This inspection took place on the 16 July 2018 and was unannounced. At the previous inspection in July 2017 the overall rating was requires improvement. At that inspection we found a Breach of Regulation 12. This was because the provider had failed to provide safe care and treatment of people because the management of falls was not consistently safe and robust risk assessments and guidelines were not always in place. We also found improvements were required to the provider’s quality assurance framework. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met. However, the quality assurance systems whilst improved still needed to be developed to provide clear actions and outcomes.
Dunsfold is a 'care home'. 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. It is registered to provide support to a maximum of 18 people and 12 people were using the service at the time of our inspection.
Dunsfold is a residential care home that supports older people living with dementia and disabilities associated with old age such as limited mobility, physical frailty or health problems such as diabetes. Accommodation was arranged over two floors with stairs and a stair lift connecting each level.
The service had a registered manager in place. 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.
We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their provider information return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Dunsfold has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been sustained.
Improvements had been made to the provider’s quality assurance framework; however, these improvements were not yet embedded or sustained. The registered manager and provider were not always proactive in identifying how ongoing improvements could be sustained. Shortfalls in the provision of training had not always been identified by the provider’s quality assurance framework. We have identified this as an area of practice that needs improvement.
Whilst risk assessments were undertaken they were not in a format that identified all risk factors considered, evaluation of action taken or the review of the actions taken.
We have recommended that the provider accesses the Health and Safety Executive (HSE) website in respect of the five steps of risk assessment or the seven steps to patient safety (NPSA 2004.)
Regular fire alarm checks had been recorded, and staff knew what action to take in the event of a fire. However, there was some confusion over the need for staff to undertake practical practice fire evacuations. At this time staff had received fire training but not regular fire drills.
We have recommended that the provider seeks advice from the fire service in respect of fire training..
People were relaxed and comfortable with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire or emergency situation. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.
Staff received training in order to undertake their role. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been when requested to ensure people were safe and the registered manager was waiting for a response from local authority.
People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.
People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were mixed and people could choose either group activities or one to one. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.
Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.