those they care for.

People told us that they were happy with the support they received, and that the staff looked after them well. They told us they liked the food, there was a choice of menu and that they chose where to eat.

Care records seen showed that people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed, and was appropriately checked and agreed with people or their next of kin.

We saw comments from relatives that included, 'We are so grateful that X is so well looked after by you and your staff'. 'Thank you for all the support you gave to my mother. We know it was not always easy but we knew the care she received was always first class'.

There were effective systems in place to reduce the risk and spread of infection.

We sampled recruitment records and saw that appropriate checks and interview processes were carried out. This ensured that suitable staff were employed to work in the home.

Staff were available in sufficient numbers to care for people and they received the training and support they needed to carry out their roles.