Archived: Durranhill

Durranhill is a period property set in large grounds to the east of Carlisle city centre.

Durranhill 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.

The home had a suitably qualified and experienced temporary manager in place. At the time of our inspection they were not the 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 staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and could talk to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans supported people well. Arrangements were in place to ensure that new members of staff had been suitably checked before commencing employment. Any accidents or incidents had been reported to the Care Quality Commission and suitable action taken to lessen the risk of further issues.

The manager had ensured that there were now sufficient staff to support people. Staff were suitably inducted, trained and developed to give the best support possible. We met experienced and confident team members who understood people's needs as well as new staff who were keen to learn.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary.

Good assessment of need was in place and the staff team analysed the outcomes of care for effectiveness. We saw people enjoying the food they had cooked with staff support.

The home required refurbishment, the provider was working closely with their landlord to improve this and agreed to refurbish the home within 12 months.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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.

We observed kind, patient and suitable support being provided by staff who knew people well. They made sure that confidentiality, privacy and dignity were maintained. People were encouraged to maintain and develop their independence and encouraged people to follow their own interests and hobbies as part of their rehabilitation. No one was receiving end of life care when we visited but there were plans in place and training available should the need arise.

Support plans provided detailed and relevant guidance for staff in the home. People in the service were involved in the writing of support plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

The manager demonstrated good vision and values. Staff were able to discuss good practice, issues around equality and diversity and people's rights. The service had a comprehensive quality monitoring system in place which was used to support future planning.

We last inspected Durranhill in June 2014 when the provider had been the Croftlands Trust. At that inspection we found the service was meeting all of the legal requirements in force at the time. The service has since been taken over by The Richmond Fellowship in August 2016 and completed the CQC registration in February 2017. The Richmond Fellowship are a national mental health provider and have taken over other mental health services across Cumbria which were also formerly run by The Croftlands Trust.

There was a registered manager in post. 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.

Durranhill provides accommodation, care and support to 10 people. At the time of the inspection 10 people were using the service.

We found that at times staffing levels were insufficient and staff were not always deployed in such a way to fully meet people’s needs. Some people living in the home were not receiving enough one to one time with staff to meet their therapeutic and social needs. People told us that staff were often busy in the office and didn’t like to disturb them. Staff also reported that at times staffing levels could drop and this meant they struggled to meet people’s needs. Occasionally this had been as low as one staff on a shift. Staff said that the new systems of The Richmond Fellowship were taking time to get used to and they had been spending more time in the office. The registered manager had an active recruitment drive to address these staff shortages.

People received support from staff trained in how to protect them from abuse. Staff knew how to recognise and report potential abuse if they had any concerns. Risks to people were assessed and centred on the needs and rights of each individual. Staff had sufficient guidance which they followed on how to manage identified risks to people.

People were supported by staff with the knowledge and skills required to meet their needs. Training was being developed that focused on a more classroom based model with a move away from e-learning. Staff reported that they found this face to face style of training more effective and encouraged a more consistent team work approach.

We have made a recommendation about staff training around therapeutic ways of working with people.

Staff received support and supervision to enable them to undertake their roles effectively. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed.

Staff supported people in line with the principles of the Mental Capacity Act 2005. People consented to care and treatment and understood the reason for their admission to the home.

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

People were encouraged to maintain a healthy diet and received the support they required to develop their cooking and budgeting skills. Staff made referrals to healthcare professionals when a person’s mental health showed signs of decline. People had access to services they needed to have their health and support needs met.

People were supported as appropriate to receive their medicines safely from staff assessed as competent to do so. Medicines were safely and securely stored at the service. People were supported to manage their medicines as part of a planned move to living independently in the community.

Staff communicated effectively with people and delivered their care in a friendly and compassionate manner. Staff encouraged people to do as much as possible to help them to maintain their independence. People’s care was provided in a way that promoted their dignity and privacy.

People received care that was responsive to their needs. People were involved in the planning of their care, support and rehabilitation. Staff assessed and reviewed people’s needs to ensure care was planned and delivered in a consistent way. Care plans were person centred and had set goals in relation to people regaining their independence. They were supported to pursue their interests and to take up new ones. However one to one time staff had to spend with people had been affected by the staff shortages.

The registered manager was approachable and open to ideas to develop the service. People knew how to share their views and to make a complaint if they were not happy about the quality of care. People said the manager was very approachable and took quick action to resolve any problems they had.

Staff understood their roles and responsibilities to support people towards independent living. The ethos of the service was to engage and empower people to manage their own mental health effectively as possible.

We have made a recommendation about standards of hygiene in the communal areas of the home.

The service was subject to regular checks and audits by the registered manager and by The Richmond Fellowship. However, we found that the auditing and monitoring system of the provider did not pick up on, or address, the issues we found at this inspection. We were particularly concerned about the staff shortages and the impact this had on the quality of the service people received.

Staff had mixed views on the support offered by The Richmond Fellowship with some feeling detached from the organisation.

We have made a recommendation about support and involvement of people using the service and staff.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in staffing. You can see what action we told the provider to take at the back of the full version of this report.