Downs Cottage is a care home with nursing for older people including people who live with the experience of dementia and other mental health conditions. There were 13 people living here at the time of our inspection.We previously carried out an unannounced comprehensive inspection of this service in June and July 2015. At those inspections a number of breaches of legal requirements were found. We met with the provider to discuss our concerns. We also issued two Warning Notices which required the provider to take immediate action in relation to staff training and the safety of the building.
Since our last inspection we have continued to engage with the provider. We also required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant that the provider had complied with the Warning Notices we had issued.
Since our last inspection, the service had experienced a period of considerable change. Whilst it was evident that the management team had effected improvements to the home, these changes now needed to be embedded and sustained.
The providers focus had been on ensuring staff had appropriate training in first aid and changing the environment of the home to make it more suitable at meeting the needs of the people who live here. This included redecorating areas of the home, and major works such as installing two walk in shower rooms and fitting ceiling hoists to help people with mobility support needs. As such other areas of improvement had been identified, but not wholly implemented. For example, whilst we found that people received appropriate care, the care plans had still not been fully updated to give guidance to staff.
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. However the registered manager had been absent from the home a number of times, and the provider’s plans to give management support at the home were not totally successful. Staff had not had the opportunity to have formal one to one meetings with their manager as per the provider’s policies. In addition a senior manager was not always available to support staff. The registered manager returned to work soon after our inspection, so these issues were in the process of being corrected.
We had positive feedback from people and their relatives about their lives at Downs Cottage. One person said, “I am happy here, I don’t think they could do better.” Another told us, “Staff are very nice and take time to talk to me.” A relative said, “I think my family member is well looked after and happy living here.” There was positive and caring interaction between people and staff.
The home was decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid with people’s mobility needs. The home had an airy and homely feel.
People were safe at Downs Cottage because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here.
Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.
Staff recruitment procedures were robust to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.
People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of medicines. All medicines were administered and disposed of in a safe way.
In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. The premises were safe to use for their intended purpose.
Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.
Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.
People had enough to eat and drink, and received support from staff where a need had been identified. One person said, “The food is nice, I like it all.” A relative said, “My family member loves her food, and even though she has to have it pureed, she comes back for seconds because it is so nice.”
People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. A relative said, “My family member had an infection recently, staff care and support helped him to get better.”
The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with them and showing interest in what people were doing. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted. The staff knew the people they cared for as individuals, and had supported them for many years, giving a family feel to the home.
Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as outlined in their care plans. Details such as favourite foods in the care plans matched with what we saw on the day of our inspection. People had access to activities that met their needs.
People knew how to make a complaint, and told us that the registered manager would always listen to what they said and take appropriate action to put things right. Staff knew how to respond to a complaint should one be received.
Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.