Archived: Duchess Gardens Care Centre

Updated 11 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 29 September 2015 and was unannounced.

The inspection team was made up of four inspectors, one of whom was a pharmacy inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case older people’s services.

We spoke with nine people who used the service and three relatives. We observed the way people were cared for and supported in the communal areas on both the nursing and residential unit. We observed breakfast and lunch on the nursing unit and lunch on the residential unit. We looked at eleven people’s care records, medication records and medicines for 22 people and various records relating to the running of the home which included four staff recruitment files, training records, maintenance records and quality monitoring audits. We spoke with the registered manager, two nurses, eight care workers, the chef, a housekeeper and the activities organiser. We looked around the home at a selection of people’s bedrooms and the communal bathrooms, toilets and living areas.

Before the inspection we reviewed the information we held about the home. This included looking at information we had received about the service and statutory notifications we had received from the home. We also contacted the local authority commissioners and the safeguarding team.

We usually send the provider a Provider Information Return (PIR) before the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not send a PIR on this occasion as the inspection was planned at short notice due to a number of concerns we had received about the provider.

Updated 11 January 2016

The inspection took place on 29 September 2015 and was unannounced. At the time of the inspection there were 54 people who used the service.

Duchess Gardens Care Centre is a converted four floor building and is registered to provide personal care and nursing to a maximum of 131 people. The home provides care for older people, people living with dementia and people with long term mental health needs.

Since the last inspection a manager has been registered. 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 service has a history of failing to meet the regulations and at the last inspection which was carried out on 27 January and 02 February 2015 we judged the service to be inadequate. The provider was in breach of a number of regulations. These included the regulations relating to respecting and involving people who used the service, care and welfare, meeting people’s nutritional needs, managing medicines, staffing and staff training and development, record keeping and quality assurance. We told the provider they had to make improvements. The regulations have changed since then; new regulations came into use on 01 April 2015. However, during this inspection we followed up the areas of concern from the last inspection to check if the provider had taken action to improve the service and make sure people were safe and receiving appropriate care. Overall, we found improvements had been made across all aspects of the service but there was still work to be done to make sure the changes were sustained.

People told us they felt safe. Staff were able to recognise abuse and told us they were confident the registered manager would take action to address any concerns they reported. Senior staff were aware of how to report abuse and were familiar with the whistle blowing procedures. However, we found junior staff were less clear about how to report concerns outside of the organisation.

Significant improvements had been made to the way people’s medicines were managed and this helped to make sure people were protected.

Staffing had improved since the last inspection. A new deputy manager with qualifications and experience in caring for people with mental health needs had been appointed. The home was continuing to recruit staff and used agency staff to cover shortfalls. We found improvements had been made to the way agency staff were booked and to the induction they were given when they worked at the home for the first time. This helped to reduce the risk that people would not experience continuity of care. There was mixed feedback about whether or not there were enough staff available to meet people’s needs. A system for checking people’s needs had been implemented to help determine the staffing numbers and skill mix. However, there were no guidelines on how often this was to be reviewed. This created a risk that the right numbers of suitably skilled staff would not always be deployed to meet people’s needs. We found this was a breach of regulation because the provider did not have a proper system in place to assess, monitor and mitigate the risk.

The provider had processes in place to make sure all the required checks were completed before new staff started work in the home. However, in two of the four staff files we found the checks had not been completed properly and this could potentially put people who used the service at risk. This had not been identified until the inspectors pointed it out. This was a breach of regulation because it showed the providers systems for assessing, monitoring and mitigating risks were not effective.

At this inspection we found the home was clean and well maintained.

There was training programme and the registered manager was in the process of making sure all staff were up to date with the training they needed to work safely and meet people’s needs. Staff told us they felt supported by the registered manager. However, six of the staff we spoke with told us they had not received any one to one supervision or appraisals and we found some gaps in staff knowledge around subjects such as safeguarding and the Mental Capacity Act 2005. We judged the provider was in breach of the regulation because although improvements had been made they were not enough to ensure staff received appropriate support and training to help them carry out their duties.

Improvements had been made to the way people who were at risk of poor nutrition were supported. However, the food and drink provided to people did not always take account of their preferences and was not always appropriate to their needs, for example in the case of people with diabetes. We found this was a breach of regulation because it demonstrated the provider did not have sufficient regard to people’s well-being in relation to meeting their dietary needs.

The home was working in accordance with the requirements of the Mental Capacity Act 2005 which meant people’s rights were protected.

People told us staff were kind and compassionate and treated them with respect. We observed interactions between staff and people living at the home were pleasant and friendly. Staff knew about people’s previous lives, family, and preferences as well as care needs. However, on occasions we observed staff missed opportunities to engage people in conversation when they were supporting them with personal care.

Some aspects of the way the services were provided helped people to stay independent. For example, we saw some people had adapted cutlery so that they could eat without help from staff. However, in some other ways people were not supported. For example, the menu was a chalk board in the dining room and it would not have been easy for everyone to read. People were given the opportunity to take part in a varied programme of planned activities.

People told us they were satisfied with the care they received. People’s needs are assessed and their individual care plans and risk assessments were up to date and provided an accurate record of their care needs. The involvement of people and/or their representatives was not always evident in their care records.

A relative told us they had made a complaint and were happy with the way the registered manager had dealt with it. We saw complaints and compliments were recorded.

Staff spoke about the registered manager with respect and admiration. They said the registered manager had made changes which had improved life for people living at the home and for staff.

The provider had not sent any quality assurance questionnaires to people who used the service or their representatives since the last inspection. There were meetings for people who lived at the home and the registered manager told us they had an open door policy and encouraged people to come and speak to them if they had any concerns.

We found improvements had been made and the registered manager and staff were clearly committed to continuing to improve the service for the benefit of people who used the service. However, we found the provider was still in breach of some regulations and these issues had not adequately dealt with in their improvement plan.

You can see the action we told the provider to take at the back of the full version of the report.