Daneside Mews

Daneside Mews is a residential care home providing personal care to up to 34 people. The service provides support to older people. At the time of our inspection there were 33 people using the service in a purpose-built building.

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

We have included a recommendation in respect of a review of relatives’ preferred involvement in their relations’ care.

People received safe care. Improvements had been made in systems for the reporting of allegations of abuse. Medication systems were safely managed. The review of risks faced by people from their health conditions and the environment had been reviewed and were up to date. Equipment used by people was serviced regularly and safe to use.

Relatives told us that their relation was safe. People appeared relaxed and comfortable with the staff team. They told us that they were happy with the way staff supported them. This was reflected in our observations. This was echoed by relatives. Staff knew people’s individual preferences and respected these.

Staff levels met the needs of people and staff worked to ensure Where people needed 1 to 1 support; this was provided appropriately. The building was clean and hygienic, and this was confirmed through what relatives told us as well as our observations.

Robust auditing was now in place with a variety of audits being carried out to monitor the quality of care provided at Daneside Mews. Relatives told us that they knew who the manager was and saw them as approachable and providing a well led service. Most relatives commented that the management team were very open and transparent and involved them in updates about their loved one’s care.

All people, families and staff were asked to comment on the care provided. The service continued to work effectively with other agencies such as district nurses to promote the wellbeing of people.

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 2 April 2021). At this inspection we found improvements had been made and the rating had improved to good.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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.

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

Enforcement and Recommendations

No breaches of regulation were identified at this inspection. We have made a recommendation in respect of the service reviewing the communication preferences between the service and relatives on their relations’ progress.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Daneside Mews is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. The service can support up to 34 people. It accommodates people in one purpose-built building.

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

People had not always been consistently protected from abuse. The reporting of a safeguarding incident had been delayed due to a lack of staff knowledge of reporting procedures and training in safeguarding. This had now been addressed at the time of our site visit with the procedure being reinforced through supervision and new reporting protocols.

Shortcomings in medication management, falls risk assessments and completion of other quality assurance documents had been identified by provider's audits. A new plan of action had been agreed between the registered manager and the registered provider to ensure compliance. Although no-one had been harmed, people were potentially at risk of harm

The premises were clean and hygienic, and measures taken to minimise the risk to people of becoming Covid-19 positive were in place. There were sufficient, appropriately recruited staff to support service users. Service users were relaxed and comfortable with the support they received. No concerns of people's personal safety were raised by relatives.

The registered provider had systems in place to check the quality of the care being provided. An external system of regular auditing by the quality director was in place and recent audits had identified some shortcomings in the internal quality assurance systems used by the registered manager. Some of these concerns were ongoing. As a result, the service was not consistently well led.

Systems were in place to gain the views of both people who used the service and their families. Relatives confirmed they were asked for their views and considered the service to be well run and the registered manager supportive and attentive.

The service always notified us of significant incidents within the service.

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

Why we inspected

We received concerns in relation to reporting safeguarding concerns and falls risk assessments. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We also 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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We found no evidence during this inspection people were at risk of harm from this concern. Please see the safe and well-led sections of this full report. The registered provider had taken steps to address these initial concerns.

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

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.

Daneside Mews 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.

Daneside Mews provides personal care for up to 34 older people who have dementia. The home has single room en-suite accommodation over two floors. Each floor has a lounge, dining area and bathing and toilet facilities. There is access into the garden, which has seating and tables. At the time of our visit, 30 people were living at Daneside Mews.

The service 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. The registered manager was present during the days of our visit. The manager had been registered with CQC since our last visit in February 2017.

We previously carried out an unannounced comprehensive inspection of this service on 7 February 2017. At that inspection we rated the service as requires improvement as we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

On this visit, we found that the two breaches identified at our last visit had been addressed.

During the last inspection in February 2017, it was identified that the registered provider had failed to take action following an investigation, in response to safeguarding concerns that had been raised. This had resulted in three safeguarding concerns of a similar nature over a period of six months because protective measures had not been identified and implemented. In addition there had been a delay of four days in reporting on safeguarding concern. This had failed to ensure people’s safety and demonstrated that systems had failed to identify this as an issue.

