The Care Quality Commission (CQC) has rated Dene Holm in Northfleet, Kent, inadequate overall, following an inspection in August.
Dene Holm is a care home providing personal care for up to 47 people, run by Rapport Housing and Care. At the time of the inspection there were 38 people living there.
Following this recent inspection, the home’s overall rating has dropped from good to inadequate. Its ratings for being safe, effective, caring, responsive and well-led have also declined from good to inadequate.
It was inspected due to concerns about safeguarding, the management of risk, staffing and the provider’s oversight of the service.
Hazel Roberts, CQC head of inspection, said:
“When we inspected Dene Holm we were concerned to find managers had no oversight of the home. Risks to people’s safety, such as falls or choking risks, weren’t being well managed.
“We found that people weren’t always supported to manage their health conditions. For example staff told us there were five people living in the service who had diabetes. We asked the chef what adjustments were made when preparing food for these people. They told us with the exception of making custard with sweetener for everyone, no adjustments were made. One person's dietary information sheet stated their favourite foods were chocolate and sweets and they took sugar in their tea. An incident form from the month prior to our inspection stated the person's GP was having difficulty in getting their diabetes under control.
“Staff told us they didn’t feel supported and were short staffed. Yet, despite this, they were doing their best to provide the best care they could.
“People and their relatives told us the staff were kind and caring, and we saw warm relationships between staff and the people living at the home.
“We have told leaders at the service what it needs to do to improve. People living in care homes deserve to receive safe care, and we will continue to monitor the service and ensure the provider makes the necessary improvements to enable them to deliver a quality service.”
Inspectors found the following during this inspection:
- Due to staff shortages the provider employed a large number of agency staff who did not know the people living there and the routines of the home. This meant people living in the service were not always supported by sufficient, skilled staff
- One person's care plan stated due to choking risks they required their food to be of a minced and moist consistency but the person chose not to follow this. There was no information in relation to the person's capacity to make this decision or any risk assessment regarding how they should be supported to eat safely
- People's medicines were not safely stored and monitored. Medicines had been stored at higher than recommended temperatures for extended periods of time. Staff had reported these concerns to the senior management team, but action had not been taken to rectify this. This meant people's medicines may lose effectiveness
- The majority of interactions with people were respectful. However, on arrival at the service at 6am inspectors found two door guards on people's bedroom doors were making a piercing bleeping sound as the batteries needed to be changed. Staff told us they had been beeping for most of the night and had kept people awake. No action had been taken to resolve this and staff had not alerted the on-call maintenance person to the concern. This demonstrated a lack of respect for people's comfort
- Risks to people's safety were not robustly monitored. Risk assessments and other documentation lacked detail and contained contradictory information regarding people's safe care. For example, incident records for two people showed they were at high risk of falls. Their care records and risk assessments contained contradictory information in relation to their mobility, the equipment they used and the level of support and supervision they required. This was of particular concern due to the high number of agency staff employed at the service who may not be fully aware of people's needs