The inspection took place on the 28 April and 03 May 2016. The first date was unannounced and the second date was announced. Denewood House Care Home provides care and support for up to 21 older people. On the days of the inspection 19 people were using the service. The home has a ground floor and a first floor with rooms that have ensuite toilet and wash basin facilities. There is a communal garden area enclosed at the back of the home.The home was last inspected on the 23 and 26 January 2015 and found not to be meeting the standards in relation to consent and good governance. We found that there were not suitable arrangements in place for establishing a person’s best interest in line with the Mental Capacity Act (MCA) 2005 and people were not being protected from inappropriate or unsafe care arising from a lack of proper records. At this inspection improvements had been made.
The manager, who was a registered manager, had been working at the service since 2013 and was registered as the manager in January 2015. 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 service was safe because there were sufficient staff to meet people’s needs. The registered manager provided details of how staffing had been reviewed and new staff recruited using the appropriate procedures to fill vacancies within the team. A document called the dependency document was used to review the staffing levels required according to people’s changing needs.
People were at reduced risk of abuse because staff knew how to recognise signs of abuse and identify people at risk from harm and had received training in safeguarding and protecting adults from harm. This was reflected in staff training records which showed when staff had received their updates on how to protect people and information collected from their personal training manuals. Staff understood the correct procedures to use when reporting abuse which included reporting concerns to their manager and recording details about incidents or poor practice.
Risks were managed and addressed. Where risks were apparent, action had been taken to address and reduce the risk. For example, one person had experienced a series of falls which led to changes in their care. Healthcare staff were contacted and a review of their care needs was agreed. Staff understood the risks to people and followed the guidance provided to keep people safe.
Plans were in place for how staff responded to emergencies. Emergency evacuation procedures were regularly reviewed and staff were kept up to date on the procedures to follow. Accidents and incidents were recorded, monitored and reflected on to take account of changes that were needed. Staff reported and recorded details in the accident log and peoples’ care records.
People’s medicines were administered safely and on time. People were told what their medicines were used to treat.
The service was effective because consent was sought from people as staff carried out their work and staff were working within the principles of the Mental Capacity Act (MCA) 2005.
People received care and support from staff that were trained , experienced and confident in their roles. People told us that staff understood their needs and were skilled at delivering their care. One person commented “They (the staff) know what support I need; I’m confident in them when they come to help”.
The home manager and registered manager confirmed that staff practice was observed regularly to maintain the quality and safety of care people received and this formed part of their regular supervision and yearly appraisal.
People received the level of support and assistance they needed to enjoy their meals and receive a balanced diet. Staff sat with people who needed support and helped them with their meals while describing and discussing the quality of the food. Staff offered people options and checked if they required more servings.
People were supported to maintain good health and received on-going in-put from healthcare staff. During the inspection we met two visiting health care staff and saw other healthcare professionals who had been requested to carry out health checks and appointments with people.
The service was caring because people were treated in a respectful manner when staff carried out people’s care. Staff were heard explaining procedures to people and reminded them of how to walk, move and maintain their safety. Explanations were clear and unhurried and people were given time to move within their capabilities.
Staff gave us examples of how they protected people’s dignity and respected their privacy. One staff member explained that some people preferred time on their own in their rooms, especially after lunch and this was understood and respected by staff. Other examples included “asking not telling people” when carrying out care and making sure people’s windows were closed and curtains drawn when intimate care was performed.
The service was responsive because people received care that was centred on their needs and reviewed periodically as their needs changed. Records showed that people were assessed before coming to live at the home and soon after they arrived. People, their families and where appropriate other health and social care professionals were involved in discussions about their needs.
People could chose from a variety of activities offered at the service and some people chose to make visits into the local community to participate in local social events.
Details about the level of independence were recorded in people’s care plans. This included whether they required one to one support or the help of more than one staff member to wash, bathe and move about. Some people needed assistance to eat their meals safely. This included making sure people were positioned safely or according to the instructions from the Speech and Language Therapist .
Complaints and concerns were acknowledged, investigated, explored and addressed. We looked at two complaints. These had been investigated and considered. Advice was sought from other agencies where appropriate and actions were taken to resolve people’s concerns. Written responses were sent following each investigation.
Staff were made aware of the risks which could compromise the quality of the service people received. Care plans, risk assessments and reviews showed details about the care support and treatment people required and staff had received record management training. Some records called daily records used by staff at the service revealed that the level of details recorded were improved since our last inspection but varied in quality and quantity.
Leadership was visible during the inspection where we met the provider, the registered manager and the home manager. Staff, people living at the home and their relatives all confirmed the availability and accessibility of the management team at other times. One person commented, “There’s always someone at the top about” while a relative said, “The managers are often available in the office and will come out to help”.
Staff spoke of a strong and developed team that worked together to support each other. Staff told us that the managers were responsive to their ideas and suggestions and that they were available when needed.
Management meetings took place where discussions involved staffing levels, admissions, progress and improvements. Checks called audits took place to ensure that the service was regularly monitored and developments continued.
People and their relatives told us that managers were readily available if they wanted to speak with them and that staff were positive when carrying out their roles and responsibilities.
An annual quality assurance survey, used to gather feedback, showed that people and their families had been asked for their views and experiences about the service. Several outcomes arising from the survey showed that actions had been implemented.