Background to this inspection
Updated
7 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection took place on 10 and 11 April 2018. The inspection was unannounced and was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience supporting this inspection had experience of working with and supporting older people.
We reviewed the information we held about the home. This included previous inspection reports and notifications sent to us. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.
We met and observed the majority of the people who lived at the service and received feedback from nine people. Not everyone was able to verbally share with us their experiences of life at the home due to their dementia/complex needs. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with three relatives to ask their views about the service.
We spoke to eight staff, including the provider, registered manager, deputy manager, senior care workers, care workers and activities co-ordinator.
We reviewed information about people’s care and how the service was managed. We looked at five people’s care and medicine records, along with other records relating to the management of the service. These included staff training, support and four employment records, quality assurance audits and minutes of residents and staff meetings. We also contacted four health and social care professionals and commissioners of the service for their views
Updated
7 June 2018
Dene Court is registered to provide accommodation with personal care for up to 28 people who may have needs due to old age, sensory impairment, physical disabilities, dementia, learning disabilities, autism or mental health needs. 24 people were living in the service at the time of the inspection. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the inspection of the home carried out in November 2015 we found breaches of regulations. The service was then rated as 'inadequate' and placed into special measures. The special measures process is designed to ensure there is a timely and coordinated response where we judge the standard of care to be inadequate.
At the next comprehensive inspection of the service in April 2016, we found significant improvements. There were no breaches of legal requirements at that inspection, but there had been insufficient time for new management systems to be embedded. Therefore we rated the service as ‘requires improvement’.
On 31 August 2017 and 5 September 2017 we carried out an unannounced focussed inspection to look specifically at the safety of the service and to check that improvements had been maintained. We confirmed this was the case and the service was safe.
The home had a registered manager. 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. They, along with the provider were committed to the improvement and development of the service and had continued to make significant changes which had a positive impact on the safety and quality of the service.
At the inspection in April 2016 we found the quality monitoring systems in place to ensure the home ran smoothly were not yet fully established. At this inspection we found there was a comprehensive system of audits in place which scrutinised all aspects of service provision and the environment. People, relatives and staff were invited to express their views of the service through satisfaction surveys and at staff and residents meetings. The information from the quality assurance processes was used to drive improvements at the service.
There were systems in place to ensure risk assessments were comprehensive, current, and supported staff to provide safe care whilst promoting independence. The computerised care planning system, accessed by staff using hand held computers, ensured that information about people’s risks was shared efficiently and promptly across the staff team. This meant staff had detailed knowledge of people’s individual risks and the measures necessary to minimise them. Care plans were comprehensive and reviewed monthly; however we had mixed views from people and their relatives about how the service involved them in this process and decisions about their care. We raised this issue with the registered manager who was already looking at ways to improve communication with families and provided reassurance they would take action to involve people and their relatives more in reviewing their care plans.
People had mixed views about the food at the service. Most said they enjoyed the food, but would prefer more choice. People had sufficient to eat and drink and received a balanced diet, and care plans guided staff to provide the support they needed. The service supported people with special dietary needs, for example a diabetic or pureed diet. However one person expressed concern about the availability of food appropriate for their specific dietary needs and staff understanding of their condition. The registered manager told us they had been working with the person, their family and health professionals to clarify what the person’s dietary needs were and how they could be better met. They had already ordered some sugar free desserts and undertook to ensure all staff had a clear understanding of this person’s individual dietary needs.
People told us they felt safe. Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. People told us staffing levels were adequate. The service regularly reviewed the dependency levels of people at the service and staffing levels to ensure people’s needs continued to be met safely. Regular environmental health and safety checks were undertaken. There were effective infection prevention processes in place, the home was compliant with fire regulations and a programme of refurbishment was in progress. People were protected from the risk of abuse through the provision of policies, procedures, staff training and an effective recruitment process.
Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.
People were relaxed and comfortable with staff and told us staff treated them with dignity and respect. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds, respected their choices and acted in accordance with their wishes.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The registered manager had made appropriate applications for people they had assessed as being deprived of their liberty, to the local authority DoLS team.
There was an activity co-ordinator at the service who was working with people to develop an activities programme which would better meet their needs.
There was a newly developed induction process and a greater focus on staff training, which meant staff were knowledgeable about their roles and responsibilities, and people’s individual needs. This included specialist training from external health professionals. Staff had regular supervision and told us they were well supported, saying they felt more valued. They told us, “It feels more like a team. We’ve got policies and procedures and the things we were meant to have “and, “Communication has got a lot better. I personally love it here. I really do. I feel a weight has just been lifted.”
The provider and registered manager were committed to promoting equality, diversity and human rights at Dene Court, ensuring potential new staff shared their values and increasing staff awareness through training.
Policies and procedures had been reviewed which meant they were now less generic and more relevant to Dene Court and the people living there. They had been explained to staff to ensure they had a good understanding of them and their responsibilities.
People knew how to make a complaint if necessary, and both complaints made since the last inspection had been dealt with in line with the services complaints policy.
We have made a recommendation about ensuring people with protected characteristics under the Equality Act 2010 have their needs properly considered and assessed.