Darland House

The provider had identified a living area as a proposed designated setting. This was one of the 10-bedded living areas on the second floor of the service. At the time of the inspection, 10 people were being cared for in this living area. One person has been admitted recently with COVID-19, however the other nine people were free from infection having recovered from the illness.

We found the following examples of good practice.

¿ Each living area, including the proposed designated setting, was self-contained. They had their own laundry areas and assigned care and domestic staff for each shift.

¿ Each room, bedroom, communal area or office had been risk assessed to identify the maximum numbers of people allowed in the room to ensure social distancing.

¿ Living areas and the proposed designated setting were accessed by a key-fob entry system. Staff did not move into other parts of the service to reduce the risk of spread of infection.

¿ The service participated in weekly testing for staff and carried out lateral flow testing for visitors.

¿ We were assured that this service met good infection prevention and control guidelines.

However, we had some concerns about the suitability of the service as a designated setting. This was because people who had recovered from COVID-19 remained within the proposed designated living area until a vacant room became available elsewhere in the service, or suitable accommodation could be found elsewhere. Senior management told us this could take on average between three and six months. There was a risk therefore that people could become re-infected. We discussed our concerns with the provider and local authority that although we were assured that the service met good infection control processes, it did not meet the criteria to be identified as a designated setting. They agreed and made the decision to remove their application for this service to be used as a designated setting

We found the following examples of good practice.

• Staff had received a good level of face to face training and assessment for infection prevention and control including how to use Personal Protective Equipment (PPE) effectively and how to maintain good hand hygiene.

• The provider had an effective and well-structured system for auditing infection prevention and control. This involved several of the provider’s locations working together to discuss best practice and overcome any gaps identified in infection prevention and control measures.

• Visits to the service had to be booked in advance. Staff telephoned visitors on the day they were coming to the service to remind them of the visiting procedure and check they did not symptoms of Covid-19.

We were assured of the provider's safe management of infection prevention and control. However, at the time of inspection the service was not suitable for the purposes of a designated care setting. There were people living in the proposed area and plans had not yet been agreed to confirm a designated staff team.

Further information is in the detailed findings below.

Darland House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is part of the health services provided by Medway Community Healthcare (MCH) and is registered to provide accommodation and personal care for up to 40 people who are living with advanced dementia. The accommodation was provided across four units, over two floors. A lift was available to take people between floors. There were 39 people living in the service at the time of the inspection.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

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 was supported in the day to day management of the service by a head of service and a clinical lead.

People told us they felt safe. There were sufficient staff deployed to meet people's needs in a timely and unhurried manner.

People's medicines were managed and administered in a safe way by staff who had been trained to carry out the task.

People were protected from the risk of harm or abuse because the provider had effective systems in place which were understood and followed by staff. People were protected from the risk of the spread of infection.

People continued to receive effective care. People were supported by staff who were trained and competent in their roles.

The provider was working within the requirements of the Mental Capacity Act (2005). The registered manager and staff demonstrated they understood the principles of the Act. Staff had received MCA training and sought people's consent before providing assistance.

People's health care needs were monitored and met. 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.

People were supported by kind and caring staff who took time to get to know people and what was

important to them. Staff treated people with respect and respected their right to privacy.

People were involved in planning and reviewing the care they received which helped to ensure people received a service which met their needs and preferences.

There were daily activities for people which they could choose to join in with. However, not everyone was engaged in activities during our inspection. We made a recommendation about this.

Complaints were taken seriously and responded to. People's religious and cultural needs were understood and met by staff.

The provider had effective systems in place to monitor and improve the quality of the service provided. People and their families had opportunities to put forward their ideas and suggestions to improve the service they received.

At our previous inspection on 14 August 2014, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches were in relation to safe recruitment and supporting nursing staff to gain the skills needed to manage some emergency medical situations. The provider sent us an action plan with timescales showing how and when the regulations would be met.

At this inspection, we found that the registered manager and provider had taken action to address the breaches from the previous inspection.

The service provided accommodation and personal care for up to 40 people who are living with advanced dementia and is part of the health services provided by Medway Community Health Care NHS, (MCH). The accommodation was provided over two floors. A lift was available to take people between floors. There were 38 people living in the service when we inspected.

There was a registered manager employed at the service. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. The provider had a dedicated system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. The registered manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. The premises were undergoing a refurbishment. This was to modernise the decoration and design to meet current published guidance for services delivering to people living with complex developed dementia. Equipment in the service had been well maintained.

People had access to qualified nursing staff who monitored their general health, for example by testing blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service.

There were policies and a procedure in place for the safe administration of medicines. Nursing staff followed these policies and had been trained to administer medicines safely.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the NMC. Nursing staff received regular clinical supervision and support.

We observed staff that were welcoming and friendly. People who could talk to us and their relatives described staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with.

The registered manager of the service, nurses and other senior managers were experienced and provided good leadership. They ensured that they followed their action plans to improve the quality of the service. This was reflected in the changes they had already made within the service.

We found that peoples complex and diverse needs were understood by the staff and were met. People were provided with meaningful activities which took into account up to date research into dementia.

People were offered choices at every meal time and could choose where they ate their meals. We saw that people were encouraged to drink and were offered snacks throughout the day. We saw that people were given the assistance they needed to eat and drink in a sensitive and discreet way.

The service had effective systems in place for minimising risks associated with infection control. All areas of the home were clean, there were no unpleasant odours, and staff received regular training updates to refresh their knowledge.

The recruitment procedures at the service were sufficiently robust to ensure the safety and wellbeing of people living there.

The service had a complaints procedure in place, and had not received any complaints since the last inspection.

We found that people were receiving the care and support they needed. We saw that staff assisted people in a caring and sensitive way and understood people's complex needs.

We saw that staff treated people with respect and with regard for their privacy and dignity. A relative we spoke with said that Darland House was 'Marvellous' and 'I can't fault the place'.

Staff said that they received the training and support they needed to enable them to care for the people living at the home.