Archived: Dane House Care Home

Dane House provides accommodation for up to twenty-five older people, some of whom are living with dementia and who may need support with their personal care. On the day of our inspection there were nineteen people living at the home. The home is a large property, spread over two floors, with a communal lounge and a conservatory looking onto a large garden. It is situated in Brighton, East Sussex. Dane House belongs to the large corporate organisation called Four Seasons. Four Seasons provide nursing care all over England and have several nursing homes within the local area.

We carried out an unannounced comprehensive inspection on 13 and 14 March 2014. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 2nd March 2015 we carried out a focused inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection we found that significant improvements had been made, however, we continued to have concerns with the recording of mental capacity assessments, staff’s understanding of Deprivation of Liberty Safeguards (DoLS), the opportunity for meaningful activities for people and involving people in the running of the home. At the inspection on 12 July 2016 we found that significant improvements had been made, however, we continue to have concerns regarding the lack of staff training, knowledge and understanding in relation to the Mental Capacity Act 2005 (MCA) and DoLS. Further areas in need of improvement related to people’s dining experience and end of life care.

People’s consent was gained before staff offered support. One relative told us “They always inform me and ask my consent if needed”. There were good systems in place to assess people’s mental capacity and ensure that any decisions made on their behalf were made in their best interests and with people that were legally able to make decisions. However, there were concerns regarding staff’s training, knowledge and understanding in relation to MCA and DoLS and we have identified this as an area of practice in need of further improvement.

People told us that they were happy with the food and that they were able to choose what they had to eat and drink. Observations showed people being appropriately supported by patient and sensitive staff. However, people’s dining experience was poor. Most people ate their meals in their rooms, whereas others were in the communal lounge. People ate their meals on lap tables in the arm chairs that they had spent most of the day in, this didn’t aid their independence or enable them to orientate to time and place and know that it was time for lunch. The registered manager recognised that this needed to improve and told us that there were plans to redecorate the conservatory area to create a ‘fine dining’ experience for people. This is an area in need of improvement.

One person was receiving end of life care, they were treated with compassion and kindness by staff and their health and physical needs were met. However, there was a lack of holistic care and the person spent their time in bed with minimal stimulation or possessions near to them. People were not asked their preferences in regards to how they wanted to be supported at the end of their lives. The registered manager recognised that this was an area that needed further improvement, they had already made contact with the local hospice and planned to implement advanced care plans for people.

The management team consisted of a registered manager and a deputy manager. A registered manager is a ‘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 home was well-led and managed well. People, relatives and staff were complimentary about the leadership and management of the home and of the approachable nature of the registered manager. One person told us “I can talk to the manager, in the past there was a rapid turnover of staff but this has all changed”. Another person told us “The deputy manager is excellent, they are keen and enthusiastic and will talk to you anytime”. There were quality assurance processes in place to ensure that the systems and processes within the home were effective and ensured that people’s needs were being met and people were receiving the quality of service they had a right to expect.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

Sufficient numbers of staff ensured that people felt safe and their needs were met. One person told us “I can ring my bell for help so that’s how I feel safe”. There were suitably qualified, skilled and experienced staff to ensure that they understood people’s needs and conditions. Essential training, as well as additional training to meet people’s specific needs, had been undertaken and used to improve the care people received. People and relatives told us that they felt comfortable with the support provided by staff. One relative told us “I think some are excellent”. A visitor told us “They must be well trained because they can deal with any occurrence”.

People’s healthcare needs were met. People were able to have access to healthcare professionals and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services.

Positive relationships between people and staff had been developed. There was a friendly and homely atmosphere and people were encouraged to maintain relationships with family and friends who were also able to visit the home. People were complimentary about the caring nature of staff, one person told us “They always have time for a chat and will do anything you ask, I can’t fault them at all”.

People’s privacy and dignity was respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Residents’ meetings enabled people to make their thoughts and suggestions known. People’s right to make a complaint was also acknowledged. The registered manager welcomed feedback and used this as opportunity to develop the service provided. People received personalised and individualised care that was tailored to their needs and preferences. Person-centred care plans informed staff of people’s preferences, needs and abilities and ensured that each person was treated as an individual.

