29 May 2018
During a routine inspection
Daubeny House provides personal care and accommodation for up to 11 people with enduring mental health needs. At the time of this inspection, six people were living at the service. This service is located near to local shops and cafe’s that can be easily accessed by people living at Daubeny House. These premises are registered with the Care Quality Commission (CQC) as 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. At this location the provider has overall accountability to provide care and support and some aspects of the building maintenance and repair. A separate landlord had responsibilities for aspects of the building and maintenance works.
At the last inspection conducted on the 31 March and 1 April 2016 the service was rated as ’Requires improvement’ in the well-led key question and as ‘good’ overall. This was because we found one breach of Regulation 18 (notification of other incidents) Care Quality Commission (Registration) Regulations 2009. The registered person had failed to notify us of incidents which had occurred whilst services were provided to people. Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key question well-led to at least good. We returned sooner than we are required to do so to carry out this follow up inspection to review the progress and any improvements the service had made. Under the Care Quality Commissions (CQC) new methodology we can no longer rate any service as 'good' with breaches of Regulation. At this inspection we found that the new manager had notified us of incidents to people.
There was no registered manager in post when we conducted this inspection. A new manager had joined the service and we were told that they were in the process of applying to become the registered manager with the Care Quality Commission (CQC). Following this inspection, the new manager’s application was received by us. The new manager was only based at the service for two days a week because they also managed two other services within the Sussex Oakleaf group. 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 new manager and the head of residential care and housing for the Sussex Oakleaf group, told us that the service was currently going through a period of transformation and that the organisation was working through a “restructure”. This meant that the service was not yet established with the new management and staff team and that further discussions with commissioners were to decide the future model for the service.
There were only three permanent staff [‘recovery workers’]. The permanent staff knew people very well and acted as their ‘key worker’ to support them to attend regular CPA (Care Programme Approach) meetings with mental health professionals. We found that the service used Agency staff employed by an external employment provider. At times the agency staff were the only people on duty and they didn’t know people as well. Staff did not always have sufficient ‘time to care’ for people in the way they liked to due to staff shortages and there was a lack of planned and meaningful activities for people. However, despite this, people were supported to engage in some meaningful activities that were important to them. People were supported to have maximum choice regarding how their mental health was treated and had control of their lives. Staff supported people in the least restrictive ways possible. Despite this, there was a lack of clarity for staff surrounding the application of the Mental Capacity Act 2005 and when this should be used to ensure people were supported in least restrictive ways when they lacked the mental capacity to make informed decisions.
People were not always suitably safeguarded from abuse or risk of harm. Staff had not received up to date training to safeguard people and risks to people were not always assessed and managed safely. This included fire risks to people who were using prescribed creams which were paraffin based. Accidents and incidents were recorded for people and actions were taken to refer to appropriate external service for sport as required. For example, we saw that a person who had fallen was referred to an appropriate falls prevention service to reduce future risks to them. At the time of this inspection, the outdoor garden space was not well maintained. Wooden garden furniture was ‘stacked’ in a way that may pose risks to people using the outdoor areas. There was also a collection of disused furniture that was disposed of in the front car park of the service. We were not always notified of safeguarding incidents that had occurred.
Medicines were mostly assessed and managed by the recovery workers and people were supported to eat and drink enough and to maintain their independence by preparing some of their meals in the communal kitchen area with staff support. However, staff were not always suitably trained or skilled to meet people’s needs effectively and safely. Risks to people using prescribed and non-prescribed creams which contained flammable ingredients were not always safely assessed and managed.
People knew how to raise concerns if they had them. There were no formal complaints at the time of this inspection.
At this inspection we found there had been a decline in the quality of care provided, and the service is now rated as ‘requires improvement’ with breaches of Regulations 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 the report.