This visit found that staff were aware of the types of abuse that could occur and were clear about how to report any concerns and had received training. Aide memoires were in place summarising the action staff needed to take in the event of an allegation being made. They were confident that the registered manager would take action on this. In addition to this, body maps were in place which recorded any unexplained injuries or marks. These were audited by the registered manager and action taken. As a result, no safeguarding issues had been missed.

During our last visit in February 2017, we had also identified that the registered provider had failed to follow processes in relation to their own safeguarding policy. In addition to this, the quality monitoring systems used by the registered provider had failed to identify and address ongoing issues in relation to a safeguarding concern.

This visit found that the registered manager had introduced a clear auditing system for the reporting of all safeguarding concerns. Any referral to the local authority safeguarding team or CQC had been recorded and a clear process of accountability established. This accountability also extended to monthly reports that the registered manager submitted to the registered provider so that all safeguarding incidents would not be missed. As a result, people who used the service were better protected.

Staff were aware of how to raise care concerns using procedures the registered provider had established. This extended to informing external agencies such as CQC.

Recruitment processes were robust. Appropriate checks were made in respect of ensuring that new staff were suitable to support vulnerable people.

Staffing levels were maintained. There were appropriate numbers of staff present during our visits to ensure that people’s needs were responded to in a timely manner.

The premises were hygienic and well-maintained. All equipment used was serviced regularly.

Risk assessments were in place for people to ensure that they were not at risk of falls, the development of pressure ulcers or malnutrition. All were up to date and risks faced by people from the environment were in place. Plans to evacuate people in an emergency where in place and easily accessible if needed.

Staff received the training and supervision they needed to perform their role. Staff were aware of the principles of the Mental Capacity Act. These principles were embedded in care practice.

The registered provider responded to the health needs of people. People were referred to medical professionals where appropriate.

The design of the building included signage to aid people who used the service. Contrasting decoration was in place to assist those living with dementia.

Care staff adopted a kind and patient approach with people who used the service. This view was echoed by people we spoke with and their relatives.

People were supported in a dignified manner which took their privacy into account. Confidential information was always kept secure when not being used.

Care plans were person centred. These outlined people’s likes, dislikes and preferences. Care plans were up to date and accurate. Assessments of care were in place to assist in devising relevant care plans. These covered all medical and social needs of individuals.

An activities programme was in place. Regular activities were held. Two people commented that they wished to re-establish activities they had had with a local church prior to them coming to live at Daneside Mews. This was raised with the registered manager.

A complaints procedure was in place. Records were maintained outlining complaints received and how they had been investigated.

The registered provider had a number of effective audits in place to assess the quality of the care provided. The views of people who used the service and their families were gained through annual surveys and touchscreen review facilities.

Staff, people who used the service and relatives commented that the registered manager was approachable, supportive and that the service was well-led.

The registered manager always notified CQC of any incidents that adversely affected the wellbeing of people who used the service.

Daneside Mews is registered to provide accommodation and personal care for up to 34 people living with dementia. At the time of the inspection visit there were 24 people living at the service. The service is situated over two floors and people have access to a secure garden which is well maintained.

There was a manager in post within the service however they were not registered with the CQC. The current manager was acting as a 'turn-around manager', employed by the registered provider on a temporary basis to make improvements within the service. The service had been without a registered manager since November 2016.

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 last inspection in January 2016 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people’s care records and risk assessments did not contain accurate and up-to-date information. These issues had not been identified by auditing processes. Quality monitoring processes had also failed to identify and act on issues with staffing levels and a failure to follow disciplinary procedures where required. At this inspection we found that improvements had been made, however we identified issues in other areas.

During this inspection we identified repeated breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was identified that the registered provider had failed to take action following an investigation, in response to safeguarding concerns that had been raised. This had resulted in three safeguarding concerns of similar nature over a period of six months because protective measures had not been identified and implemented. In addition there had been a delay of four days in reporting on safeguarding concern. This had failed to ensure people’s safety and demonstrated that systems had failed to identify this as an issue.

You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we identified two occasions where the registered provider had failed to notify the CQC of safeguarding concerns that had occurred within the service. This is a legal requirement that is placed on the registered provider.

At the last inspection in January 2016 we found that staff did not have a good knowledge of the Mental Capacity Act 2005 (MCA) and that mental capacity assessments were not in place. At this inspection we found that staff had a good understanding of the MCA. Whilst mental capacity assessments had been completed as required, there were some outstanding. The manager told us that action would be taken to complete these.