Below is a summary of what we found. The summary describes what people, visitors and staff told us, our observations during the inspection and the records we looked at. At this inspection we spoke with four of the people who lived at the home, three visitors and six care staff. We also spoke with the covering manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they were satisfied with the support they received. Their comments included 'I am looked after well' and 'I feel safe and I am happy living here'. However, some care plans were not sufficiently detailed to allow staff to deliver safe and effective care. We also saw a lifting technique used which potentially placed people at the risk of injury. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were robust recruitment procedures in place and required pre-employment checks had been completed. Staff files contained all of the information needed by the Health and Social Care Act. This showed the provider had effective selection and recruitment procedures in place.

There were insufficient qualified, skilled and experienced staff to meet people's assessed needs. Although the home used a dependency tool for calculating staffing levels this was not being used effectively. This was because key information, needed to inform this process, was not taken into account. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. We found that suitable policies and procedures were in place, however, insufficient staff had been trained to understand when a DoLS application should be made and how to submit one.

Is the service effective?

People told us overall that they were happy with the care delivered and felt that their needs had been met.

Staff had not received regular formal supervision or appraisal. This meant that their knowledge and practice was not regularly assessed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that the staff were kind and attentive. We saw that care workers showed patience and encouragement; however, we found that care delivery practices did not always promote people's dignity. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

People's needs had been assessed before they moved to Dane House Care Home. This meant the service had determined that they had the skills and facilities to meet people's identified needs from the outset. Where people's needs had changed or specialist advice was required, we saw the home had responded appropriately.

Is the service well-led?

The name of a previous registered manager appears in this report. They were not in post at the time of the inspection. An acting manager was in post. The acting manager was not present on the day of our inspection. The running of the home was overseen by a covering senior home manager.

The home had quality assurance systems intended to monitor and make improvements. However we identified shortfalls in care planning, maintenance and incident and accident monitoring. This demonstrated that audit processes were not effective at this time because they had not identified the shortfalls highlighted. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Care plans for people's personal care indicated which aspects of care they were able or preferred to undertake themselves. A person visiting their relative told us 'They have a nice way with Mum and I can see it's all based on her consent.' We observed people being offered choices about their care and support, such as whether they wished to go to the lounge or to join activities.

The registered nurses wrote and monitored care plans, which were based on initial assessments of need. We saw people were referred to specialist services when nurses had concerns about particular issues, with resulting guidance being incorporated into care plans. Staff recorded that they checked on people's wellbeing regularly, in line with care plan directions.

A part time activities worker was employed to encourage people in maintaining interests and social contact. We saw that that in the previous week a person had experienced a quiz, chocolate tasting, individual chat, a throwing game and poetry reading. People told us they were supported to use the garden in fine weather. However, there were times when stimulation was not available to people. The provider's satisfaction survey in 2013 showed most people in the home were dissatisfied with the choice or variety of activities. The area manager told us this was an area identified for development.

We asked people if they saw the home as a safe place to live. They were all definite in answering 'yes.' They spoke of committed, caring staff and open dialogue with the nursing staff.

We found the recruitment process was conducted consistently. It demonstrated the service sought to appoint people with the skills and experience needed by people in the home. Prospective staff were checked for their suitability to work with vulnerable people. People we spoke with confirmed they were introduced to new staff, and saw them being shown around. A person's relative contrasted this with the lack of continuity of care when agency staff were used.

There was a detailed annual survey of people living in the home and their relatives. This, together with daily and monthly monitoring within the home and by the area manager, identified areas for improvement, which were addressed through an ongoing action plan. Developments in the service were discussed with staff and people in the home through regular meetings.

At the time of our inspection there was no registered manager employed at Dane House. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection; therefore their name still remains on any reports until such time that this information has been received. We spoke with the new manager, a registered nurse, three care workers, the activities coordinator and two domestic staff.

This told us people or their representatives had been able to express their views about the care provided, and where possible people who used the service had been involved in making decisions about their care and treatment.

People’s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

People’s care had been provided by care staff who understood their care needs.

People told us that they felt safe. They knew who to talk with if they had any concerns about the care provided.

The organisation had systems in place to regularly audit the care provided.