All inspections: Deanbrook - Care Quality Commission

This unannounced inspection took place on 4 April 2018. Deanbrook is a small residential ‘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.

Deanbrook is registered to provide personal care and support for up to six people with learning disabilities. Deanbrook does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were three people living at the home.

At the last inspection, the home was rated Good.

At this inspection, we found the home remained Good.

Why the home is rated good.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home continued to provide safe care to people. The registered manager and staff understood their role and responsibilities to keep people safe from harm; protect people from any type of discrimination and ensure people's rights were protected. Staff were available when people needed assistance and had been recruited safely.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.

Care plans were well-organised and contained personalised information about the individual person's needs and wishes. Care planning was reviewed regularly and whenever people's needs changed. People's care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Risks in relation to people's care and support were assessed and planned for to minimise the risk of harm. People were protected from the risks associated with unsafe medicine administration because medicines were managed safely.

People were cared for and supported by staff that were kind, caring and treated them with dignity and respect. Some staff had worked at the home for many years. Staff and people knew each other well and we saw kind and friendly interactions between them. People were supported to make choices about how they wished to be cared for and staff supported their independence. Records showed that people were supported to take part in a variety of activities, both in and out of the home.

The home was safe, clean and well maintained and equipment had been serviced regularly to ensure it remained in safe working order.

People’s bedrooms were personalised to reflect people's individual tastes. Staff supported people to keep in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

People benefitted from a home that was well led. Relatives and staff told us the manager was accessible, supportive and had good leadership skills. The home had an effective quality assurance system and shortfalls were identified and addressed.

Further information is in the detailed findings below

Deanbrook is a residential home that is registered to provide care and support for up to five people with learning disabilities. On the day of inspection there were four people living at the service.

This unannounced inspection took place on 29 January 2016. The service was last inspected in February 2015 when it was rated as ‘Requires improvement’. At the inspection in February 2015 we found the service was not meeting the regulations in relation to assessing the quality of care and people’s health care needs. The registered provider had sent us an action plan to tell us they would have rectified these matters by September 2015. We also found improvements were needed to the way some risks were managed. People were not protected in the case of emergency and the risks of people developing malnutrition had not been assessed. Improvements were also needed to the way people’s weights were monitored and how people’s privacy was respected. At this inspection in January 2016 we checked to see if the improvements had been made. We found that improvements had been made in all areas.

A registered manager was employed at the service. 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 also registered to manage another service owned by Havencare (South West) Limited. They were supported in their role at Deanbrook by a service manager who was in day to day control of the service.

Kind and caring staff ensured people received care and support that was responsive to their needs. Staff ensured people’s privacy and dignity was respected and all personal care was provided in private. Staff reassured people with hugs and kind words and were respectful in their interactions with people. People’s care plans gave staff instructions on how their needs were to be met. Staff knew the people living at Deanbrook and their needs and preferences well. One relative contacted us by email following the inspection. They wrote ‘Above all I have seen that there is a genuine warmth and love towards the residents at Deanbrook, the staff and manager go that extra mile. I know my [relative] is very happy and well cared for at Deanbrook’.

People were offered choices in all aspects of their lives. People’s relatives could be involved in making decisions about care provided by staff, if they chose.

There were enough staff available to meet people’s needs and support people to take part in activities and outings. There was a regular programme of activities available for people to participate in. On the day of our inspection people went out to local shops and cafes.

People were supported to maintain a healthy balanced diet and had a choice for each meal. Photographs of foods were used to help people make their choice. Staff ensured people’s health care needs were addressed. People were supported to attend dental appointments and received visits from healthcare professionals. Following the inspection we contacted the speech and language therapist who emailed their response. They wrote ‘I always feel I can trust the team to implement any recommendations and can rely on their report re progress’. People's medicines were stored and managed safely and they received their medicines at the times they were prescribed to be given.

People were protected from the risks of abuse. Staff knew how to recognise and report abuse both within the service and to outside agencies. Thorough recruitment procedures ensured the risks of employing unsuitable staff were minimised. People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

Staff received training that helped them meet people’s needs. This included mandatory training such as first aid as well as training more specific needs such as epilepsy and autism. Staff also received regular supervision to support them in their role. Staff told us the registered manager and service manager were very open and approachable.

There were effective quality assurance systems in place to monitor care. Regular audits were undertaken to ensure the quality of care was maintained. One relative who contacted us via email wrote ‘Deanbrook is a well-run care home, it is always clean and welcoming. I feel very happy with the quality of care provided by the team’.

Deanbrook is a residential home that provides care and support for up to five people with learning disabilities. Nursing care is provided by the local community nursing service.

The inspection took place on 17 February 2015 and was unannounced. There were four people living at the home. The service had last been inspected on 27 January 2014 when it was compliant in all areas looked at.

Prior to the inspection concerns had been raised about the behaviour of two members of staff. Following a full and thorough investigation by the registered providers action was taken to protect people.

