We inspected Dean Wood Care Home on the 13 and 14 September 2016. We previously carried out a comprehensive inspection on 24 and 25 February 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to people not being moved and transferred safely. We also identified areas of improvement required in relation to the management of medicines, staff not receiving regular supervision and the culture and morale of staff. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these concerns.
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, and confirm that the service now met legal requirements. We found improvements had been made in the required areas, however we identified further areas of practice that needed improvement.
Dean Wood Care Home is registered to provide accommodation and care, including nursing care for up to 80 people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is located in Woodingdean, East Sussex in a residential area. There were 77 people living at the service on the days of our inspections.
A registered manager was in post, however at the time of our inspection they were on planned leave. 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 and associated Regulations about how the service is run. Day to day charge of the home was taken by a support manager and the deputy manager, to provide consistent management cover until the registered manager returned to post. They are referred to as the manager in this report.
A formal supervision strategy for staff was yet to be fully established, as was a clear structure of one to one supervisions, as to who provides them and is accountable for them to be implemented. This issue had been identified through the providers own quality monitoring processes and systems have started to be put in place. However, this needs to be embedded, to ensure that the provider’s policies and good practice guidelines are being implemented.
The culture and values of the provider were not embedded into every day care practice. We received mixed feedback from staff in relation to whether they felt supported within their roles, and being able to approach management with issues and concerns. Mixed feedback was also received in relation to staff morale and feeling valued in their role.
Daily records used to monitor the assessed levels of air mattresses to help prevent pressure damage contained gaps in their recording, or were missing. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, the provider was unable to identify the specific actions from these audits and could not demonstrate improvement or impact for people over time.
The above issues have all been identified as areas of practice that need improvement.
People told us they were happy living at Dean Wood Care Home. One person told us, “The staff are helpful and kind”. A visiting relative said, “It’s brilliant care, they’ve really picked up on [my relative’s] personality”. People’s privacy and dignity was respected. Staff had a good understanding of people’s needs. They treated people with respect and protected their dignity when supporting them with personal care. One person said, “Staff are kind and considerate, they ask what I want to do”.
Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.
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.
People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).
Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
There were sufficient numbers of staff to ensure that people’s needs were met and that they received care and treatment promptly. One person told us, “There seems to be mostly enough staff. They come when I call them and pop in to check on me”. A relative said, “I think there are enough staff, that’s the beauty of a big home”. People commented they felt safe living at Dean Wood Care Home. One person told us, “I feel safe, it’s secure here”. Safe moving and handling practices were observe throughout the inspection. Staff were aware of what actions they needed to take to raise a safeguarding concern. Policies and procedures were in place to safeguard people.
Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including caring for people with dementia, and training around the care of pressure damage. Staff were positive in their feedback of the training available. 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.
People spoke highly of the food. One person told us, “The food is nice, not bad at all”. Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.
Care and treatment focused on the needs of the person and acknowledged their individuality and identity. There was a focus on meaningful activities to ensure people’s social and emotional well-being was fully promoted. There were activity co-ordinators in post who led on the provision of meaningful activities. A relative said, “My [relative] is not keen on socialising and games, they offer, but don’t push. They realised though that she likes watching the activities and they picked up on that”. People were also encouraged to stay in touch with their families and receive visitors.
People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.