When we visited the service there were 54 people living at Davenham Residential home and Bradbury Court. People with dementia are cared for in Bradbury Court. The homes are next to each other and are managed by the same manager. We spent time in both homes. We spoke with different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spoke with four people who used the service, a relative, four carers, the manager and a domestic. Some people using the service were unable to answer complex questions and we spent time observing people, to see how they were cared for and how staff interacted with them.We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask:-
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
We saw that a comprehensive risk and needs assessment had taken place before people had gone to live at the home. Care plans reflected assessed risks. We saw that when people had been assessed as requiring a hoist to help them to move, care plans were in place. Where equipment was used to care for people, this had been serviced regularly and staff knew how to use it. There were enough hoist slings of the appropriate size but there was no system in place to allocate slings for individual use. At Bradbury Court, the appropriate size of hoist for each individual was shown on a chart. At Davenham, the correct size of sling was not recorded. Carers that we spoke with knew the correct size of sling for each person who needed one which showed us that the equipment was used safely. However, the lack of documentation showed us that there was a potential risk that the wrong sized sling could be used.
Before staff had started work at the service all the appropriate checks had been completed. This ensured that people were safely cared for by staff who were suitably qualified, honest, reliable and trustworthy. All staff had received the appropriate training to meet people's needs, which included training about infection control and caring for people with dementia. Measures were in place to safeguard people from abuse.
Staff understood what to do in the event of a fire or other emergency.
Is the service effective?
A person using the service said, 'I'm so glad I came here.' A relative that we spoke with said, 'I am very happy with the home.' They told us that they believed their relative could not have been cared for as well anywhere else. They told us that their relative was not eating when they had come to the home but had put on weight since being there. This was because the service had implemented a plan to help the person to receive better nutrition. A person told us how their ability to walk had improved since being at the home. Other people said that they thought that the exercise classes provided two or three times a week had improved their mobility.
We saw that satisfaction surveys had been completed by people, their relatives and professionals who had visited the service. One person had commented that one of the things they liked most about the home was, 'The freedom to live my life as I have always led it.' Nearly all of their comments were positive and responses to questions about the quality of care at the home were all either 'good' or 'very good'. All of the people surveyed said that they would recommend the home to others.
We saw that care and support had been carefully planned to meet people's needs and included personal preferences. This showed us that the service was effective.
Is the service caring?
The service was very caring. All of the people that we spoke with mentioned how caring the staff were. A person told us that, 'The staff are marvellous and can't do enough for you.' Another person said, 'It is ever so good, we are like one big happy family.' People living at the home who completed the survey commented, 'Warm and caring, superb staff.' and 'Excellent, very caring.'
A survey for stakeholders asked about the 'caring attitude of our staff towards residents' and all of the responses said it was good or very good. Several of the people that we spoke with referred to the atmosphere of the home being caring and supportive.
We spoke with care staff who told us about the needs of people using the service in a caring and affectionate way. A carer who had previously worked for an agency said, 'I have never come across a team (of staff) that cared so much.'
We observed that when staff interacted with, or helped people they called people by name and were kind, patient and cheerful.
Is the service responsive?
The service was responsive to the changing needs of people using the service, to recommendations from safety inspections and to suggestions and comments made by people and relatives. A carer told us how they had listened to and acted on suggestions made by a relative when a person had become unable to talk about their preferences.
We saw that most care plans were regularly updated and were changed when people's needs changed.
In the stakeholders' survey, everyone had replied that the response of the service to complaints or comments had been 'very good'. The manager told us that in response to comments that people had made about their first few weeks living at the service, a new 'Welcome Pack' was in progress. This would include a guide to the service for people and their relatives. We saw that recommended improvements and upgrades made following a fire safety inspection had been, or were in the process of being implemented. During our visit we took part in a fire drill which the manager told us, had been revised and improved following the fire safety inspection. We saw records of residents' meetings that took place regularly and the manager told us how they had addressed concerns raised by people. We saw that changes to the food and drinks available for people had been changed in response to, or following consultation with people using the service. This included asking people for their own recipes which the chef then prepared.
Is the service well led?
The service was very well led. A person told us that the manager was always ready to talk and, 'knows everyone's name.' They said that, 'Getting the atmosphere right is most important.' They felt that the manager had achieved an, 'excellent ethos.' A relative said that the manager was, 'inspirational' and 'I think that she is the source of the caring attitude.'
Carers told us that the manager was, 'approachable, helpful and always stays calm.'
There was an effective system in place to monitor and assess the quality of the service. This included annual surveys for people using the service and another for stakeholders, and separate meetings for staff, residents and relatives. The manager told us that they had reviewed the training that staff received, and in response to comments were in the process of changing the way training was delivered so that e-learning and face to face training would be better balanced. All staff took part in regular supervision meetings and had an annual appraisal. Independent and provider safety and quality assessments had taken place. We saw that action plans had been formed and implemented to address any shortfalls meeting the expected standard of safety and quality.