Archived: Dene Court Residential Care Home

At the inspection of the home carried out in November 2015 we found breaches of regulations. The service was then rated as 'inadequate' and placed into special measures. The special measures process is designed to ensure there is a timely and coordinated response where we judge the standard of care to be inadequate.

At the next comprehensive inspection of the service in April 2016, we found significant improvements. There were no breaches of legal requirements at that inspection, but there had been insufficient time for new management systems to be embedded. Therefore we rated the service as ‘requires improvement’.

On 31 August 2017 and 5 September 2017 we carried out an unannounced focussed inspection to look specifically at the safety of the service and to check that improvements had been maintained. We confirmed this was the case and the service was safe.

The home 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. They, along with the provider were committed to the improvement and development of the service and had continued to make significant changes which had a positive impact on the safety and quality of the service.

At the inspection in April 2016 we found the quality monitoring systems in place to ensure the home ran smoothly were not yet fully established. At this inspection we found there was a comprehensive system of audits in place which scrutinised all aspects of service provision and the environment. People, relatives and staff were invited to express their views of the service through satisfaction surveys and at staff and residents meetings. The information from the quality assurance processes was used to drive improvements at the service.

There were systems in place to ensure risk assessments were comprehensive, current, and supported staff to provide safe care whilst promoting independence. The computerised care planning system, accessed by staff using hand held computers, ensured that information about people’s risks was shared efficiently and promptly across the staff team. This meant staff had detailed knowledge of people’s individual risks and the measures necessary to minimise them. Care plans were comprehensive and reviewed monthly; however we had mixed views from people and their relatives about how the service involved them in this process and decisions about their care. We raised this issue with the registered manager who was already looking at ways to improve communication with families and provided reassurance they would take action to involve people and their relatives more in reviewing their care plans.

People had mixed views about the food at the service. Most said they enjoyed the food, but would prefer more choice. People had sufficient to eat and drink and received a balanced diet, and care plans guided staff to provide the support they needed. The service supported people with special dietary needs, for example a diabetic or pureed diet. However one person expressed concern about the availability of food appropriate for their specific dietary needs and staff understanding of their condition. The registered manager told us they had been working with the person, their family and health professionals to clarify what the person’s dietary needs were and how they could be better met. They had already ordered some sugar free desserts and undertook to ensure all staff had a clear understanding of this person’s individual dietary needs.

People told us they felt safe. Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. People told us staffing levels were adequate. The service regularly reviewed the dependency levels of people at the service and staffing levels to ensure people’s needs continued to be met safely. Regular environmental health and safety checks were undertaken. There were effective infection prevention processes in place, the home was compliant with fire regulations and a programme of refurbishment was in progress. People were protected from the risk of abuse through the provision of policies, procedures, staff training and an effective recruitment process.

Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

People were relaxed and comfortable with staff and told us staff treated them with dignity and respect. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds, respected their choices and acted in accordance with their wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The registered manager had made appropriate applications for people they had assessed as being deprived of their liberty, to the local authority DoLS team.

There was an activity co-ordinator at the service who was working with people to develop an activities programme which would better meet their needs.

There was a newly developed induction process and a greater focus on staff training, which meant staff were knowledgeable about their roles and responsibilities, and people’s individual needs. This included specialist training from external health professionals. Staff had regular supervision and told us they were well supported, saying they felt more valued. They told us, “It feels more like a team. We’ve got policies and procedures and the things we were meant to have “and, “Communication has got a lot better. I personally love it here. I really do. I feel a weight has just been lifted.”

The provider and registered manager were committed to promoting equality, diversity and human rights at Dene Court, ensuring potential new staff shared their values and increasing staff awareness through training.

Policies and procedures had been reviewed which meant they were now less generic and more relevant to Dene Court and the people living there. They had been explained to staff to ensure they had a good understanding of them and their responsibilities.

People knew how to make a complaint if necessary, and both complaints made since the last inspection had been dealt with in line with the services complaints policy.

We have made a recommendation about ensuring people with protected characteristics under the Equality Act 2010 have their needs properly considered and assessed.

