2 September 2014
During a routine inspection
We visited the service again on 2 July 2014 and found that people's care and welfare had improved and therefore the warning notice was removed.
The purpose of this inspection on 2 September 2014 was to check that the provider's action plan had been implemented. We judged there had been improvements and the service was now compliant with safeguarding people from abuse, management of medicines, staffing, notifications of incidents, and record keeping.
At the time of this inspection there were three people living at Dean View. They were able to understand our questions but could not provide detailed responses. We observed their responses to our questions, and also observed their interaction with the staff.
During our visit to the home, we looked at the care records for people living at the home and spoke with five staff to find if people received the care and support they needed, as agreed in their plan of care. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?
Is the service safe?
The service was safe because people's health and care needs were understood by staff who had been suitably trained and supported. In the five months before this inspection new staff had been recruited to fill vacant posts. This had resulted in fewer agency staff working in the home and a more stable staff team who knew the people living there and understood their needs.
The staff we spoke with had received training on all essential topics including safeguarding and understood the actions they must take if they suspected any person had been abused or neglected. Risks to people's health and welfare were understood and managed in line with their assessed needs and measures were put in place to minimise any potential risks. There were monitoring processes in place for all aspects of the care and support people received
Care plans included considerations of the Mental Capacity Act (2005) and staff demonstrated an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People's human rights were therefore properly recognised, respected and promoted.
Is the service effective?
The service was effective because people's health and well-being was promoted. Care plans and records had been reviewed and updated and provided detailed information about all areas of each person's support needs. Staff understood each person's needs and we saw that routines were carried out in accordance with each person's care plan, for example making sure people were offered drinks regularly throughout the day, and making sure medicines and creams were administered at appropriate intervals throughout the day as prescribed.
Is the service caring?
The service was caring because we saw staff communicating in a warm and caring manner. We saw staff asking people for their consent before carrying out tasks. Staff recognised the importance of respecting each person's privacy and dignity when carrying out personal care tasks.
Is the service responsive?
The service was responsive because people's wishes and their likes and dislikes were taken into account. Advice and treatment had been sought appropriately when staff recognised people's needs had changed. We saw evidence of visits and appointments with health and social care professionals. For example a person who had shown signs of ill health recently had been referred to their doctor who had arranged for tests to be carried out.
Staff told us they understood each person's needs. They were able to describe people's care needs, including the medicines they required and how the medicines should be administered. They were able to communicate with each person and understood their requests and preferences.
Is the service well-led?
The home did not have a registered manager. The provider has submitted an application to the Care Quality Commission to de-register the home in the near future. They plan to offer supported accommodation to the people living in the home instead of residential care. New management systems had been put in place in the last five months in readiness for the planned changes. The provider has registered a personal care service known as Exeter Home Care Guinness Care and Support and they intend to offer people living at Dean View care and support through this service. The registered manager of this service was overseeing the management of Dean View at the time of this inspection. Staff told us the management arrangements were working well and there were good systems of monitoring, support and communication in place.
We saw that daily routines were monitored, reviewed and adjusted where necessary. Monthly audits were carried out by the management team. Where problems had been found we saw the provider had action plans in place to address these.
Staff meetings and individual supervision sessions were held regularly. Staff told us there was good teamwork and it was a happy and positive place to work. When team leaders or managers were not present in the home they could easily be contacted by telephone to provide advice or support if needed.