Archived: Downshaw Lodge

The same inspector visited the service on 27 June 2014 to carry out an unannounced follow up inspection to see if the necessary improvements had been made. During our inspection we spoke with the registered manager, one unit manager, the maintenance person and the estates surveyor for the organisation. We looked at a selection of the provider's records, including a sample of people's care records.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The full report contains the evidence to support this summary.

Is the service safe?

Systems were in place to monitor people's records and to make sure their needs were being met appropriately and in a timely manner.

Equipment used by people living in the home was being regularly monitored and maintained to make sure it remained safe to use.

Systems used for the safety of people living, working and visiting the home such as the fire alarm was tested and maintained on a regular basis.

Is the service effective?

There were effective systems in place to assess, monitor and regularly evaluate how well the service was operating. Information was available to demonstrate that regular reviews of care plans and people's assessed needs were carried out. This meant that the management team could make changes to people's support needs quickly and effectively.

Is the service caring?

Records seen during this visit to the service demonstrated that other healthcare professionals such as doctors, speech and language therapists, dieticians and the district nursing service were contacted in a timely manner when people's health needs changed.

Is the service responsive?

The registered manager of the service responded in a timely manner to address the concerns we raised during our last inspection visit to the service in April 2014.

The maintenance person responded in a timely manner when concerns were noted about staff's lack of knowledge around fire zone areas in the home. Laminated signage was placed in the zone areas immediately to address the concerns.

Is the service well led?

Evidence seen during this inspection visit demonstrated that the provider and manager took appropriate action to address the concerns raised during our inspection carried out in April 2014.

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff team. One person told us, 'I wouldn't like to leave here, they [staff] are my friends'.

Systems were in place to make sure that the manager and staff team learn from events such as accident and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The registered manager and senior staff spoken with had received training to understand when an application should be made, and how to submit one.

We saw evidence that all new staff received a thorough recruitment check before starting work in the home. This helped to minimise the risk of unsuitable people being employed.

Records kept indicated that things such as window restrictors, hot water temperatures, wheelchairs and the fire alarm system had not been checked on a regular basis or in accordance with the organisations own policies and procedures. Lack of such important checks taking place regularly was putting people at risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to health and safety matters.

Is the service effective?

There were advocacy services available if people needed them, this meant that when required people could access additional support.

People's health and care needs were assessed with them, or with the support of their relatives or other healthcare professionals.

We found that some of the documentation relating to care planning was not always being fully completed or being updated within the required timescales. Lack of such important information being available meant that staff did not have proper guidance to inform them of the up to date health status of the person using the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping.

Is the service caring?

The atmosphere in the home was found to be calm and relaxed and care staff were observed interacting with people using the service in a professional and attentive manner.

People were given time to make choices and decisions about the care they wished to receive. Care staff were seen to support people sensitively and with patience especially when supporting people with personal care.

One person using the service told us, 'We are looked after very well. I like the food and I like to spend time in my room. If I need anything [named staff] helps me, he is very good and I like him'.

Is the service responsive?

Evidence was available in records to demonstrate that other healthcare professionals were involved in meeting people's care and support needs where appropriate. For example, visiting chiropodists, speech and language therapists, district nurses and optometrists. This meant that people using the service received co-ordinated care and support.

Is the service well-led?

Since our last inspection visit to the service a new manager had been appointed and registered with the Care Quality Commission.

People received their care in a co-ordinated way with the right care and attention from the appropriate professionals.

Information available from other healthcare professionals indicated that it was generally thought improvements to the service had taken place since the new manager had taken up post.

We found that there were a number of systems in place to audit and monitor the quality of service and care being provided in the home. There were also independent audits by local commissioners of services to check the quality and standard of service delivery on a regular basis. Such monitoring of the service helped to ensure that people received a high standard and quality of service at all times.

Some people who used the service had limited communication skills due to their dementia and because of this we were limited to the number of people we could speak with who could tell us what they thought of the service and how they were treated. In light of this we also spoke with care staff, observed care practices and observed people who used the service.

Those people we did speak with told us they were happy with the care and support they received at the home and their comments included, 'I'm being looked after well', 'I get a shower when I want one, the guys (staff) are very good' and 'I still like living here, the staff are fantastic with me.'

Staff were observed to support and care for people appropriately, competently and sensitively during our visit. They interacted with people appropriately, respected their wishes and maintained their dignity at all times.

All areas of the home were found to be clean, tidy and free from any unpleasant smells.

Following a recent inquest into the death of a person using the services at Downshaw Lodge who was on End of Life care, some significant concerns were raised about the level of care provided. Those concerns included the person not receiving sufficient hydration (fluids), poor communication between staff and other health care professionals and poor record keeping.

We looked at the action taken by the registered manager to make sure people living in the home were being cared for appropriately and according to their assessed needs.

Action had been taken by the registered manager to address those concerns identified during the recent inquest and within the complaint that had been raised. Evidence was available to demonstrate that staff had received further training in End of Life care and this was still ongoing at the time of our visit to the service.

Appropriate action had been taken by the registered manager to make sure that records relating to the care and well being of people living in the home were being monitored, reviewed and audited on a regular basis.

Evidence was also available to demonstrate that the registered manager was seeking the support and input from other health care professionals where it was felt they could support best practice for those people living in Downshaw Lodge.

We found that action had been taken to address the concerns raised at the last review.