Archived: Down House Residential Care Home

Is the service safe?

This is a summary of what we found-

Is it safe?

During our previous inspections in October 2013, and July 2014, we identified the provider had failed to ensure the home was clean. At this inspection we found infection control procedures in the home were not followed by all staff. Parts of the home were not clean. The home's infection control processes were not followed and as a result people were not protected from the risk of infection.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is it safe?

People's needs had been assessed and care was delivered to them in line with their needs. Care plans were clear and informative and staff were aware of people's needs and how to meet them. Risks relevant to the individual had been identified and care plans contained guidance on how these should be managed. People had the equipment they required to move around the home safely, and we observed staff assisting people using safe techniques.

The manager was aware of their responsibilities under the Mental Capacity Act (MCA). No applications had been made under the Deprivation of Liberty Safeguards (DoLS) however, the manager was aware of the procedures to follow should this be necessary. People were cared for by staff who understood their human rights. Records kept on people's care were clear and understandable.

Systems were in place to ensure the home was kept clean. However, some of these measures were not effectively ensuring people were protected from the risk of infection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection prevention and control.

Is it effective?

People told us they were happy in the home and their care needs were met. One person said, 'I've everything I need. They [the staff] know what they are doing'. Daily records of care showed people received the care they required which was in line with their care plan. Staff were aware of people's individual needs and provided care accordingly.

Staff training needs were identified and staff had completed training appropriate to their role. Where people had specific dietary or moving and handling needs, we observed these were met. People's individual preferences were known and respected.

Is it caring?

The staff provided support with a caring attitude. They were attentive to people's needs and provided care in a respectful way. We observed staff adapting their communication style to ensure people with hearing or language difficulties were included and their views were known. This enabled people in the home to make choices because staff adapted to their needs.

Is it responsive?

Staff responded to people's needs and external professionals were involved in people's care as needed. Staff had time to sit and talk with people. They provided people with encouragement to eat and/or drink whenever this was needed. Feedback was sought from people on a group, and one to one, basis and this was acted on. Where concerns with staff practice, or the environment had been identified, action plans and supervision discussions addressed these.

Is it well-led?

Staff told us the manager and provider were available to talk to at any time. One staff member told us, '[They] are really approachable. You can discuss anything with them'. The manager carried out audits and checks regularly and ensured concerns were recorded and acted on. Staff practice was monitored and training needs identified and addressed. This meant the quality of the service provided was monitored and improved as necessary.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for by staff who were aware of their needs and who had the skills to provide the support people required. People received the support they needed to move around the home. Some people were assisted to use a walking frame or a wheelchair and we saw this was carried out safely. However, risks to people's health, although identified, were not always managed effectively. The manager did not assure themselves that staff were following people's care plans accurately in order to keep people safe. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Robust recruitment processes were not in place or followed. This led to a member of staff being employed who had not been interviewed. Staff had also not been subject to the necessary checks on security and their suitability to work in the home. This posed a potential risk to people in the home. We have taken enforcement action in relation to this and the provider must take action to improve.

Is the service effective?

Arrangements were in place to ensure people were provided with the support they needed. For example, people who needed pureed food received this, and staff were on hand to provide people with support to eat where this was required. People told us they had their needs met. One person said they were 'quite happy with everything'. The manager had ensured people's weight could be monitored when, due to frailty, some people were unable to use conventional scales. However, some risk assessments impacted on people's ability to retain some independence within the home.

Is the service caring?

We observed staff showed a caring attitude towards people. People were encouraged in a kindly manner to participate in a music and singing session and were assisted to do so. Staff ensured people had sufficient to eat at mealtimes and where malnutrition or dehydration had been identified as a risk, staff supported people by offering a variety of different foods.

During this inspection we saw some work had been completed on improving people's care plans however these did not yet fully show how people's needs would be met. We also found some staff did not follow procedures to ensure people's health and welfare were cared for following a fall. We observed one person was assisted to move in an unsafe manner.

We also identified some concerns about the training and supervision of staff. Issues identified at supervision had not been addressed effectively and some records kept for supervision were vague and did not demonstrate that a productive conversation had taken place.

In addition we found quality assurance checks were not recorded for checks on medicines and the environment. We also found checks had not identified when furniture needed to replaced or repaired and there was no system in place for the manager to ensure that staff provided the care people required.

People told us they enjoyed the food. However, we found frozen foods were not stored appropriately or according to published guidance. We also found that whilst there was a variety offered, people were not offered a choice of meal. Some food storage areas were not clean.

The communal areas of the home and people's rooms were clean. However, we found toilets were not clean and there was a lack of personal protective equipment, such as disposal gloves and aprons available in bathrooms.

There were enough staff available to care for people's needs. Staff had completed training appropriate to their role. A complaints policy was in place and people knew how to complain. People told us they had no complaints and the service had not received any complaints.