We carried out an unannounced inspection of this service on 3 November 2015, with a further two announced inspection visits on 5 and 12 November 2015.
Dean Wood Manor is owned and operated by a partnership trading as Dovehaven Care Group. The premises are based around an original Grade II listed building that has been extended. There are extensive gardens surrounding the home and on-site car parking is available.
We last inspected this location on 12 August 2014 and found the service to be compliant with all regulations we assessed at that time.
The vast majority of people who used the service at Dean Wood Manor were living with a diagnosis of dementia; therefore people were accommodated in the service depending on their assessed needs. The Woodlands Unit, located on the lower ground floor, provided residential type care, whereas the ground floor at Dean Wood Manor accommodated people living with more complex needs. For the purposes of this report, care provided on the ground floor of Dean Wood Manor, will be referred to as the ‘nursing unit.’
Dean Wood Manor is registered with the Care Quality Commission (CQC) to provide nursing and personal care to a maximum of 50 people. At the time of this inspection, 33 beds were occupied on the nursing unit, and each of the seven beds were occupied on the Woodlands Unit.
At the time of this inspection there was no registered manager in post at Dean Wood Manor. The acting manager told us they were applying to the CQC to register as the registered manager for the service. A registered manager is a person who has registered with the CQC. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
During this inspection, we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, receiving and acting on complaints, good governance and staffing. We are currently considering our enforcement options in relation to these regulatory breaches.
Following the takeover of Dean Wood Manor in March 2015 by Dovehaven Care Group, the new owners embarked on an extensive refurbishment programme. At the time of our inspection visit, the refurbishment work was still on-going and the building contractors were still on site. We looked at how the service had planned to manage and mitigate the risks associated with the refurbishment programme and found a risk assessment had been produced in July 2015. However, during our inspection visit, we found the service had failed to adhere to its own risk assessment which exposed people who used the service to the risk of avoidable harm.
During day one of our inspection, we found the service had failed to ensure that the building contractors were working in a way which would keep people who used the service safe. They were working in a way which exposed people who used the service to a risk of harm. We found a communal door leading to an area where building work was being carried out had been wedged open. This area was left unsupervised and contained power tools, trailing electric cables, and step ladders. We also observed a number of care staff going about their duties without recognising the potential danger for this situation.
We found the service had failed to deploy sufficient numbers of staff in order to meet the needs of people who used the service and failed to demonstrate a systematic approach in determining the number of staff required. Furthermore, the service failed to ensure staff were suitably qualified, competent, skilled and experienced; and failed to ensure staff received appropriate professional development and supervision.
The service failed to protect people who used the service against the risks associated with the safe management of medicines. We found medication was not administered as per instructions; errors were identified on Medication Administration Charts and the medicine’s fridge temperature was too high on the nursing unit.
People were not protected against the risk associated with the control of infection. We found that during refurbishment work, wall mounted personal protective equipment (PPE) such as disposable gloves and aprons and hand cleansing units had all been removed. This meant appropriate PPE was not available at the point of care.
Care plans and associated documentation were not of a consistently good standard with gaps and omissions in recording. Information was disorganised and not easy to understand. Care plans were not sufficiently person-centred and did not consistently demonstrate people’s likes, dislikes, personal preferences and their life history.
We found the service had failed to ensure that people who used the service, and/or their representatives, had been involved in decisions relating to the refurbishment work and that insufficient information had been provided.
We found the service had failed to follow nationally recognised evidence based guidance in the care and support of people living with a diagnosis dementia.
We looked at staff recruitment to make sure safe recruitment practices were being followed. We found the identity of people applying to work at the service had been checked, references had been sought and checks had been completed with the Disclosure and Barring Service (DBS). A DBS check helps to ensure that potential employees are suitable to work with vulnerable people.
The service had an appropriate whistleblowing policy in place and staff told us they were aware of the policy and were confident about how to use it.
Records confirmed that regular checks of the fire alarm had been carried out to ensure that it was in safe working order. Documentation and certificates demonstrated that relevant checks had been carried out on the gas boiler, electrical systems and fire extinguishers.
Personal emergency evacuation plans (PEEP) were not always completed and the evacuation status of each person who used the service was not readily available as the service did not maintain a ‘PEEP grab file’ for use in emergencies.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.
The service had a policy in place concerning DoLS and information was included about best interests. We looked at a sample of DoLS documentation and found that due processes had been followed by the service and that decisions were made in those peoples best interests. However, we found the conditions of two peoples’ DoLS had not been adhered to and the service had failed to keep these people safe.
On the nursing unit, we found the mealtime service was rushed and chaotic, and noise levels were unacceptably high; all of which contributed to a poor meal time experience for people who used the service. On the Woodlands Unit, people who used the service were encouraged to eat and drink in a positive manner and the dining experience was calm and well managed.
We looked to see how the service supported people with their on-going health and support needs and found appropriate referrals were made to external professionals and agencies in order to meet people’s needs. For example, the service had regular contact with community older age mental health services and regular input from physical health teams such as community physiotherapy.
Throughout our inspection visit, we found a lack of co-ordinated operational leadership which impacted on the quality of care being provided. Additionally, since taking ownership of Dean Wood Manor, we found the provider had failed to demonstrate sufficient oversight to recognise and respond to existing and newly emerging issues. The Provider failed to deliver on reassurances made to CQC during the takeover of Dean Wood Manor. In particular, reassurances around training and development of staff and involvement of people who used the service and/or their representatives.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve;
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made;
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of ‘Inadequate’ for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.