We carried out a review of the data available to us about Devonshire House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Devonshire House, you can give feedback on this service.
Devonshire House is a residential care home providing care to up to 69 people. The service provides support to mainly older people some of whom are living with dementia. At the time of our inspection there were 48 people using the service.
People’s experience of using this service and what we found
People and their relatives told us they felt safe living at Devonshire House. All staff from every department were well thought of and words such as , ‘fantastic, lovely and kind’ were used to describe them.
Improvements to systems and reporting procedures had ensured that any events such as people falling and accidents leading to bruises were effectively managed and people were kept as safe as they could be along with appropriate medical interventions.
The quality assurance system was now more effective in identifying the issues we found during the last inspection. The action plans put in place at our last inspection had been effective.
Medicines were stored and managed safely within the home. Medicines were administered in a timely manner and in a way that respected people’s preferences. People’s medicines were considered in relation to whether they may contribute to the risk of falling.
Staffing levels meant that people were safe and they received their care in a timely manner. Recruitment procedures had been followed to ensure new staff were suitable.
Staff felt supported to carry out their roles effectively. People and staff were asked their opinions on the quality of the service. Relatives told us that they were happy with the service. One relative said, “We liked it here straight away. We liked its approach to us and our relatives.”
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
The last rating for this service was requires improvement (report published 9 June2022).
Why we inspected
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, Responsive and Well-led which contain those requirements.
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 Devonshire House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Devonshire House is a residential care home providing care to up to 69 people. The service provides support to mainly older people some of whom are living with dementia. At the time of our inspection there were 49 people using the service.
People’s experience of using this service and what we found
Staff were not always following safeguarding procedures when they identified unexplained bruising. The provider took action to ensure this was resolved.
The quality assurance system had not been effective in identifying the issues we found during the inspection. Action plans were not always clear regarding who was responsible for the action and by when.
Medicines were stored and managed safely within the home. Medicines were administered in a timely manner and in a way that respected people’s preferences. The risk of people falling did not consider the contribution of the medicines they were prescribed.
Staffing levels meant that people were safe and they received their care in a timely manner. Recruitment procedures had been followed to ensure new staff were suitable.
Staff felt supported to carry out their roles effectively. People and staff were asked their opinions on the quality of the service. The local authority had supported the home with improving the safe use of medicines.
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
The last rating for this service was good (report published March 2019).
Why we inspected
We received concerns in relation to the number of falls, medication errors and unexplained bruising. 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 has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Devonshire House on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 following safeguarding procedures and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
People’s experience of using this service:
We found that developments had taken place and people were now provided with better overall outcomes. The three beaches in regulation found at the last inspection had all been systematically addressed. People at this service were now provided with a more caring, consistent, responsive service that was being effectively managed through a period of change.
• The management of medicines was not always effective and sometimes placed people at risk of harm.
• Staffing remained a challenge but was safe with sufficient, appropriately trained staff supplied and people’s needs were met consistently.
• Risks associated with people's care were identified and staff knew how to manage them to keep people safe.
• People, relatives and staff were consulted and involved about changes made and those planned.
• People’s feedback was consistently positive about the care, support and staff. One person told us, “I am undoubtedly treated with dignity and respect. They are kind and caring to everyone. They are very nice and do whatever you ask.” A relative told us, “I have never come across anything that was not perfectly proper. They go above and beyond.”
• People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.
For more details please see the full report which is on the CQC website www.cqc.org.uk
Rating at last inspection: We rated Devonshire House as requires improvement and published our report on 8 March 2018.
Why we inspected: Previously we had rated this service as requires improvement and therefore have been back to check that it had improved to good. We had received an action plan telling us what the service managers would do to become compliant and therefore we checked this action had been taken.
Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated good.
Devonshire House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Devonshire House is registered to accommodate up to 69 people. On the day of our visit there were 58 people resident. There were 21 people living on Ryder unit. This is a specialised unit with adapted facilities for people living with dementia.
At CQC we have a named registered manager on records, but had been informed that the registered manager no longer worked at the service. We await an application for them to deregister. 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.
Devonshire House is a relatively new acquisition for Anchor Trust and this along with the changes in management mean they need to develop a clear vision and credible strategy to deliver high quality care and support at Devonshire House that involves all stakeholders. The lack of consistent quality leadership has led to the breaches found at this inspection.
We found three breaches in the regulations. Risks to people’s safety and welfare were not robustly assessed. This was particularly in relation to supporting people with distressed behaviour that were living with dementia and also falls prevention. We observed altercations between people that went unnoticed and had potential to escalate. Guidance for staff was not clear to minimise risks and promote people’s safety.
There were insufficient staff deployed consistently to meet people’s needs. Managers at the service did not have oversight as to where people were within the service and how many staff were deployed and where they were working. There were examples particularly on Ryder unit where people were not supported appropriately. There were gaps in past the rosters despite managers using dependency tools to determine staffing.
The complaint systems in place did not effectively address people’s concerns raised nor were they used to drive improvements. People were not supported by the provider to raise concerns when necessary. We found responses to concerns raised were not robust or individualised.
Overall the service people received was inconsistent. There was a lack of involvement of people in how the service was run therefore matters such as activities on offer and planning for end of life care needed further development. Anchor Trust had recognised these shortfalls for themselves and had started to action some points. Additional management support had been drafted in. There were consultations in place about the development of the environment. Environmentally this was a pleasant place for people to live, but the Ryder unit needed development to enhance the experiences for people living with dementia.
Staff supporting people were caring and compassionate. They were dedicated and willing to support people the best way they could. Staff on the Ryder unit would benefit from enhanced training in dementia. People did receive access to good health care and had sufficient to eat and drink. Staff promoted choices and independence for people.
You can see what action we told the provider to take at the back of the full version of the report.