Archived: Denison House Nursing Home

Updated 26 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 February 2017 and was unannounced. The inspection was carried out by one inspector and an expert by experience that had experience of community nursing. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The registered provider had returned a Provider Information Return (PIR) in July 2016. We did not ask the them to submit this document again. The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at all notifications and contacts we had received from or about the service. This information helped us to plan the inspection. We also contacted the local authority contracting team for an update. They told us that the embargo on admissions that had been in place was now lifted due to improvements made at the service and there was an agreement in place whereby the registered provider would only admit two people a month.

During the inspection we spoke with five people who used the service. In order to understand the experience of those people who could not communicate with us verbally we used the short observational tool (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed practice throughout the inspection.

The registered manager made themself available throughout the day to answer any questions we had and supply any documents we requested. In addition the quality manager was present to provide support. We spoke with three care workers, the maintenance person and the administrator. We were also able to speak to a district nurse and physiotherapist who were visiting the service on the day of the inspection and four relatives.

We reviewed the care plans, risk assessments and medicine records of two people in detail and looked at two other care plans. We observed medicines being administered and a member of staff explained the way in which medicines were managed within the service. We observed lunch time.

We inspected records relating to the running of the service. These included five staff recruitment and training files, the training matrix, maintenance and servicing documents and the quality assurance system.

Updated 26 April 2017

This inspection took place on 17 February 2017 and was unannounced. This meant that staff and the registered provider did not know we were visiting.

At the last inspection on 17 August 2016 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 11 Consent, Regulation 12 Safe Care and treatment, Regulation 17 Good Governance and Regulation 18 Staffing. At this inspection we saw that improvements had been made and there were no breaches of regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Denison House is registered as a nursing home but has not provided nursing care since September 2014. The service is registered to accommodate 30 people. There were 13 people living at the service when we inspected. One person was in hospital so only 12 people were present during the inspection.

There was a registered manager employed at the service. They had only recently been registered but had worked at the service since November 2016. 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.

Risks to people's health and safety had been identified. Care plans contained risk assessments relating to people’s health and there were risk management plans to guide staff.

Safe recruitment procedures were in place to ensure suitable staff were employed to work with people at the service. There were sufficient staff to meet people's needs. The registered provider used a tool to determine the numbers of staff required to meet people’s needs. We recognised that the numbers of people who used the service were low accounting for suitable staffing levels but the registered manager assured us that this would be reviewed when numbers increased.

Accidents and incidents were recorded, analysed and trends identified.

Medicines were managed safely.

The service had some signage in place to encourage people to find their way around. Signage covered communal areas. There were plans in place to develop this further.

Staff knew the people they cared for and were trained in areas that related to their role. They were supported through supervision.

Staff worked within the principles of the Mental Capacity Act 2005. Consent was sought from people about what assistance they needed with daily activities. Deprivation of liberty safeguard (DoLS) authorisations had been submitted by the registered manager in order to ensure that people were not being detained without authorisation. Where day to day decisions were taken for people, staff had completed a mental capacity assessment and best interest decision tool to evidence the decision.

People's nutritional needs were met. Although drinks were always available unless staff assisted some people they were unable to access them. We have made a recommendation about best practice in hydration.

The service was caring. Staff approached and spoke with people kindly and with respect.

Care plans were person centred and were regularly reviewed.

There was an activities organiser employed at the service and staff assisted in organising activities for people which reduced the risk of social isolation.

There was a complaints policy and procedure and people knew how to make complaints.

The quality assurance system in place used audits in each area of the service so that there was a consistent approach to improvement.

Staff were happy in their work and were positive about the support they received from management. They worked together with health and social care professionals in order to ensure good outcomes for people.

The provider had allocated a quality manager to support the registered manager. They and the staff were provided with sufficient direction and leadership to ensure that people received a consistently good standard of care.