Archived: Devenish House

A registered manager was in post at the time of our inspection, however they were absent during the inspection period. 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.

People told us they felt safe with staff and the staff we spoke with demonstrated their understanding of how to safeguard people and report their concerns. People were protected from the risk of abuse.

People had risk assessments in place that detailed their individual areas of risk and how these should be managed to keep people safe. All staff were updated daily on people’s changing needs to ensure staff had the information they required to provide safe and appropriate care.

There were sufficient levels of suitably skilled staff available to meet people’s needs. Whilst there had been some staff changes the provider had ensured staffing levels were maintained. Agency staff were checked for their suitability to work with people and as far as possible the same agency staff were used to provide a continuity of care for people.

There were processes in place for the safe ordering, storage and disposal of medicines and medicines were administered to people by trained staff. Guidance was available to staff on what the medicines were for and people’s preferences for how to take their medicines. Some prescription medicines are controlled under the Misuse of Drugs Act 1971 these medicines are called controlled drugs (CD’s). Procedures were in place and followed to ensure these medicines were safely managed.

Staff completed an induction into their role to ensure they were competent to carry out their responsibilities. Staff were supported by the registered manager and nursing staff through regular supervision and an annual appraisal. Staff completed a range of training to develop the skills and knowledge they needed to meet people’s needs. Records showed staff had completed most of the provider’s mandatory training with the exception of training in the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

The provider did not always follow their procedures to ensure people’s rights were upheld in line with the MCA (2005). It was not evident that mental capacity assessments and best interest decisions were carried out when people lacked the capacity to make their own decisions. This meant people could be at risk of inappropriate and unlawful decision making.

People were offered choice by staff and where people had made decisions, these were respected by staff. Staff were knowledgeable about people’s preferences and acted to ensure these were met.

People told us the food was ‘very good’. We saw that a varied and nutritious menu was offered and the chef was aware of people’s likes, dislikes and food safety needs. People were asked for their feedback on the quality of the food and this was acted on. People were referred appropriately to the relevant healthcare professionals when staff had concerns about their wellbeing in relation to nutrition. People had experienced positive outcomes in their health through good nutrition management.

People’s healthcare needs were attended to promptly and people were seen by a range of healthcare professionals as required.

People received care and support from staff who knew them well and were caring, compassionate and thoughtful in their approach. The relationships between staff and people receiving support demonstrated dignity and respect. People’s diverse needs in respect of their spiritual beliefs and their preferences regarding staff gender choices were respected and met.

People’s decisions for their end of life care were known and respected. People and their families were supported and staff acted with care and attention to ensure people at the end of their life received appropriate and person-centred care.

People’s care plans were person-centred and included their preferences for how their care should be delivered. Care plans were regularly reviewed and updated with people’s changing needs to ensure they remained current and appropriate. People and their relatives told us that the care provided at Devenish house had resulted in improvements to people’s quality of life.

A range of activities was available for people to participate in if they chose to do so and people told us they enjoyed these. People’s individual activity and social needs were met by a team of activity coordinators and volunteers.

A system was in place for people to raise their complaints and concerns and these were acted on quickly and appropriately.

Quality assurance systems were in place to monitor aspects of the quality of service being delivered and the running of the home. However, we noted that audits were not always effective in addressing the shortfalls identified. For example the actions taken to address omissions in people’s medicines administration records had not prevented reoccurrences. Whilst people, their visitors and relatives’ views had been sought on the quality of the service, it was not evident how the information had been used to drive continuous improvement to the service. The falls monitoring in place did not include identifying patterns and trends to ensure all possible measures had been considered and appropriate action taken to prevent reoccurring accidents. The systems and processes in place were not always effective in assessing, monitoring and improving the quality and safety of the service people received.

There was a positive culture in the home and staff were aware of and acted in accordance with the provider’s values. Staff were supported to be clear about their roles and responsibilities through supervision, training and team meetings. Adequate arrangements were in place to provide leadership and management support during the absence of the registered manager.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us "It's like a five star hotel," "nothing is too much trouble," "staff couldn't look after us more if we were their own family" and "If you want anything you only have to ask". People were supported by a caring and established staff team who understood the needs of people well and who reacted quickly when people's health deteriorated.

There was a choice of nutritious meals that met people's individual needs. Food and drink were provided in sufficient quantities and staff offered support and encouragement to help to ensure that people remained well nourished and hydrated. People said that the home was always very clean and there were effective systems in place, which staff adhered to, to reduce the risk of spread of infection.

There were robust recruitment procedures which helped to ensure that all staff were of good character and that they had necessary skills and knowledge for the work to be performed.

All five people told us they were happy at Devenish House. Individual needs of people had been assessed and were reviewed, and care plans updated in the light of changing needs. Two people who had moved into the home within the previous six months described the consequent positive outcomes. People experienced care, treatment and support that met their needs and protected their rights.

People told us 'It's like a five star hotel', 'Every need is catered for', and 'I love it here', 'It's an amazing view from my room'.

We looked at safeguarding arrangements. We found that people were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff rotas, staff training records, observation of staff supporting people and discussion with people demonstrated that there were enough qualified, skilled and experienced staff to meet people's needs.

The provider had in place effective systems system to monitor the quality of service, which sought people's views, took account of complaints and comments and learnt from investigations into incidents.