Denison House Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last inspection under the old provider we rated this key question good. At this assessment we did not assess all quality statements within this key question. The overall rating for this key question remains good. People and their relatives told us there was limited day time activities or support for them to enjoy personal interests and activities of their choosing. The provider understood the need to provide equitable support for people to access all areas of the home. For example, a stair lift had been installed due to the passenger lift being out of action and requiring on going repairs. However, some people told us they were not happy to use this. There was no information including timescales to action the repair, but the manager told us they would look into this. People told us the new manager was keen to support them to provide feedback. Resident meetings were held, and some surveys completed. The processes would benefit from further improvements in analysis of the feedback to provide outcomes and deliver identified service improvement. We observed meaningful and positive engagements between staff and people. People told us they were offered day to day choices and their preferences were respected. Newer care plans had been updated and were focused more on the individual. Where completed, End of Life care plans were detailed and informative, with advanced care planning in place for some, but not all. People had access to information in a format they could understand. There was good use of accessible information standard with a wide range of guides and policies in easy read format. People had good access to a range of health professionals. Care provision, integration and continuity of care, support and treatment were in place.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us there was no activities that were meaningful or enhanced their lives. Comments from people included, "I don’t get out much. There is a garden, but it could be made a lot better. There isn’t a lot to do really here." and “There are no activities really. A normal day is sat here watching TV and talking." Despite the lack of activities there was a homely feel and people told us their everyday preferences were supported. One person said, “I am completely happy here. I have the freedom to make my own choices. I get up when I want.” and “I can get up when I want. I usually get up early, but it is up to me. I stayed up last night to watch the football."

Staff told us they put people first and always tried to respond to any requests. One staff member said, "If people ask for things then we always try to accommodate this.” Care plans were not always in place or sufficiently detailed to guide staff on aspects of care delivery to meet people's needs. The provider was responsive to our feedback and confirmed they are currently in the process of reviewing and updating their recording systems.

We observed people were supported in response to their known support needs and personal wishes. However, this response was limited for some people as there was a lack of recorded guidance in care plans.

Relatives told us that there had been some slight improvements with working with other health professionals. However, feedback indicated further improvements would be of benefit to people. Comments from people included, "I haven’t been to a dentist for years, or an optician.” and, “ I would probably speak to my husband if I needed any of those. I think staff here would help me also though.”

Staff were able to discuss the processes in place to ensure up to date information in care records would accompany people to facilitate continuity of service when accessing other health services. For example, a hospital. Staff told us, "Information would go with the person about anything to do with a DNAR, continence care & needs, hospital passports, medication information, NOK contact details." Another staff member told us, "I wouldn’t be involved in this, as I am only a Carer. However, I do know that we do an over-view sheet, with specifics on such as allergies, specific likes and dislikes." The new manager told us that people’s care records and risk assessments were currently being reviewed and updated where necessary. Staff supported people to maintain and enjoy relationships with family and friends.

There was no negative feedback from partners regarding the availability of information or support for people to access other health services.

People’s immediate needs had not always been included within their care plan. Some people’s care records included information about their health needs and the external healthcare professionals involved in their care. However, this was not consistent across all care records that were reviewed. The provider was in the process of updating records.

Relatives spoke positively about communication from the service about their loved ones. They told us, "Communication is very good. I can ask them about anything. I think it is improving all the time." and "Communication is really good. They are on the phone straight away about Mum if anything is wrong.”

Staff told us how communication has recently improved under new management. Staff told us, "Yes, the Service is good at communicating, there are resident’s meetings where family members can attend as well. It has always been good but really improved in the last few months." and, "Yes, the service is good at communicating and definitely since [new manager] joined. Information is shared with ourselves when we start out shifts. When we do the 'Residents meeting, we put notices up and encourage them to attend."

The provider ensured people had access to information in a range of formats they could understand. Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication. Staff assessed people's communication needs and took them into account when planning care.

People and relatives were generally complimentary about information shared. Each person had a service user guide available to them with an overview of the service, contacts and expectations. A relative said, “[New manager] seems good. We have been to resident/family meetings. I think they listen and want to improve the place.”

Staff were clear on how to support people to raise any concerns and to provide feedback about the service. Staff told us, "Yes, I would know how to help them and yes, I am confident now, that it would be responded to appropriately." and, "People know now that [new manager] is here and that they can talk to her at anytime. The residents meetings will help with this, there is a suggestions box in Reception."

The provider had systems in place to enable people to share feedback and raise complaints about the care and support they received. This included a complaints process, residents’ meetings, relatives’ meetings and surveys. However, we were not assured that all concerns and complaints were actioned and addressed to ensure people’s experiences improved as actions were formulated. There was no overview of what had been done in response to survey feedback. However, the manager explained this is something she is going to develop.

People told us they had some access to other health professionals and were involved at times with their care and support.

Staff told us people were supported to access health and support to meet their needs. Feedback from staff included, "District Nurses attend the Home, Chiropodists attend monthly, GP’s call weekly (where we speak with them), and a hairdresser attends every week. We can always get in-touch with people to attend.” and, "This is dealt with by the Seniors, there are weekly telephone calls with the GP’s, Opticians come to the Home every couple of months."

The service held professional working relationships with a range of services to help maximise the effectiveness of people’s care and treatment.

Processes were in place to review people's health care and well being. The service had use of a dedicated 'Medicare' laptop, where they reported issues to the Senior who will then take appropriate action after reviewing the concern. A nominated GP attended the service and District Nurses visit every week, A podiatrists attends every other week, a hairdresser comes in weekly. Further improvement was required to ensure thorough reviews and assessments of peoples needs were recorded to ensure meaningful conversations were held with other specialists where evaluation of peoples care required it.

People were happy with the service they received and told us they were predominantly happy with the care provided.

Staff told us people were treated equally and equitably according to any personal preferences. Adjustments were made to ensure people received equity in experience and outcomes. Staff told us, "We have lots of residents with dietary requirements, [choice is catered for and fully supported], we did have a resident with specific religious beliefs, so we ensured that she always had a bible available to her."

Staff had a clear understanding on the need to ensure people received an equitable service. However, improvements were required to ensure environmental barriers including the inaccessible person lift (currenlty supported by a stair lift) and a protocol to support effective emergency access were implemented without delay.

People and relatives were involved with planning for their future. Some people did not wish to discuss future plans, however support was available when needed.

Staff told us people's preferences for their future care were recorded in their Care Plan. A staff member said, "Details of this are recorded in the person’s care plan, if the person lacks capacity then this is discussed with their relatives."

Where people had chosen to, care plans were in place with details to support their wishes and preferences for end of life (EOL) care and support. Advanced care planning was in place for some people, but not all, and staff received training to support people with EOL decision making and planning. Where people had exercised their right to agree to a DNAR (Do Not Attempt Resuscitate) then they have a Butterfly on their bedroom door alongside their photo. Details of this are recorded in people's Care Plan. If the person lacks capacity to understand and agree this option then this is discussed with advocates/relatives.