Archived: Deanwood Lodge

There was a registered manager in position. 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.

We last inspected in July 2016 and found that the provider was not meeting all of the regulations. We found that people were not always supported by staff who had the training and support they required to carry out their roles. Following our inspection in July 2016, the provider issued us a plan of the actions they would make. At this inspection we found appropriate action had been taken to address our concerns.

The provider had systems to monitor and improve the quality of service people received, however these systems were not always effective and did not always identify concerns, or ensure action was taken when concerns had been identified.

People’s care and risk assessments were often reflective of their needs; however some people’s care and risk assessments did not reflect their need. The registered manager and clinical lead were taking action to address this concern.

People and their relatives were positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People benefitted from the activities provided to them.

People benefitted from positive caring interactions with care staff. Care staff supported people to make choices and respected their wishes. Care staff took time to engage with people in a positive and meaningful way and ensured that personal care was a positive activity.

People and their relative’s views were sought and acted upon by the registered manager and provider. People’s relatives were confident their concerns would be responded to and resolved.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff had received training to meet people’s healthcare needs. Staff felt supported and had access to a structured supervision (one to one meeting) and appraisal process. Staff spoke positively about the support they received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

We last inspected in January 2016 and found that the provider was not always meeting the regulations. We found that people did not always receive safe care and treatment as they were not always protected from the risk of choking. People were cared for in an environment which was not always safe. Additionally people did not always benefit from person centred care and did not have access to activities and meaningful stimulation. The provider did not have effective systems to monitor and improve the quality of service people received. Following our inspection in January 2016, the provider issued us a plan of the actions they would make. At this inspection we found appropriate action had been taken.

There was a registered manager in post on the day of our inspection. 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 cared for by staff who had not yet all completed their formal training in all the topics they needed. A number of people living at the service had a diagnosis of dementia, however not all staff had effective training around dementia. All staff felt supported by the registered manager and provider. The registered manager had a clear plan in relation to staff training.

People and their relatives were positive about the home, the staff and management. People told us they were safe and looked after well in the home. Staff managed the risks of people’s care and understood their responsibilities to protect people from harm. People had the assistance they required with their prescribed medicines.

People had access to plenty of food and drink and received a diet which met their needs. Staff ensured their on-going healthcare needs were met.

People benefitted from activities and person centred care. There was a friendly, pleasant and lively atmosphere within the home. People also enjoyed the time they spent with each other and staff and carrying out activities. People were offered choices about their day. People and relatives told us they felt listened to and able to raise concerns or suggestions.

Staff were supported by a committed registered manager. There were enough staff with appropriate skills deployed to meet the needs of people living at the service and support them with activities. Staff spoke positively about the home and the registered manager.

People and their relatives spoke positively about the management and the service. The registered manager ensured people, their relatives and external healthcare professional’s views were listened to and acted upon. The registered manager and provider had systems to assess, monitor and improve the quality of service people received at Deanwood Lodge.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We last inspected in March 2015 and found the provider was meeting all of the requirements of the regulations at that time.

There was not a registered manager in post on the day of our inspection. The previous registered manager had left in November 2015. A new manager had been appointed and they were in the process of applying to become the 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 told us there were not always things to do and that life in the home could be boring. Some people went periods of time without any contact with care staff. There was an activity co-ordinator in post who was due to leave the service, however another two activity co-ordinator was due to start at the home shortly.

People were not always protected from the risks associated with their care. One person had a choking incident as they had been given food which was not in accordance with their assessed needs.

The provider had not ensured that systems were in place and regularly undertaken to sufficiently assess, monitor and continually improve the quality and safety of the services provided, including the quality of the experience of service users in receiving those services.

People were not always protected from the risks of environment or in the event of a fire. Fire safety and maintenance checks were not being carried out in accordance with the provider’s policies. Some rooms which contained items that could put people at risk were not always secured.

Care staff treated people with dignity and respect when they assisted them with personal care and mobility. However, they did not always ensure people’s drinks were left close to them to enable them to assist themselves independently. Care staff sometimes made choices for people over what they would like to eat or drink, without giving them choice.

People received their medicines as prescribed. Care staff did not always keep an accurate record of the support they have given people with their medicines. Where people needed their medicines covertly, care staff followed clear guidance to ensure their needs were met.

Care staff ensured where people needed assistance with their personal hygiene that they were kept clean and comfortable. Staff showed genuine care for people if they were anxious or unhappy.

People were supported by kind, caring and compassionate care staff. Staff spoke positively about people in the home and knew what was important to them.

People told us they felt safe in the home. Staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People's needs were assessed. Where any risks were identified, management plans were in place. People’s care plans were being updated by staff at the home.

People’s relatives spoke positively about the manager. The manager had clear aims to improve the quality of service people received in the home. A new clinical lead had been appointed and the provider had implemented an action plan with an aim to ensure people received a good service.

Care staff had access to development opportunities to improve their skills and the service people received. Care staff received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We found that two compliance actions issued at a previous inspection had been addressed. These related to the management of people’s medicines and how the service monitored people who were nutritionally at risk. There were arrangements that ensured medicines were managed safely and a system to monitor people who had been identified as being nutritionally at risk was now in place.

The environment was cleaned to high standards and no offensive odours were found. A system was in place to monitor the control of infection.

The provider had arrangements in place to regularly assess and monitor the service provided to people who used the service.

Prior to this inspection we had received some information of concern about the care people were receiving especially in relation to food and fluid intake and the recording of these.

We found that people who were assessed as being nutritionally at risk and had food and fluid charts in place were were not always being monitored by staff. Food and fluid charts were not always completed and there were gaps in the recordings on these. We also found they were not reviewed by a senior member of staff and actions taken when people had limited food and fluid intake. We fed back our findings to the representatives from the provider they told us they had already identified concerns with this and they were about to implement some actions to address it.

We found that some of the medication procedures in place were not being followed and we observed some unsafe practice for administration of people's medication.

We observed some people had alot of interactions with staff but other people who were not able to communicate verbally received very little.

We followed up on the compliance actions we issued at a previous inspection. We found that a system had been put in place to monitor people who were nutritionally at risk and that any weight loss was being identified and actions taken.

We examined the care records of three people who used the service and found that some improvements were still required. However, the registered manager explained the actions she had planned to address the shortfalls with some people's care records.

One person who used the service told us they were well looked after and had no complaints. The three relatives and one person spoken with thought the environment was “lovely” and “well maintained”. One relative thought it was “nicely decorated”.

We examined the care of one person in detail and examined the care records of some other people. We found their care records were not always personalised to their individual needs. We identified some people had lost weight but this had not been identified and acted upon.

Prior to the inspection we had received some information of concern about staffing levels and the use of agency staff. The registered manager told us they had recruited some new staff but were waiting for their pre-employment checks to be returned. Where agency staff were being used the home was trying to make sure they had the same member of staff for continuity, however this was not always possible.