This inspection took place on 23 and 24 November 2016 and was unannounced on the first day. We last inspected Davenport Manor on 13 and 14 April 2015. At that time, we rated the service requires improvement overall and identified breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one regulation of the Health and Social Care Act 2008 (Registration) Regulations 2014. We asked the provider to make improvements in relation to the supervision of staff, provision of person-centred care based on an assessment of needs and preferences, management of medicines, the safety of the environment and governance and monitoring of the service. The provider sent us an action plan to tell us how they would ensure they would meet the requirements of the regulations.
At this inspection we found the provider had implemented their action plan and had made improvements in a number of areas. However, we identified three breaches of the regulations. These were in relation to the safety of the environment, working within the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, good governance and keeping accurate records of care. You can see what action we told the provider to take at the back of this report.
We made five recommendations. These were in relation to reviewing guidance and procedures in relation to the administration of medicines, the use of surveillance in care homes, recruitment procedures, assessing staffing levels and the provision of activities.
Davenport Manor is a residential care home registered to provide care and support to up to 34 people. The home is situated in the Davenport area of Stockport close to local shops and churches. There is a regular bus service and Davenport railway station is approximately a quarter of a mile away. At the time of our inspection there were 31 people living at the home.
There was a registered manager in post. 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.
The provider had not taken adequate steps to ensure the environment was safe for people living at the home. We found window restrictors in place to prevent potential falls from height were not sufficiently robust. The provider had not ensured timely action had been taken to address concerns raised following an electrical safety inspection. We received evidence shortly after our inspection that these shortfalls had been addressed.
Staff told us they had sufficient time to complete all their duties. Staff told us there were sufficient numbers of staff to meet peoples’ needs, and people living at the home confirmed they did not have to wait long if they required any support. Staff told us night shifts could sometimes be hard work but that the on-call manager would provide support if required.
Medicines were managed safely, and staff we spoke with demonstrated a good knowledge of requirements in relation to peoples’ medicines. There were no clear instructions for staff to follow in relation to the administration of ‘when required’ medicines. However, our discussions with staff showed they were aware when to give these medicines and what they were for.
There were no vacancies for care staff at the time of our inspection, which meant care was provided by a consistent staff team. People told us they liked and got on with the staff. Care staff knew people well and were able to talk with us in depth about peoples’ needs and preferences.
Care plans were reflective of peoples’ current needs and had been reviewed regularly. Staff were aware of the guidance contained in care plans.
We received positive feedback from GPs who regularly visited the service, who told us staff followed their guidance and sought advice when required. We saw a variety of health professionals had been involved in peoples’ care, and that referrals were made if health concerns were identified.
People were positive about the food and drink provided. However, peoples’ intake was poorly monitored and there were significant gaps in these records. The issue in relation to the monitoring of nutrition and hydration had been recently raised by the provider and had been raised in a previous CQC inspection. Whilst measures had been identified to improve recording; these had not been wholly effective at the time of our inspection. We found daily records of care were sometimes lacking in detail.
Although actions had been taken to ensure feedback from people using the service and other stakeholders was received and analysed, we found continued shortfalls in the systems in place to monitor and improve the quality and safety of the service. For instance, there were no formally recorded medicines audits, and audits of the environment had not identified the issue with the window restrictors.
The registered manager was visible and accessible to staff, relatives and people living at the home. We saw frequent interaction between relatives and the registered manager, and relatives told us they were confident to approach the registered manager or a staff member with any concerns they might have. Staff told us they felt the service had improved since the return of the registered manager following a period of absence. They were consistently positive about the registered manager’s support and leadership of the service.
The provider was not consistently working within the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider could not demonstrate that adequate steps had been taken to assess whether people should be given medicines without their knowledge (covertly). The approach taken towards the application for DoLS also meant there was a risk some people would be deprived of their liberty without proper authorisation being in place.
We saw some ad-hoc activities taking place during the inspection. We received a mixed response from people when we asked whether they had enough to keep them occupied. Staff told us they would like more time to be able to support people with activities or the support of a dedicated member of staff for activities.