The Donnington Care Home

The Donnington Care Home is a care home providing personal and nursing care for up to 40 adults. At the time of our inspection, 25 people lived at the service and there were 35 staff. The care home has two floors, with individual bedrooms, ensuite toilets and shared baths and shower facilities. There are communal areas such as lounge rooms and a dining room.

People’s experience of using this service and what we found

People, relatives and community-based professionals told us care was safe. Improvements were made to people’s risk assessments to ensure they contained information to support people in the right way. More oversight of the care documentation was completed by the registered manager and deputy manager to ensure that risks were properly identified and mitigated. People were protected from abuse and neglect. Recruitment processes were strengthened to ensure that the correct pre-employment checks were always completed.

People, relatives and healthcare professionals told us the service had improved since the registered manager commenced in post. The deputy manager and registered manager worked well to assess areas for improvement and take steps to ensure this occurred. There was a continuous improvement model in place, with an ongoing action plan to record updates on improvements. The quality assurance programme ensured that the service was well-led and achieved positive outcomes for people. There was positive feedback from people and relatives. They were able to have a say in how the service was led, provide suggestions and felt listened to. Community health and social care professionals confirmed the service worked in partnership with them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 17 May 2019) and there were three breaches of the regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 April 2019 and 9 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve risk assessments, personnel files and auditing of care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Donnington Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Donnington Care Home is a residential care home with nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is set in its own grounds and is situated close to local amenities. People had their own bedrooms with en-suite facilities and use of an enclosed private garden. Some of the people supported at the home lived with dementia and other health related conditions. The service is registered to provide care and nursing care for up to 40 people. At the time of our inspection there were 31 people residing at the home.

People’s experience of using this service:

The service assessed risks to the health and wellbeing of people who use the service and staff. However, we could not always be assured care was delivered by staff in line with the people’s care plans to mitigate these risks.

Safe recruitment practices were not always followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

Governance system were not always effective and did not always identify actions for continuous improvements.

We found some very positive examples of the difference staff had made to people’s lives. However, we found that care records were not always up to date and accurate.

There was an activities programme and some people were involved in activities. However, people told us that some activities didn’t always take place when they were scheduled to do so and did not always meet their needs.

We have made a recommendation that provider explores all relevant guidance and best practice on how to ensure they make environments used by people with dementia more dementia friendly.

People were assisted to take their prescribed medicines by staff who were assessed as competent to do so. Where people required their medicines at a specific time or with food, this need was met. Storage and handling of medicine was managed appropriately.

Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately.

Feedback from relatives and people was that staff were caring and respected their privacy and dignity.

We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided.

People and their relatives knew how to complain and knew the process to follow if they had concerns.

People had their healthcare needs identified and were able to access healthcare professionals such as their GP, when needed. The service worked well with other health and social care professionals to provide effective care for people.

The service had regular residents and relatives' meetings as well as staff meetings to ensure there was opportunity to feedback about the home and that there would be a consistency in action taken. The staff team had handovers and daily meetings to discuss matters relating to the service and people’s care.

People and relatives felt the service was managed well and that they could approach management and staff with any concerns they may have.

Rating at last inspection:

At the last inspection the service was rated as Good overall. (Report published 12 October 2016).

Why we inspected:

This was a planned comprehensive inspection based on the rating of the last inspection.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor all information we receive about this service. This informs our ongoing assessment of risk and ensures we are able to schedule the next inspection accordingly.

The Donnington Care Home is a detached Victorian building that has been extended and converted over the years into a fully modernised care home. The home is surrounded by its own grounds and is situated near Newbury within West Berkshire. People have their own bedrooms with en-suite facilities and use of communal areas that include an enclosed private garden. The people living in the home need care and support from staff at all times. Some of the people live with dementia and other health related conditions. The service is registered to provide care and nursing care for up to forty people. There were thirty-five people in residence during our visit.

There is a registered manager running the service. 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 registered manager was present throughout the inspection.

There were robust processes in place to monitor safety when giving people their medicine. The recruitment and selection process helped to ensure staff of good character supported people. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. There were enough staff to meet people’s needs safely.

Staff had received health and safety training that included medicine management and administration and had attended specialist training such as dementia care. They were supported to obtain health and social care qualifications. However, not all staff had taken the opportunity to access short specialist training courses that were provided by external professionals, to meet people's specific needs. They said they had to do the training in their own time. This had proved to be a miscommunication amongst the staff team and was rectified by the registered manager during our visit to encourage staff training and development.

People’s care plans were up to date to reflect their care needs and identify individual risks. For example, to promote falls prevention and person centred care. However, two people had missed healthcare appointments that had not been identified within the staff handover or through the review of their records. The registered manager initiated improvements at the time of our visit to advocate best practice to promote and meet people’s health and welfare needs at all times.