Dene Court is registered to provide accommodation with personal care for up to 28 people who may have needs due to old age, sensory impairment, physical disabilities, dementia, learning disabilities, autism or mental health needs. At the time of this inspection there were 27 people living there, which included two people on a respite stay.

At the inspection of the home carried out on 10 and 13 November 2015 we found breaches of regulations. The service was then rated as 'inadequate' and placed into special measures. The special measures process is designed to ensure there is a timely and coordinated response where we judge the standard of care to be inadequate.

The last inspection took place on 4 April 2016 when we found significant improvements. There were no breaches of legal requirements at that inspection, but we were concerned there had been insufficient time for new management systems to be embedded. Therefore we rated the service as ‘requires improvement’.

We carried out this focused inspection to check that improvements had been maintained. We also wanted to ensure people were receiving safe care following anonymous concerns shared with us about the quality and safety of the service. Prior to the inspection the provider had investigated the concerns and provided reassurances that people were not at risk. At this inspection we confirmed this was the case and found the service was safe.

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 registered manager, and the provider, had worked constructively with the local authority quality assurance and improvement team to improve the quality and safety of the service. A comprehensive service improvement plan had been developed which demonstrated that improvements had been made in a range of areas including care plans and risk assessments, recording, safe staffing levels, environmental safety, quality assurance and the development of an open and transparent culture where people, relatives and staff would feel able to raise any concerns.

The staffing structure at Dene Court provided clear lines of accountability and responsibility. The registered manager was very visible in the home and proactive in observing and monitoring the quality and safety of the care provided. Quality assurance systems were comprehensive and ensured the service met people’s needs safely and effectively.

People told us they felt safe living at Dene Court. A relative said, “I’m very grateful my family member is somewhere safe.” Staff had the knowledge and skills required to meet people’s needs, and sought specialist advice from external health and social care professionals where necessary.

There were sufficient numbers of staff to keep people safe. During the inspection we saw that in addition to supporting people with tasks and daily routines, staff spent time sitting and chatting with people. The registered manager told us they now had a stable staff team, which meant agency staff were no longer needed. People therefore received consistent support from familiar staff who knew them well.

People were protected from the risk of abuse through the provision of policies, procedures, robust recruitment and staff training.

Risks in relation to people’s physical and mental health were assessed, monitored and managed well. Risk assessments were comprehensive and reviewed regularly. They provided clear guidance to enable staff to meet people’s needs according to their individual needs and preferences, promoting their rights and independence whenever possible. Systems were in place to ensure people received their medicines safely.

The service was proactive in reducing any risks related to social isolation through the provision of activities and social stimulation according to people’s individual needs and interests. A relative told us their family member, “used to love to read, although they wouldn’t be able to read a whole book any more. They put a bookcase in their room with books on it so they think they’ve been to the library”.

There were systems in place to make sure the premises and equipment were safe. People were cared for in a clean, hygienic environment and staff understood what action to take in order to minimise the risk of cross infection. Emergency plans were in place, for example in the event of a fire. There were effective arrangements in place to manage the premises and equipment, and all relevant checks were up to date.

Dene Court is registered to provide accommodation with personal care for up to 28 older people. At the time of this inspection there were 20 people living there (one person was in hospital). . There was a manager in post who was not yet registered. They have submitted an application for registration and we are currently processing this. 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.

We found significant improvements in all aspects of the management of the service since the last inspection. There had been input from the local authority safeguarding team, the commissioning team and the Quality Assurance and Improvement Team (known as QAIT) since the last inspection. These professionals had closely monitored the home and provided training and support to help the provider and management team establish effective care and management systems. We have been kept informed and updated about progress towards achieving the provider’s action plan. Staff and people living in the home told us the home was now well-managed.

Improvements had been made in all aspects of safety. While we were satisfied the home was safe and fully compliant in all areas of safety at the time of this inspection we have yet to see that safety standards have been embedded and can be sustained.

Risks to people’s health and safety had been assessed, monitored, and there were systems in place to ensure risks were minimised where possible. At the last inspection we found people experienced a high number of falls. During this inspection we found the incidence of falls had decreased significantly. This was due to a number of factors, including improved monitoring of fluid and food intake levels, increased staffing levels which meant staff were able to monitor people’s whereabouts more closely, and increased activities and stimulation. Where people had previously experienced anxiety or displayed aggression the staff had worked closely with relevant professionals to find solutions, and we saw examples where this had resulted in positive benefits for people.

