This inspection took place on 14 January 2016. The inspection was unannounced. The last inspection of Delaheys Nursing Home took place on 29 April 2013. At that time we found that the provider was fully compliant with all the regulations assessed.Delaheys is a Care Home with nursing registered to offer personal and nursing care for up to 28 people. The home is a detached property with accommodation located on the ground, first and second floor. A passenger lift is in place for ease of access. The property is surrounded by garden areas and there is a large conservatory at the front of the building. Accommodation is in single and shared rooms, some with en-suite facilities. The home is furnished to a high standard.
The registered manager was available and received feedback throughout the inspection. The registered manager was also the nurse on duty during our inspection.
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 found that the service provided a good standard of person centred care. Feedback from people who lived at the service was positive in regards to the care and support from staff. People told us that they felt safe and well cared for.
We found that the service had a safeguarding policy and procedure. However this was not easily accessible for people who lived at the service and or their relatives. We found that staff lacked knowledge about types of abuse and referral procedures. Some staff had undertaken training for safeguarding vulnerable adults as part of their health and social care diploma; however we found that service specific training has not been undertaken. Training should identify internal procedures and the local safeguarding authority referral process to enable staff to identify and report abuse.
The environment was clean, safe and well maintained. A very high standard of interior was maintained throughout the service and the providers prided themselves on maintaining this.
We looked at care records and found that staff worked positively with community professionals such as dieticians and speech and language specialists to ensure that people’s needs were met.
Care plans were being developed to move from a medical model to person centred. Care plans showed that people were encouraged to participate in the care planning process. However we found that this was not always in line with the Mental Capacity Act 2005.
Records showed that mental capacity assessments were not always undertaken prior to making a decision on the person’s behalf. We found the manager and care workers lacked knowledge about the Mental Capacity Act 2005 (MCA 2005) and the related Deprivation of Liberty Safeguards (DoLS). This meant that people were not always provided care and support that had been assessed in line with the MCA 2005.
We found that staff training and development required improvement. Staff told us that they felt confident in their roles and supported.
We looked at how the service protected people from avoidable harm and injury. We found that people who lived at the service had been assessed for risks associated with clinical care, such as skin integrity and malnutrition. However we found that personal emergency evacuation plans were not in place to enable emergency evacuation at the service should it be needed.
We discussed this with the providers who agreed to take immediate action.
We found shortfalls in medicines management that placed people at risk of not receiving their medicines as prescribed. Shortfalls included inaccurate recording on medicine charts, unsafe administration and ineffective care planning around people’s medicine regimes and preferences.
We found that people were supported to maintain a healthy and balanced diet. People were assessed against the risk of malnutrition and encouraged to maintain a good intake of foods and fluid.
We observed the lunch time meal service and found that people were offered choice and control. One person did not like the pudding options so were offered an alternative.
We found that the presentation of texturised meals required improvement to ensure that people with such needs experienced the same meal presentation of those who were able to eat a normal consistency meal.
We received mixed feedback about the food people received. Some people were very positive; others commented that they would like more choice on the menu.
We found people who received end of life care and those needing bed rest were provided a very good standard of person centred nursing care. People appeared comfortable and stimulation was provided in each person’s bedroom. One person enjoyed listening to 1920’s music.
We observed staff interact with people in a kind and compassionate way. Staff understood the needs of people who lived at the service and were passionate about maintaining people's independence and wellbeing. Throughout the inspection we observed staff take time to sit and talk to people. Conversation was free flowing and we could see that positive and trusting relationships had been built between staff and people who lived at the service.
People told us that they felt confident to raise their concerns and felt listened to. Records of service user meetings were not available; however people who lived at the service told us that they felt involved in the running of the home. We have made a recommendation about maintaining written evidence of how the service involved people in the general running of the home.
We looked at how the service managed complaints. We found that the registered manager did not effectively record when she had dealt with people's concerns and how she managed complaints. However we received very positive feedback about the running of the service and people felt able to disclose their concerns.
Surveys were issued on a regular basis for people who lived at the service, relatives, staff and external professionals. Results were analysed by the registered manager. However evidence of survey feedback to stakeholders was not evidenced.
We found that the registered manager, who was also the provider and nurse, played an active role at the service. They lived on site and were very much committed to providing person centred care. People told us that the family run business was well managed and that they felt confident that the manager responded to their concerns.
Activities at the service were planned on a day to day basis. We received mixed feedback about activities; some people were happy others wanted more choice.
We looked at how the service was monitored for quality. We found that audit records were not available, however the registered manager told us about how they continually assessed the service and acted upon changes needed. We discussed with the registered manager the importance of maintaining written records to show how they monitored the service for quality and development.
The registered manager told us that they had recently invested in a new care system for policies and procedures and they intended to roll out auditing processes based on this new system.
We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safeguarding, risk assessment, medicines, need for consent, staff training and support and governance. You can see what action we have told the provider to take at the back of the full version of the report.