The inspection took place on 16 March 2016 and was unannounced.Downlands provides nursing and personal care and support for up to 23 older people or people with a physical disability. The service offers long term and respite care. At the time of inspection there were 19 people living at the service. People were mostly older with complex needs or physical frailty requiring personal care and nursing support with all activities of daily living. Accommodation is provided over three floors, in single rooms with en-suite facilities to all bedrooms. The service is located on a main road in a residential area, close to transport links to local shops, the seafront and the city centre. The provider, Beaumont Nursing Home Limited, has another service in Northamptonshire.
The service had two registered managers. This is because one of the registered managers had stopped managing the service but had not submitted an application to CQC to cancel their registration. The current registered manager in post was present throughout the inspection. 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. Downlands registered with CQC on 3 February 2015 and has not been previously inspected.
Individual preferences were not always respected for example people were not supported to get up or go to bed at their preferred time. People told us that the food was good but they were not offered a choice at meal times. On the day of inspection everyone was served the same menu item even though two people told us they did not like this menu item. There was a four week menu in place but it was not displayed and suitable alternatives were not routinely offered to people. This meant that care was not always person centred as people’s preferences were not respected.
Staff did not always act in accordance with the Mental Capacity Act (2005) (MCA). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the support they receive. One person who was thought to lack mental capacity did not have a mental capacity assessment or sufficient detail in their care plan to support a decision made on their behalf to use bed rails and we identified this as an area that needs improvement. Staff were aware of those people with a DoLs authorisation the details of which were stored alongside the care plan in their individual records.
There were regular Infection Control and Medication Audits which demonstrated improvements but other systems to assure quality and drive improvements to the service were limited or informal. Relatives and residents surveys had taken place but people and relatives told us they did not feel confident to express their concerns or preferences and we have identified this as an area that needs improvement.
Staff understood their responsibilities in relation to keeping people safe from harm and there were sufficient staff on duty to meet people’s needs.
The management of medicines was safe. People received their medicines correctly and on time. A person said, “I can get pain relief when I need it, I will ask staff.” There was clear guidance and information provided to staff to support them to administer medicines safely.
Individual risk assessments were in place to ensure that people’s health needs were appropriately managed and these were updated regularly and in accordance with any guidance from health care professionals. Planned care accurately reflected care delivered. There was a system in place to monitor accidents and incidents. The environment and equipment was managed through regular checks and servicing and there were emergency plans in place for the service and individuals.
People with difficulties eating and drinking for health reasons were identified and supported by timely referral to health professionals such as Speech and Language Therapists. Any recommendations made by health care professionals were detailed in individual care plans and followed by staff.
There was a training plan in place and staff said they felt supported. Staff told us that they received regular supervisions, competency checks and observed practice. The nursing staff we spoke to were knowledgeable and experienced in the care of people with complex nursing needs.
Relatives described staff as, “Kind and friendly.” One person said, “Yes, they are nice to me, they (staff) help me.” Staff were genuinely interested in people and were caring and kind in their interactions with them. Staff took time to encourage people to join in activities that they knew they would enjoy or to make it possible for people to attend an event despite their limitations. Staff took care to maintain people’s privacy and dignity whilst supporting them.
There was an activity plan in place and activities were planned according to the interests and preferences of people living at the service. There were activities going on throughout the day ranging from individual chats to group activities. People were supported and encouraged to attend those activities they enjoyed and staff made an effort to ensure that those who preferred not to join in group activity were not isolated.
There was a complaints process in place and all complaints had been responded to appropriately and within a reasonable time frame.
The registered manager and other staff were active in the local health care community. They met regularly with local care home managers and activity staff to keep up to date and share best practice. The provider also worked with other agencies such as the Alzheimer’s Society and the Blind Society to support people who were at risk of social isolation.
We identified a breach 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.