Archived: Daisy Nook House

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices, and there was a space for staff to change before and after their shift.

Communal areas were well spaced and with support from staff, residents were encouraged to maintain social distancing. Clear plans were in place for those who were required to self-isolate. For those residents who struggled with isolation additional support was provided.

Following a fund-raising initiative, the provider purchased a table sized tablet computer. This enabled some popular activities stopped due to Covid-19 to continue, such as armchair exercise and the community choir, as well as new interactive activities to support resident’s wellbeing. The large screen also facilitated virtual visiting and interaction with friends and relatives.

There were detailed plans in place to allow for safe visiting where essential and in readiness for when government restrictions are lifted.

Staff continued to support people to access healthcare, and arrangements were in place should residents need to attend, for example outpatient appointments safely.

Daisy Nook House is a large, purpose-built establishment owned and managed by Meridian Healthcare Limited. The home provides accommodation and support for older people, some of whom live with dementia. At the time of our inspection there were 40 people living at the home.

People’s experience of using this service:

People who used the service, their relatives and visiting professionals spoke positively about their experiences and the quality of care and support offered. A range of activities both in and away from the home were provided, offering variety to people’s day. We were told that staff were kind and respectful and were aware of the individual needs and wishes of people.

We saw that people’s prescribed medicines were stored safely. Clear guidance was provided with regards to ‘when required’ medicines, covert medication and the use of medication patches. Immediate action was taken following the inspection reinforcing to senior staff the need for accurate and complete records about people’s current medication and administration. Where people administered their own medication, checks were not completed. We have recommended the provider reviews the system for self-administration to ensure people are kept safe.

People continued to receive good healthcare support to ensure their well-being was maintained. A visiting health professional told us that staff were quick to respond to people’s changing needs. People’s dietary needs were understood and catered for. Additional records were to be implemented in relation to the use of prescribed thickeners.

Whilst people said staff supported them in a timely manner, we found from our observations, feedback from relatives and staff and a review of records that at times adequate supervision may not always be available. Following a discussion, the management team agreed to review the current arrangements to make sure enough staff were available at core times.

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. A review of people’s care records showed that pre-admission assessments, care plans and risk assessments were kept under review and reflected the individual needs and wishes of people.

We found compliance with the regulations had been maintained with regards to safe recruitment, procedures, on-going programme of staff training, infection control and hygiene standards, safeguarding people, access to health care support and good nutrition, health and safety and maintenances checks. These systems helped minimise the risks to people and keep them safe.

There was clear evidence of management and oversight of the service. Audits and checks were completed to monitor and review the service. Opportunities were provided for people and their visitors to comment about their experiences. Records showed that any themes or patterns were explored; where improvements had been identified, the management team shared ‘lessons learnt’ across the organisation to help improve practice.

Rating at last inspection:

At the last inspection the service was rated Good (24 October 2016).

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Our findings demonstrated that the service continued to meet all relevant fundamental standards. More information is in the full report.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme.

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

Daisy Nook House is a care home with accommodation for up to 40 people who require personal care, some of who are living with dementia. The service had three communal lounge/dining areas which contained a small kitchen so staff could access hot and cold drinks at any time for people. Each lounge area consisted of comfortable seating, occasional tables, TV and radio.

‘A registered 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.’

Staff had been safely recruited with relevant checks completed prior to them starting work. Staff were provided with training to enable them to care effectively for the people they supported. Staff told us they felt supported by the registered manager and found them to be open and approachable.

The registered manager kept a log of all accidents, incidents and safeguarding concerns and audited these for patterns and themes.

Staff had an understanding of how to recognise and report any concerns or allegations of abuse and described what action they would take.

Risks to people had been managed safely. Records demonstrated when risk had been identified, action had been taken to reduce them wherever possible.

We found policies and procedures were in place to manage people’s medicines safely. Medicines were administered by trained staff who had their competency to do so checked regularly.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm.

There were sufficient staff on duty with the necessary skills and experience to support the people using the service. Training was up to date with staff completing some training electronically. Staff received regular supervision and had an annual appraisal.

Relatives and people felt staff were caring. Staff treated people with respect and dignity and promoted people’s independence wherever possible, offering choices and options.

People were provided with a varied and nutritious menu. Staff supported people to eat and drink if required. They ensured people at potential risk of undernutrition received adequate nutrition and hydration.

The provider had information about advocacy services available for people and their relatives.

Care plans were personalised enabling people to receive care and support that was responsive to their individual needs. People were provided with access to health care appropriate to their needs.

The registered provider had a process in place to obtain the views of people and their families by using a survey. The registered manager also held regular meetings for people and their families to attend to express their views, raise issues or concerns as well as providing information.

The registered provider had a system in place to monitor the quality and effectiveness of the service provided to people and their families in order to drive improvement.

The registered manager submitted statutory notifications to CQC when necessary. People’s personal information was kept safely and securely in line with Data Protection Act.

The registered provider had a business continuity plan in place to ensure staff had guidance and contact numbers in case of an emergency. People had an up to date personal emergency evacuation plan (PEEPs) on their file. A copy was also held in a grab bag which contains equipment and information for staff to access in case of an emergency.

"I really enjoy myself here and I couldn't be anywhere better. The staff are so helpful. They do most things for me, but they do it in a way that suits me."

"I feel in control. If I don't like something the staff will listen to me."

Relatives we spoke with told us that they were very happy with the service and that they felt confident in the way the staff team provided care and support. All the relatives we spoke with told us that they thought staff had a good knowledge and understanding of the people they worked with.

We saw that there were good systems in place to promote the involvement of people living in the home. This was done by one to one consultation or relatives and residents meetings.