This unannounced inspection of Devereux House took place on 17 July 2017. Devereux House provides residential care for older people over the age of 65. It is located above a day centre within a residential area of Farnborough, Hampshire. The home offers a service for up to 16 people. At the time of our visit 11 people were living in the home full time and two people were being supported temporarily with respite care.We last inspected Devereux House on 11 and 13 January 2016 and found the provider to be in breach of regulations in relation to good governance and fit and proper persons employed. We issued a warning notice for the breach of regulation in relation to good governance. The provider was required to meet the regulation relating to the warning notice by 31 May 2016. During this inspection we found the provider had taken action to ensure the requirements of this regulation had been met.
We served a requirement notice on the provider regarding the breach of regulation in relation to the employment of fit and proper persons. The provider was required to send us an action plan detailing how they were going to make improvements to meet the regulation. During this inspection we found the provider had made some improvements to their recruitment process but there were still some gaps in relation to staff previous employment histories. However, prior to the completion of this report the registered manager had provided evidence to demonstrate that all gaps in staff employment histories had been addressed. In addition the provider had also made improvements to their recruitment documentation to ensure robust processes going forward.
The service 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.
People were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and had access to guidance to help them identify abuse and respond appropriately if it occurred. Staff were able to demonstrate their role and responsibility to protect people.
Risks specific to each person had been identified, assessed, and actions implemented to protect them. Risks to people had been assessed in relation to their mobility, social activities and eating and drinking. Staff were able to demonstrate their knowledge of individual risk assessments and how they supported people in accordance with their risk management plans.
People’s care plans had been reviewed to ensure they included all of the information staff required to meet people’s needs.
The registered manager completed a daily staffing needs analysis to ensure there were always sufficient numbers of staff with the right skills mix and experience to keep people safe. We reviewed staff rotas which confirmed that people had been supported by sufficient numbers of suitable staff to keep people safe. Staff had undergone pre- employment checks as part of their recruitment, which were documented in their records.
People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the registered manager.
The provider’s required staff training was up to date, including safeguarding people from abuse, moving and positioning, the Mental Capacity Act 2005, fire safety, food hygiene and infection control. This ensured staff understood how to meet people’s support and care needs. Training was refreshed regularly to enable staff to retain and update the skills and knowledge required to support people effectively.
Staff had received individual supervisions and appraisals from their supervisors who completed competency assessments in relation to staff skills such as moving and positioning.
Staff supported people to make as many decisions as possible. People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and deprivation of liberty legislation and guidance.
People were supported to have enough to eat and drink and were provided with a balanced, healthy diet. People were supported to consume sufficient nutritious food and drink to meet their needs, in accordance with their care plans.
Records showed that people had regular access to healthcare professionals such as GPs, speech and language therapists, opticians, dentists and podiatrists. The registered manager had developed excellent links with specialist nurses, particularly the Specialist Community Nurse for Care Homes, who held regular clinics at the service. Staff had benefitted from training and guidance from a range of specialist nurses.
People and where appropriate their relatives were supported to be actively involved in making decisions about the care they received. Staff had developed positive caring relationships with people and spoke with passion about people’s needs and the challenges they faced. Healthcare professionals made positive comments about the positive impact on people’s well-being due to how well staff had implemented their guidance.
People’s privacy and dignity were maintained by staff who had received training and understood how to support people with intimate care tasks. Staff demonstrated how they encouraged people to be aware of their own dignity and privacy.
The management team were committed to ensuring people were involved as much as they were able to be in the planning of their own care. Staff reviewed people’s needs and risk assessments monthly or more frequently when required to ensure that their changing needs were met.
The registered manager sought feedback in various ways, including provider surveys, visitor’s questionnaires and trustees visits, which they used to drive continuous improvement in the service. Since our last inspection there had been no complaints raised. People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs.
The registered manager and management team inspired staff to deliver good quality care to people living at Devereux House. Staff were able to tell us about the values of the provider and we observed staff followed these in practice. The registered manager was highly visible within the service and readily available to people and staff. The registered manager and senior staff had developed and sustained an open and positive culture in the service, encouraging staff and people to raise issues of concern with them, which they always acted upon.
The registered manager had established systems and processes that enabled them to identify and assess risks to the health, safety and welfare of people who use the service and to ensure compliance with legal requirements. The provider had maintained accurate, complete records in relation to people, including a record of the care and treatment provided and decisions taken. The provider’s audits of medicines management, staffing needs analysis, staff recruitment, accidents and incidents and care records enabled the provider to identify and assess risks to the health, safety and welfare of people and take appropriate actions to improve the service..