This inspection took place on 17 and 18 November 2016 and was unannounced. The previous inspection of Deerhurst was in May 2013. At that time there were no breaches of the legal requirements.The service had a registered manager. 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.
Deerhurst is a care home with nursing care for up to 66 predominately older people. People have general nursing care needs or are living with dementia however the service places greater emphasis on looking after people living with dementia. The home is split into four areas. On the ground floor was the butterfly trail for 10 people and butterfly cottage for 16 people. Both were for people living with dementia but the cottage accommodated people who were more mobile. On the first floor there were two areas, the honeysuckle suite and bluebill rise. The building was a purpose built care home designed around the needs of the older person and in particular those people with dementia or cognitive impairment and physical impairments. There was one passenger lift and three secured staircases which meant all parts of the home were accessible for people with impaired mobility.
There was level access into the home was from the car parking area. There was a courtyard garden within the centre of the home. People were able to sit out in this area in warmer weather. The courtyard was also decorated in one part as a seaside theme and in another part was set up as a sporting area. To the rear of the property there were sensory gardens, a greenhouse and a large caged area for the hens.
Just prior to our inspection the registered manager had received the Inspirational Leader of the Year 2016 in the National Dementia Care Awards. The service had also been awarded the highest level Quality of Life butterfly kite mark. In order to achieve this the service incorporated the five principles of person centred care. These were occupation and purpose, attachment and a sense of belonging, comfort, identity and inclusion.
The registered manager provided good leadership and management for the staff team. The service and staff demonstrated their commitment to care for people with dignity, to further improve and to follow best practice for the care of people living with dementia. They linked with care provider forums ensured people had access to the local community. The service had a good reputation within the local community and also with health and social care professionals.
The service was very well-led and well managed. The service had a robust programme of audits in place to monitor the quality and safety of the service. Action plans were developed where shortfalls were identified so that improvements could be made. The provider continually looked to make things work better so that people benefitted from an improved service. Any planned improvement actions were followed up to ensure they were implemented.
People were looked after with a person centred approach care and where possible had been involved in drawing up their care plans. Knowledge of the person’s history and personality assisted the staff team and volunteers to provide the right support and maintain the person’s dignity and choices. Care plans were well written and provided detailed information about how the person wanted to be looked after and how their care was to be delivered. People were encouraged to have a say about things that mattered to them and to raise any concerns they may have.
People were looked after by staff and volunteers who were kind and caring. The staff met not only their specific care and support needs but also their emotional and social needs. The staff formed good working relationships with the people they looked after but also genuinely cared about them. People told us they were well looked after. We were told about times when the registered manager, staff and volunteers had gone over-and-above what was expected of them to meet people’s social and emotional needs. This had resulted in improved well-being for people. People were able to participate in a range of different meaningful activities, both in Deerhurst and outside of the service.
People were provided with an effective service that met their individual needs. They were encouraged where possible to make their own choices and decisions about aspects of their daily life. Where people lacked the capacity to make decisions for themselves the staff knew what to do to ensure that any decisions made on behalf of the person was made in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
People were provided with the food and drink they liked to eat. They were provided with choice and given sensitive assistance if they needed help to eat their meals. Where there were risks of malnutrition or dehydration there were plans in place to reduce that risk. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so. Feedback for health care professionals was extremely complimentary. The service had successfully looked after a number of people who had been “difficult to place” because of challenging behaviours.
People were kept safe. This was because any risks to their health and welfare was well managed. The premises were well maintained and staff were trained in how to move people requiring assistance from one place to another safely. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. The management of medicines was in line with good and safe practice.
Staffing levels were adjusted regularly and took account of the number of people being looked after and their care and support needs. The staff were well trained which meant they were able to carry out their roles and responsibilities effectively. Staff were well supervised and supported by their colleagues and line managers. New staff had a robust induction training programme to complete which met the standards of the Care Certificate.