Devonshire House

Devonshire House is a residential care home that provides accommodation and personal care for up to 25 people. On the day of our visit there were 21 people using the service, some of whom were living with dementia.

People’s experience of using this service and what we found

At our last inspection we made two recommendations in respect of medicines. At this inspection the provider had implemented all of the recommended actions, made suitable improvements, and the management of medicines was safe.

People said they felt safe and well cared for. People were safeguarded from abuse and staff understood their safeguarding responsibilities. Comprehensive and personalised care plans and risk assessments were in place. Staff were suitably trained and there were enough staff to meet people’s needs.

The management team was approachable and supportive. The provider had clear and effective management systems in place. Audits were undertaken regularly, and the audits effectively identified areas for improvement. Action plans were created, implemented and reviewed to support continuous improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 4 September 2019). Two recommendations were made in respect of medicines.

Why we inspected

As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures.

Additionally, we undertook this inspection to check the provider had made the necessary improvements to meet the recommendations. This was a focused inspection looking at the IPC practices the provider had in place and the key questions safe and well-led based on the previous rating.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on findings at this inspection.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Devonshire House on our website at www.cqc.org.uk

Devonshire House is a residential care home that provides accommodation and personal care for up to 25 people, some of whom were living with dementia or learning disabilities. On the day of our visit there were 25 people using the service.

People’s experience of using this service and what we found

Medicines were managed safely at the home, but some improvements were still needed.

We have made two recommendations regarding medicines.

People were happy living at Devonshire House and felt safe. Appropriate safeguarding procedures were in place to protect people from abuse. Staff knew how to report concerns internally but some were unsure how to report concerns externally. The registered manager assured us they would revisit safeguarding procedures at the next team meeting to refresh the staff. Staff were confident that any concerns raised would be taken seriously by management.

There were enough staff to meet people’s needs and they were recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were happy with the food provided and the cook catered for everyone’s needs. Although work was still ongoing, for example the building of a shower room and decoration, we found the environment had improved.

Staff were caring and treated people with kindness. People were treated with dignity and respect.

People had clear, detailed and person centred care plans, which guided staff on the most appropriate way to support them.

There was a clear management structure and staff were supported by the registered manager and provider. Improved quality assurance systems were being introduced. However, this was a new system and needed to be sustained further.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 February 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People's risk assessments did not consistently cover all potential areas of risk, such as the risk of pressure damage and aggression and did not consistently mitigate risks. We looked at the systems in place for medicines management and found they did not always keep people safe. People felt safe in the care of staff members and were happy with staffing levels. However, staff were not utilised effectively. The provider had appropriate systems in place to support staff to raise any safeguarding concerns. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection. Premises continued to need work to become safe.

People told us they received effective support. Systems were in place to ensure that staff received appropriate supervision to support them in their roles. Staff felt they were trained to the right level to effectively work with people. Checks were made on the ongoing competency of staff. People were supported to eat meals of their choosing and were supported to access health professionals when necessary. Where people wanted to remain independent with personal care the lack of a shower prevented this.

People told us care staff were caring and kind. People's privacy and dignity needs were not always maintained by staff members caring for them. We could not evidence people were receiving regular baths.

Care plans contained lots of information on people’s life history, likes and dislikes. However, every person had the same index of which care plan was included whether this was needed or not. Activities were taking place but needed more work to either involve people as a group or on a one to one basis.

The providers systems and processes in place to monitor and audit the service continued to require improvement. Records management needed improvements regarding medicines, risk assessments and quality monitoring of the service.

The service continued to meet the characteristics of requires improvement but had deteriorated to inadequate in well led.

More information in the full report.

Rating at last inspection: Requires improvement, (published March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At the last inspection in January 2018, we asked the provider to take action to make improvements. Some action had been completed however further improvements were required. This is the second consecutive time the service has been rated Requires Improvement.

Follow up: We will request an action plan from the provider to understand what immediate action they will take to improve the quality and safety of care provided to people. We will also meet with the provider to discuss this action plan.

This service has received a rating of 'Inadequate' in one or more domains and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Devonshire House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 23 people living at the service.

A registered manager was in post at the time of the inspection visit. They were registered with the CQC in December 2004. A registered manager is a person who has registered with the CQC 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 service was last inspected in August 2016 and received a rating of Good.

We could not evidence people received their medicines as prescribed due to poor recording. Medicines were stored safely.

Risks to people arising from their health and support needs and the premises were not always assessed and plans were not always in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However, two out of three bath hoists were broken and water temperatures were low. The last electrical safety certificate stated it was unsatisfactory and needed work, but there was no record to show the work had been done. The gas boiler service certificate was sent after inspection and showed that suitable checks had been carried out.

We saw day staff had received fire drills three times in 2017; however the records did not document what time the drill took place and how long it took to evacuate. Night staff had never received a fire drill and no staff had practised a full evacuation. We have made a recommendation regarding this.

There were concerns with infection control as staff were not adhering to good practice and the laundry room had no facilities to wash hands after handling infected/contaminated linen.