There was 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. There was also a service manager at the home who acted as a deputy to the registered manager.

Not all risks to people were being managed safely. People’s risks of developing malnutrition had not been assessed. One person had been assessed as being at risk of choking. There was conflicting information on their care plan and it was difficult to find the most up to date information with regard to the type of food they should receive.

People’s health care needs were not always well met. One person had been assessed as having an eye condition that required regular eye washes. There was no care plan in relation to this need and no evidence that the person was receiving regular eye washes.

People’s weights were not monitored well. People were not weighed regularly despite care plans indicating this should be the case. However, people were supported to receive a balanced diet with sufficient to eat and drink. People were offered plenty of snacks and drinks through the day.

People were not protected in the case of emergency as individual plans that would ensure they could be safely evacuated from the building were not readily available.

People’s privacy was not always respected. Everyone had their own room and the doors had locks on them. However, staff said the locks weren’t used as people often went back to their own rooms and would not be able to use a key. One person sometimes walked in to other people’s rooms and took items. Staff said this was not a problem as they always put the items back. It had not been recognised that this may not respect people’s privacy.

Care plans were person centred but had limited input from people. They were very large documents and contained some confusing information. However, the registered providers had started to introduce a new care planning system that used technology to enable people to be involved in planning their care whatever their abilities. An ipad had been purchased in preparation for the use of the new system.

There was no formal quality assurance system in place. The registered providers had visited the service on a regular basis. However, there was no evidence they had undertaken checks on the quality of the care being provided at the service for over 12 months. The environment and medicines were the only aspects of the home that were regularly audited. One environmental audit had identified a missing panel on a wheelchair, which had been replaced. People’s medicines were managed well and were stored safely and appropriately.

Three people had lived at the home for over 25 years. People could not answer detailed questions about their care, but we saw that good positive relationships had been formed. People said staff were “nice” and “friendly” and they “look after me”. People were offered choices and asked what they wanted to do throughout the day. Staff respected people’s choices. Staff were able to describe people’s needs and how they liked them to be met. The registered manager told us that there had only been four people living at the home for some time. This was because they had been careful to ensure anyone who came to live in the home would not disrupt the lives of the people already living there.

Comprehensive information had been recorded in relation to involving other health care professionals in people’s care. For example, psychiatrists, GPs, epilepsy nurses, podiatrists and dentists had been consulted.

One person’s advocate told us that they had known the person for many years when they had lived in other places. They said “Deanbrook is the first place they have ever called home”. Staff understood and met people’s preferences, likes and dislikes. For example, one person was given a pot of coffee and mug on a tray because they liked to be able to pour their drink themselves.

People were protected from the risks of abuse. Staff demonstrated a good knowledge of different types of abuse. They told us how they would recognise abuse, and what they would do if they suspected abuse was occurring within the service. Robust recruitment procedures were in place. The registered provider had a policy which ensured all employees were subject to the necessary checks which determined that they were suitable to work with vulnerable people.

People’s needs were met by sufficient numbers of staff. Staff told us there was never a time when people’s needs couldn’t be met. People received care and support from staff who had the skills and knowledge to meet their needs. Staff had received a variety of training including moving and transferring, infection control, epilepsy and safeguarding adults. Not all staff had received training on the Mental Capacity Act 2005 (MCA). However, staff did have an understanding of the principles of the act and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

The registered manager and service manager were open and approachable. They dealt with staff and people living at the home in a professional manner. One health professional told us staff were very keen to have outside professional advice and actively encouraged their involvement. The registered manager told us they had not received any complaints for many years. There was a system in place should anyone wish to make a complaint.

We found a number of breaches 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 this report.

During our inspection we spoke to one person's advocate who told us that 'staff know their likes and dislikes; their needs come first. Most definitely things are only done with their consent'.

During our visit we saw that staff treated people respectfully and engaged with them in a range of activities. The atmosphere was very relaxed and there were clearly good relationships between staff and people they were supporting.

We saw that processes were in place for the safe administration and storage of medicines. In each person's care folder we saw a medicines information and support pack. This was an accessible easy read document that included various images to help explain the information about the medicines people were taking.

All the staff told us that they felt well supported and had good access to training. One support worker said 'I have very good support and regular supervision, which is very useful'.

We found that people were supported to make choices and decisions about their daily lives and routines. Staff supported people to access the community. We observed staff demonstrate their knowledge of non verbal communication and behaviours to facilitate choice and meet needs.

Everyone who lived in the home had a support plan in place which contained person centred plans around their individual needs.

The service had effective recruitment and selection procedures in place which helped ensure the safety and welfare of the people living in the home.

The provider had systems and procedures in place to monitor the quality and safety of the service provided.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Deanbrook

All Inspections

4 April 2018

During a routine inspection

29 January 2016

During a routine inspection

17 February 2015

During a routine inspection

27 January 2014

During a routine inspection

6 March 2013

During a routine inspection

Reports under our old system of regulation