New staff had been employed following safe procedures. Staffing levels had increased and this meant there were sufficient staff to meet each person’s needs safely. People received care and support from a staff team who had received relevant training and qualifications. Staff had the knowledge and skills needed to enable them to meet each person’s mental and physical health needs. Communication systems had improved and staff were kept well informed about any changes to people’s needs through staff meetings and handover sessions between each shift. Staff received supervision regularly in line with the provider’s supervision policy. Staff told us they were well supported and there were good systems of communication.

Staff knew how to recognise possible abuse, and the actions they should take. They were confident any suspicions of harm or abuse would be listened to and acted upon appropriately. Staff told us “It’s so much better here. We feel we can do a good job and keep people safe and the work is more rewarding.”

People’s social needs had been assessed and actions had been taken to provide activities and social stimulation for each person according to their interests and preferences. A new activities co-ordinator had been recruited who provided a range of group and individual activities including games, arts and crafts, musical entertainment, and reminiscence. Staff were seen sitting and chatting to people. There was a relaxed and happy atmosphere throughout the home.

Care plans had been improved since the last inspection. Care plans had been re-written and were personal to the individual which meant staff had details about each person’s specific needs and how they liked to be supported. Care plans were very person centred, focussing on what the person could do for themselves, what support they needed day and night, any continence issues and what activities and likes and dislikes they had. Daily records had improved and these showed staff had provided care in line with each person’s care plan. Legal authorisation had been sought for those people who lacked capacity to make important decisions for themselves, and who may be deprived of their liberty.

Everyone we spoke with was happy with the food and drinks provided in the home. One person said “The food is lovely. I like it.” Another person said “Yes, the food is alright.” The kitchen staff knew which people were on special diets such as puree or used thickening for fluids due to being at risk of choking.

Improvements had been made to the storage and administration of medicines. There were safe systems in place to closely monitor medicine administration and these meant medicines were administered safely at all times.

Improvements had been made to the decoration and maintenance of the home. There were plans in place to make further improvements in the future. Maintenance records showed actions were taken promptly to address any repairs necessary. Equipment was regularly maintained and repaired or replaced appropriately. .

New quality monitoring systems had been put in place to ensure the home ran smoothly. However, these had not yet been fully established and therefore we are not yet fully confident that improvements can be sustained on a long term basis. We have rated the outcome areas ‘Is the service safe’ and ‘Is the service well-led’ as ‘requires improvement’. We will visit the home again within the next 12 months to check that standards of safety and management of the service have been maintained and remain fully compliant.

We found people received care, treatment and support that met their needs and protected their rights. People told us they were happy living there and felt well cared for.

Since our last inspection the provider has carried out redecoration and improvements to the home. Further improvements are planned for the near future including replacement of carpets. People we spoke with told us they were happy with their rooms.

People praised the staff. They told us the staff were friendly and had the skills necessary to meet their needs. The staff told us they enjoyed their jobs and were well supported and well trained. We saw evidence of training covering a wide range of topics.

The provider had a range of methods in place to check the quality of the services provided. They had systems in place to make sure the service was safe and well managed.

People's privacy, dignity and independence were generally respected. They were cared for by staff who were supported to deliver care safely and to an appropriate standard. People confirmed that they saw staff treated other less mentally or physically able people kindly and respectfully. One person added 'Everybody gets treated well.' Another said 'We have a good bit of fun' when discussing how staff supported them. Someone who described themselves as a 'worrier' told us that staff always took time to reassure them. However, we found the provider did not have appropriate arrangements in place to manage people's medicines safely.

The provider had systems to monitor the service's quality and manage risks to those who used the service or others. People's views and experiences were taken into account. Those we spoke with felt able to make a complaint if necessary.

A recent survey by the home showed excursions and bedding as areas for improvement. The manager told us that new bedding had since been obtained. People had indicated general satisfaction with the facilities, their room, privacy, food, and how their clothing was dealt with. Their comments included 'Nice and always clean', 'Definitely staff available at all times', and 'Brilliant home.'