We visited the home on 8, 9 and 17 July 2014. We spoke with 32 staff, the registered manager, five relatives and thirteen people using the service. We looked at the care plans of 16 people using the service and also looked at other records relating to the running of the service.The inspection team who carried out this inspection consisted of four inspectors, three specialist advisors who specialised in differing areas of care delivery and an expert by experience. An expert-by-experience has personal experience of using or caring for someone who uses this type of care service.
Due to the complex needs of some people living at The Old Deanery Care Home they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed two mealtimes and spent time in a communal lounge.
During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.
If you want to see the evidence that supports our summary please read the full report.
Is it safe?
The service was not consistently operating in a way that ensured people were safe. Some people told us they felt safe and secure and we found staff had knowledge of when and how they should report any concerns about the safety of people using the service. However, we found that some concerns, had not been investigated by the manager. This meant action had not been taken to investigate some incidents and determine if referrals to the local authority for consideration under their safeguarding vulnerable adult's procedures were needed.
We found that recruitment procedures in the home were rigorous and thorough to ensure staff were safe to work with vulnerable adults. However when arranging staffing, the management team did not always ensure there was a suitable skill mix in relation to competencies, knowledge, qualifications and experience.
We saw that where people had been assessed as being at risk from acquiring infections or were at risk of falling, the assessments did not give staff information on how they could support people and minimise these risks.
We looked at whether the service was applying the Deprivation of Liberty Safeguards (DoLS) appropriately. We found that although some staff had a lack of knowledge of DoLS, the registered manager had a good understanding and there were people with a DoLS authorisation in place in line with current policy. However, we found the Mental Capacity Act 2005 (MCA) was not being adhered to. This meant people were not always being supported with decisions made in their best interest.
Is the service effective?
The service was not consistently effective. Communication between staff was inadequate at times and led to delays in people receiving appropriate healthcare support from external professionals such as a GP.
We found that although staff were given training, they were not always putting this training into practice to ensure people were cared for safely.
Is the service caring?
The service was not consistently caring. We saw that some staff showed patience and gave encouragement when supporting people. We received some positive comments from people who were more independent. One person said, 'Very pleasant here. I am glad I moved here.' Another person said, 'It is a friendly place. It is pleasant.' Three other people told us they were very happy in the home with one saying, 'I wouldn't have anything to complain about.'
However, the needs of people who lived with a dementia related illness were not consistently understood or met in a caring way, by staff that supported them. We observed some people receiving care and support from staff who had little understanding of how to care for people with dementia. We saw this led to people with a dementia related illness not being supported to have choices, not always being treated with dignity and being placed at risk, for example burning themselves on hot food.
Staff had a good understanding of how they should support people with their privacy and dignity and we observed examples of staff respecting this. However we also saw examples of when people and their belongings were not treated with dignity. We heard staff refer to people as room numbers and tasks rather than by their name. This meant people were not always treated as individuals.
We saw inconsistencies in care plans in relation to people's likes, dislikes and information about the person's life history. This meant staff did not have the information they needed to make sure people were cared for in a way which they preferred.
Is the service responsive?
The service was not consistently responsive. We found that people who had a high level of need were not always being given the same choices as people who were more independent. People who were more independent told us they were happy with the level of care they received however our observations of people who needed more support from staff were not as positive.
We found that when people made complaints these were not always responded to and resolved appropriately or to the satisfaction of those that had raised them.
Is the service well led?
The service was not consistently well led. We found concerns in relation to the care and support people using the service were receiving. Throughout our inspection it was clear there was a lack of leadership of staff and systems were not robust enough to ensure people received a service that provided consistent good quality care. Other than the matron and the registered manager's reviews there was no system for the provider to check that those reviews were effective in identifying issues and/or improving the quality of the service.
We found that the service was not learning from experience because there was a lack of oversight when analysing or evaluating events to establish cause; identify any trends or themes and continually review practice. Whilst in some cases investigations were being, or had been, undertaken in relation to the conduct of some staff, there was no system in place to develop solutions and risk reduction actions to protect people and ensure future lapses were minimised.
The service did not have effective systems to assure the quality of the service they provided. The way the service was run had been regularly reviewed but action had not always been taken to improve the service or put right any shortfalls found. Information from the analysis of accidents and incidents had not been effective in identifying changes and improvements to minimise the risk of them happening again.