At the last inspection in January 2016 we identified that care records and risk assessments did not contain sufficient or accurate information to enable staff to meet people’s needs. At this inspection we found care records had improved and risk assessments contained explicit detail around how people should be supported. Care records were personalised and contained details of people’s likes and dislikes. This helped to ensure people received the correct level of support.

At the last inspection in January 2016 people told us that they did not feel there were enough staff and there had been no staffing tool in place to determine the number of staff required. At this inspection there were enough staff to meet people’s needs, and a tool in place which showed that the registered provider had enough staff. Staffing rotas showed staffing levels to be consistent which helped ensure people were kept safe.

At the last inspection in January 2017 we identified that disciplinary procedures were not being used where in line with the registered provider’s own policy. At this inspection we saw examples where these procedures were being appropriately used to hold staff accountable, and to maintain standards of care.

Staff had received training in areas required for them to carry out their role, however a recent safeguarding investigation had identified that staff had not received training in managing behaviours that challenge. This was despite staff working with people who needed support in this area. An action plan has since been completed by the registered provider in relation to this which showed immediate action was being taken.

During lunch time we observed that staff did not always spend sufficient amounts of time with those people who required support with eating. We checked records of those people affected to ensure that they had not experienced any weight-loss, and found that they had not. The manager raised our concerns with staff so that these could be addressed.

Positive relationships had been developed between people and staff. Staff supported people to engage in activities such as having a walk in the garden, singing and knitting. We saw staff spending time with people talking and laughing. People’s relatives commented that they felt welcome at the service and were offered refreshments.

People had been involved in the development of their care. Care records contained details around their life histories, likes and dislikes. There was information with regards to people’s end of life wishes, and information was clearly displayed where people did not want to be resuscitated in the event of their death. However there was no evidence to show that people were involved in the review of their care needs. We raised this with the manager who informed us this would be implemented during future reviews.

There was a complaints process in place which people had made use of. Complaints records showed that concerns had been responded to in a timely manner. This ensured that people’s concerns were being addressed.

The environment was kept clean and tidy and smelled fresh. Parts of the environment had been adapted to meet the needs of people living with dementia, for example communal areas were decorated with colour schemes appropriate for people living with dementia. However, other parts of the environment required further consideration with regards to accommodating the needs of those people living with dementia. The manager told us that plans were in place around this.

'They (the staff) are good to you.'

'They're (the staff) very good. They're nice people.'

'You can do what you want, you can walk about, you can sit outside in the summer.'

'I'm happy. Lovely girls (the staff).'

'I was poorly this morning so I went to the staff. They told me to lie down. They put Tom Jones on for me. I like Tom Jones. I'm fine now.'

The relatives we spoke to were happy with the support and care provided. They said people's individuality and dignity was promoted. They said their relatives saw health care professionals when needed and that the staff were generally good at keeping them informed about any changes to needs. Some comments made were:-

'I'm here every day. The staff are very co-operative. I couldn't wish for better.'

'The staff treat people as individuals.'

'In my experience I have always found that the home provides good care. The staff are very compassionate and caring and give understanding to those that are in their care. They are treated with respect and dignity.'

We spoke to four staff who said that a good service was provided and that people were well looked after.

We observed positive interactions between the people who used the service and the staff. Staff were attentive, had a caring attitude and were supportive.

We found that there were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

The staff were provided with the support they needed to enable them to meet the needs of people with dementia.

We found that the service involved and communicated with health and social care professionals when they were needed to ensure the needs of the people who used the service where appropriately met.

There were systems in place to monitor the quality of the service for people who had dementia.

We spoke to five people who used the service. They said they were well looked after and happy with the service received. They were positive about the staff who supported them.

The information we gathered from relatives and visitors indicated that they were happy with the care and support provided. They described the staff as caring and attentive.

We spoke to one health professional who supported people who used the service. They said that a good service was provided at the home.

There were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service. They had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

The staff were provided with the support they needed to enable them to meet the needs of the people who used the service.

There were systems in place to monitor the quality of the service.

We asked LINKs and Cheshire West and Chester Council for information about how the service operated. LINKs had no current information and no information of concern was reported by the Council.