The Old Downs Dementia Residential Care Home

The Old Downs Residential Care Home provides accommodation and support for up to 41 people living with dementia. It is set within its own grounds in the village of Hartley, close to Dartford, Kent. At the time of our visit, there were 35 people who lived in the service.

There was a new registered manager at the service. The new registered manager started in May 2017. 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.

At our previous inspection on 08 June 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People's medicines were not always managed safely. Appropriate procedures were not followed in managing covert medicines and medicine risk assessments were not carried out. Malnutrition Universal Screening Tool (MUST) records were not always completed to identify adults who are malnourished, at risk of malnutrition (under nutrition) or obese. We asked the provider to submit an action plan by 07 September 2016. However, due to the registered manager leaving her position, we did not receive an action plan.

At this inspection, we found that the provider had met the breach of the regulation.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the service. Malnutrition Universal Screening Tool (MUST) records for five people we looked at were fully completed.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

The registered manager had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the service; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the service.

The service had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Training records showed that all staff had completed training in a range of areas that reflected their job role, such as essential training they needed to ensure they understood how to provide effective care, and support for people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and the service complied with these requirements.

The food menus offered variety and choice. They provided people with a nutritious and well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs. Both people and relatives told us they were happy with the food in the service.

People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the service to make sure that the service could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice.

People spoke positively about the way the service was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

The Old Downs Residential Care Home provides accommodation and support for up to 41 people living with dementia. At the time of our inspection there were 38 people using the service. There was a new manager in post since April 2016 and they had applied to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People’s medicines were not always managed safely. Appropriate procedures were not followed in managing covert medicines and medicine risk assessments were not carried out. Malnutrition Universal Screening Tool (MUST) records were not always completed to identify adults who are malnourished, at risk of malnutrition (undernutrition) or obese. There were systems in place to monitor the quality of the service but these systems were not always effective. For example, pharmacy advice had not been sought regarding the administration of covert medicines. You can see what action we have told the provider to take at the back of the full version of this report.

People using the service said they felt safe and were well cared for. Safeguarding adults procedures were in place and staff understood how to safeguard the people they supported. Risks to people were assessed and monitored regarding falls, call bells and moving and handling and guidance was available to staff on how to safely manage these risks.

Staff had undergone an induction when starting work and had received appropriate training to ensure they had the skills required for their roles. Staff were also supported in their roles through regular supervision.

Staff sought consent from people when offering them support and the registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff treated people with dignity, kindness and consideration. People's privacy was respected. People were provided with information about the service when they joined in the form of a 'service user guide' which included details of the provider's complaints policy.

Relatives were involved in people’s care planning. The care and support they received was personalised and staff respected their wishes and met their needs. Care plans provided clear information for staff on how to support people using the service. They were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People were supported to be independent where possible, for example by attending to some aspects of their own personal care.

Staff were knowledgeable about people's individual needs. There were a variety of activities on offer that met people's needs. People's cultural needs and religious beliefs were recorded to ensure that staff took account of these areas when offering support.

Relatives knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary. They spoke positively about the management of the service and staff told us the management team were available to support them when needed.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account. People were protected from abuse and cared for in a safe and inclusive environment. There were enough qualified, skilled and experienced staff to meet people's needs. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.

A person who used the service told us 'Before I came to this home I had no future, now I do' and 'The staff are always professional and caring too'.

We found that staff respected people and involved them as far as possible in all aspects of their care, also encouraging input from relatives. Records showed that staff were knowledgeable, sufficiently trained and supported in their work. We found that The Old Downs was taking reasonable steps in safeguarding people and had an effective system to monitor the quality of service that was being provided.