People’s nutritional needs were met with meals that were appetising and cooked to meet individual needs. Staff treated people with respect and kindness. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

The service had taken the necessary action to ensure they were working in a way that recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and consent issues, which related to the people and their care.

People, their relatives and staff told us they felt listened to by the registered and deputy manager who had promoted a positive culture within the home. There were systems to regularly assess and monitor the quality of service people received. These included various formal audits and quality monitoring visits by one of the organisation's area managers and by external professionals to promote the well-being and safety of people who use the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were able to describe the circumstances when an application should be made and knew how to submit one.

People told us they felt safe and secure. They said they would approach staff if they were worried about their safety or worried about the services provided and felt they would be listened to. Comments from people included: “I would speak up if I was worried”.

Staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Health and safety audits were undertaken by the home and by the provider. Equipment was regularly serviced and health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

Is the service effective?

People had individual care plans which set out their care needs. Assessments included needs of any specialist equipment to promote their health and wellbeing. Risk assessments identified risks associated with personal and specific health related issues, and recorded guidance for staff to minimise those risks.

Staff received training, support and guidance to ensure the health and welfare needs of people were continually met. People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People we spoke with felt the staff always respected their privacy and dignity. One person said: “They respect my dignity, I could not find fault with any of them”.

Staff had received training and support to be fully aware of people’s preferences, interests and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were respected.

People were complimentary about the care staff and felt they had the skills needed when providing them with care and support. Comments from people included: “Staff are wonderful, very caring”. “It’s nice here they look after me”.

Is the service responsive?

Care plans were reviewed regularly and amended, as necessary, to meet people’s current needs. People told us that staff responded to their needs. Comments from people included: “They respond quickly when I ring my call bell”. However, we saw that some people who used the dining room at suppertime waited longer for assistance from staff. The manager had taken immediate action on the day of our visit to improve the services in the dining room at suppertime.

The home asked people about their views of the services provided and had taken action to improve. People knew how to make a complaint if they were unhappy. They told us the manager and staff were approachable.

Is the service well-led?

The service had a robust quality assurance system. Audits completed by the home or by the provider showed that any shortfalls were addressed to improve the services provided. The manager and staff listened to what people had to say. Comments from people included: “I’ve met them all; kitchen staff, laundry staff, care staff and nurses. They are all very nice”.

The home worked well with other agencies and services to make sure people’s needs were met. At the time of our visit the manager had through joint working, arranged for staff to receive assistance from a Care Home In-reach Team comprising of health and social care professionals. The in-reach team worked with staff, reviewing people’s needs and training staff to enhance their skill and improve their confidence by building on existing good practice.

We found that people were offered a varied and balanced menu and were helped to eat and drink enough to keep them as healthy as possible. People told us the food ''the food cannot be faulted, it looks lovely and tastes just as good''.

We found that people were prescribed medication by their doctor, which was given to them safely and at the correct times. We saw that the medicines in the home were stored properly, at the right temperature and in locked cabinets in locked rooms or cupboards.

We found that there were enough properly trained staff to meet people's individual needs. People told us that there were plenty of staff about and said, ''bells are answered pretty quickly most of the time''. People described staff as ''kind and patient''.

We found that the home had ways of looking at the care they offered so that they could make sure they maintained and improved it. People told us the ''manager is very approachable, she would listen to us if we had any worries''. Relatives said they had the ''greatest respect for the manager and have great confidence in her''. We saw that the home took health and safety seriously and kept people as safe as possible.

The plans of care showed that people were cared for appropriately and records were detailed and up-to-date. People told us that they were ''very well looked after ''. They said that they ''couldn't ask for better care'.

The home recorded and investigated any bruising or minor injuries and took action to try to prevent any repetition. The home had developed ways of helping people who may sometimes have harmful or distressing behaviour. People told us they felt 'very safe'.

The service looked at all aspects of the home to make sure that the people who lived there received a good quality standard of care. Relatives told us that if there were any concerns, no matter how minor the home responded immediately. They told us they were 'totally satisfied' with the care their family member received.

Although people told us that they were ''very well looked after '' and that it was a ''lovely place to live'' we found that care and treatment was not always planned in line with their individual care plan. We found that the cause of unexplained bruising and minor injuries had not been investigated. Appropriate plans to deal with behaviours that may cause harm or distress to people were not in place. However staff had received safeguarding of vulnerable adults training and were clear about their responsibilities to protect the people in their care. People told us that they felt ''very safe'' in the home.

People told us that there were always staff available to help them and one person described the staff team as ''marvellous''. The home made sure that they used appropriate recruitment procedures when employing new staff.

The home had a system to assess and monitor the quality of service it provided but this had failed to identify shortfalls in care planning and safeguarding processes. People told us that they were confident to talk to any of the staff or the manager if they had any concerns.