Staff had received all the training they needed to carry out their roles effectively. However, we saw evidence to show that they were not always putting this training into practice. We have made a recommendation regarding this.

Staff were fully supported from supervisions and a yearly appraisal.

People enjoyed the food provided and were offered choice. Staff were aware of people’s dietary needs, however records needed updating.

People who lived at the service were safeguarded from abuse and potential abuse. People told us that they felt safe at the service. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

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.

We found there was sufficient staff employed to support people with their assessed needs. However, the registered manager should look at how these staff were deployed.

Staff knew people and their life history’s well. However we found that not all staff knowledge was recorded in people’s care files. Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Care plans had information of people’s wishes and preferences; however there was nothing recorded about people’s wishes and preferences for end of life care. We saw little evidence that people had been included in their care planning process and we have made a recommendation regarding this.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health.

We found the interactions between people and staff were kind and respectful and people were offered choice throughout the day.

Procedures were in place to support people to access advocacy services should the need arise. At the time of inspection two people were using an advocate.

We saw evidence of activities taking place.

The service had a complaints policy that was applied if and when issues arose.

Audits were taking place, however they were not robust enough to highlight the issues we found during our visit.

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

We had visited the service on the 15 January 2016. We had found that medicines were not stored and administered in a consistently safe manner. There was a risk that people were not receiving their medicines as prescribed due to poor record keeping. We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, on how they intended to mitigate and address the breach of Regulation 12 of the Health and Social Care Act 2014 in managing medicines safely. The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found.

Devonshire House is situated in the village of West Auckland close to all amenities. It currently provides residential and respite care, nursing care and care for people with dementia and people with physical disabilities. There are 21 single occupancy rooms and 2 double occupancy rooms. Three of the rooms within the home have en-suite facilities. The service is family owned and it has a close knit, family feel to the home.

There is 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 a registered nurse and had worked at the home before they applied to be the registered manager.

On this visit we were met with a registered nurse who showed us how medicines were stored, dispensed, ordered and returned. They explained the checks they carried out to ensure medicines were administered correctly. They also showed us the new policies the service had written which staff had read and signed. This nurse told us the service had reviewed how it dealt with medicines and had discussed this in meetings and in supervision sessions with the registered manager.

We saw medicines were stored and administered safely.

Devonshire House is situated in the village of West Auckland close to all amenities. It currently provides residential and respite care, nursing care and care for people with dementia and people with physical disabilities. There are 21 single occupancy rooms and 2 double occupancy rooms. Three of the rooms within the home have en-suite facilities. The service is family owned and it has a close knit, family feel to the home.

There is 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 had just completed their registration prior to our visit and was a registered nurse and had worked at the home before they applied to be the registered manager.

All people we spoke with told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. We saw safeguarding incidents were very well recorded, investigated and managed by the registered manager.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The service did not have many people subject to a DoLS safeguard and it had an open door policy. The registered manager agreed that they may need to make further applications subject to a capacity assessment if they needed to secure the front door on a more permanent basis.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of older people such as end of life care and dignity. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other.

Medicines were not stored and administered is a consistently safe manner. There was a risk that people were not receiving their medicines as prescribed due to poor record keeping.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home and people were able to visit local shops and facilities.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. People told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had a complaints procedure and staff told us how they could recognise if someone was unhappy and how to report it.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Devonshire House. Action plans and lessons learnt were part of their on-going quality review of the service as well as a service improvement plan to improve décor and signage within the service.

The home was very much part of the local community and people were free to come and go as they pleased. Many visitors popped in during the course of our visit and were warmly welcomed.

You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we saw the provider had put various quality control checks in place. These included carrying out assessments in relation to medications practice, charts for cleaning and monitoring people who used the service but preferred to stay in their rooms.

We looked at the area where the records of people who previously used the service were kept and saw this had now been closed off to the public with the use of a locked door.

We saw the care plans and risk assessments of people who used the service had been regularly reviewed and the provider had put a system in place to ensure this was done on a monthly basis.

We saw people's care records now contained details of appointments they had with healthcare professionals such as the GP and district nurse as well as a record of hospital out-patient appointments and admissions.

We saw people who lived at the home were looked after by people who had the appropriate training to carry out their work. Staff said they were happy in their work and felt they gave the best level of care they could.

The provider had sent some questionnaires to service users, staff and families of people who used the service, but had failed to take account of what had been said.

The provider has failed to maintain accurate records with regards to people who lived at the home and has failed to ensure the records of previous service users were stored securely prior to disposal.

We spoke to three people who used the service. One person said 'They said I could go to another place, but I like it here.' Another person told us 'We came to look around first and I liked it.'

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spoke to people who used the services and they told us staff were very good. One person said 'Staff are brilliant' and another said 'They (the staff) are nice people.'

The staff felt they cared for people who use the service appropriately and felt they were able to speak openly to both manager and owners. One person told us 'I would always say if I felt there was something wrong with the way people were being treated.'