Dene Park House

Updated 9 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, a pharmacist specialist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Dene Park House is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Dene Park House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. An interim manager had been in post for several months. After our inspection the provider informed us that a new manager had been appointed, who will apply to become the registered manager in the near future.

When we gave feedback to the provider and new manager at the end of the inspection, the nominated individual was present. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 18 May 2022 and ended on 1 July 2022. We visited the home on 18 and 25 May 2022.

What we did before the inspection

We reviewed the information we held about the service including information submitted to CQC by the provider about specific incidents. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We sought feedback from the local authority contracts monitoring team, Clinical Commissioning Group (CCG) and safeguarding adults' teams and reviewed the information they provided. We used all this information to plan our inspection.

During the inspection

We reviewed a range of records. This included six people's care records, medicine records for 13 people and recruitment records for three members of staff. We also reviewed the induction information for eight agency staff members who had recently been employed at the home. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

We carried out observations in the communal areas of the home. We spoke to 12 people, two relatives and 16 members of staff during the inspection. This included the interim manager, the regional manager (provider’s representative), one nurse, one senior, six care assistants, the maintenance person, one domestic, two kitchen staff, one domestic and the administration officer.

An Expert by Experience spoke with 13 relatives on the telephone on 30 May 2022.

After the inspection we asked for further information regarding safeguarding records, staff training and recruitment.

Updated 9 August 2022

About the service

Dene Park House is a residential care home providing personal and nursing care to up to 51 people. The service provides support to younger and older people, some of whom are living with dementia and/or a physical disability. At the time of our inspection there were 37 people using the service.

People’s experience of using this service and what we found

Medicines were not always managed safely. Some topical medicines such as creams were out of date, handwritten entries had not been counter signed in line with the provider’s policy and national guidance, and guidance for staff lacked detail regarding people’s individual needs.

Pre-employment checks on permanent staff and records relating to the induction of agency staff contained gaps.

There were mostly appropriate infection prevention and control measures in place, although we did advise the provider about PPE compliance.

People told us they felt safe and were happy with the care they received. Staff recognised different types of abuse and how to report it. The manager understood their safeguarding responsibilities and how to protect people

People's care plans included risk assessments about individual care needs and control measures to reduce the identified risk. Staff knew people well and were aware of people's risks and how to keep them safe. There were enough staff on duty to meet people’s needs in a timely way.

We have made a recommendation about staff training and supervisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we did find records were not always in place where decisions had been taken in people’s best interests.

Staff treated people with care and respect. We saw staff interacting with people in a warm and compassionate way. People were supported to make decisions and choices about their care. Relatives were involved in decision making where appropriate.

Some care plans lacked the necessary detail to guide staff how to support a person with a specific need. Not all care plans were person-centred. The provider had already identified care plans needed improving and work was underway to address this.

We have made a recommendation about complaints records.

Systems to monitor and assess the quality of the service were not robust. The provider had not identified all of the issues we found on this inspection. There were gaps and errors in records and people's care records did not always contain the level of detail staff needed to support them safely.

Most relatives we spoke with felt that communication needed improving.

Since the inspection, a new manager had been appointed. They had been the registered manager at one of the provider’s other services.

There was a positive atmosphere at the home and people told us they were happy with the care and support they received.

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

Rating at last inspection

The last rating for this service was good (published 20 September 2021).

Why we inspected

This inspection was prompted in part due to concerns received about medicines. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Due to the shortfalls identified during this inspection we asked the provider to take steps to address these issues immediately. The provider gave us assurances these issues would be addressed and we saw evidence of action being taken to mitigate the risks identified during our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dene Park House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.