Denville Hall

Updated 4 February 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 11 January 2022 and was announced. We gave the service 24 hours notice of the inspection.

Updated 4 February 2022

About the service

Denville Hall is a care home providing personal and nursing care for up to 40 people from the acting profession aged 65 and over. At the time of the inspection, 33 people were using the service. Accommodation was provided on two floors and there was a separate unit which specialised in providing care for up to 15 people living with dementia.

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

The provider had effective systems to help ensure people who used the service were safe from avoidable harm. Where there were risks to people, these had been assessed and management plans included clear guidelines to help reduce risk. People received their medicines safely and as prescribed. Staff received training in the administration of medicines and had their competency at managing medicines safely checked.

Lessons were learned when things went wrong. The provider had processes for recording and investigating incidents and accidents.

Appropriate recruitment checks were carried out before staff started working for the service. People were supported by staff who were suitably trained, supervised and appraised.

People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean, tidy and well maintained throughout.

People’s nutritional and healthcare needs were met and we saw that staff took appropriate action when concerns were identified.

The provider acted in accordance with the Mental Capacity Act 2005. People had their mental capacity assessed before they moved into the home. Where necessary, people were being deprived of their liberty lawfully. 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.

The environment was tailored to the individual needs of people who used the service, including those living with the experience of dementia.

The registered manager led a caring and dedicated team. Together, they met people’s individual needs and maintained their quality of life.

Care plans were developed from initial assessments and contained relevant and up to date information about people’s needs and preferences, so staff knew how to care for and support them. Where possible, people had an end of life care plan in place which stated their individual wishes when they reached the end of their lives.

People were engaged in meaningful activities according to their interests and background. People reported they were very happy with the activities on offer. Staff were responsive to people’s individual needs and knew them well. They ensured that each person felt included and valued as an individual.

The provider had robust systems in place to monitor the quality of the service and put action plans in place where concerns were identified. People’s care records were reviewed and updated monthly or more often if their needs changed.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 July 2018). At this inspection we found improvements had been made and the provider was now rated good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.