Davids House

Davids House is a nursing home providing personal care and nursing care to up to 30 people. At the time of our inspection there were 27 people using the service, the majority of whom were living with dementia.

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

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.

People were protected from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place.

Medicines were stored, managed and administered safely. Infection control and prevention systems were in place. The premises were suitable, well maintained and 'fit-for-purpose'. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.

The service assessed people's needs before they began living at the service, so they knew whether they could meet their needs. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate.

Systems were in place for dealing with complaints. People were supported to maintain relationships with family and friends, and to engage in meaningful activities. Staff consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way.

The manager of the service actively sought the views of people and their relatives about the running of the service. The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

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

The last rating for this service was Good 15 November 2017.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Davids House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. Policies and procedures were updated regularly following any changes in national guidance.

The registered manager had identified, assessed and mitigated COVID-19 related risks to people, staff and visitors. A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

To ensure people were protected against Covid19, staff took a lateral flow test every day before commencing work.

Staff had received training about Covid19, infection control, hand washing and in the use of personal protective equipment (PPE). Training records confirmed this. Staff also received infection control competency checks. This has helped assure the provider that people were protected and safe as staff had a good understanding of infection prevention and control.

The care home had supported people to keep in contact with family and friends. This contact had included socially distanced visits and phone and video calls.

An infection control policy was in place and there were standard operating procedures that were regularly updated in line with changes in government policy.

Regular audits of infection prevention and control (IPC) practice were carried out by management to assure the provider that people were protected and safe.

There was an ample supply of PPE for staff and visitors to use. Hand sanitiser was readily available throughout the service.

To reduce the risk of infection transmission, there were enhanced cleaning schedules were in place. These included regular cleaning of frequently touched areas such as handrails, light switches and door handles.

The provider ensured they kept up to date with all relevant guidance to do with the pandemic. Updates were promptly communicated to staff, people and relatives. This and regular communication with the local authority, public health teams, community healthcare professionals and managers from other care homes helped to ensure the home carried out good infection prevention and control practice that kept people safe.

Any staff or person who had tested positive, were isolated in line with government guidance. This minimised the risk of spread of infection in the home and people and staff becoming unwell.

Further information is in the detailed findings below.

During our previous inspection on 2 and 3 November 2015, we rated the service as “Good” and found no breaches of regulation.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People and their relatives spoke positively about the care provided in the home. People told us that they had been treated with dignity and respect. They felt safe living in the home and in the presence of staff. On the day of the inspection, we observed that there was a calm and homely atmosphere in the home. The welfare of people was at the centre of the home’s ethos. Management and staff worked well together to ensure people had an enjoyable and meaningful life whilst promoting their independence.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Comprehensive risk assessments had been carried out and were in place. Staff were aware of potential risks to people and how to protect people from harm.

On the day of our inspection we observed there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were sufficient and said they had enough staff to carry out their duties. The registered manger informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

The home encouraged people to be independent and mobile where possible. In order to address the risk of falls, the home had implemented various measures to prevent falls where possible. This included having Falls Champions in the home, staff training as well as practical measures such as mobility equipment.

Fire and emergency procedures were in place and there was evidence to confirm that necessary checks were carried out regularly. We found the premises were clean and tidy and there were no unpleasant odours throughout the day.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly by staff and were updated when people's needs changed.

Care staff told us that they felt supported by management. They told us that management were approachable and they raised no concerns in respect of this. We saw evidence that staff had received training in various areas which helped them in their role. Staff had also received regular supervision sessions and yearly appraisals and this was confirmed by staff.

Staff we spoke with had an understanding of the principles of the MCA and the importance of ensuring people were able to make their own decisions where possible. People’s capacity to make decisions was clearly documented in their care support plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. We found that the appropriate DoLS authorisations were in place.

People spoke positively about the food provided in the home and said that the food was freshly prepared. There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. We observed that there was a set menu which included a variety of different foods. People were offered a meat option or vegetarian option daily but alternatives were always available. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.

During our inspection, we observed people having their lunch, which was unhurried with a relaxed atmosphere. Dining tables were laid attractively with fresh flowers, linen tablecloths and the food menu. Portions were generous and lunch was attractively presented. Staff were attentive and created a pleasant atmosphere chatting with people over lunch.

Throughout our inspection, we observed that people appeared comfortable and at ease in the presence of staff. We saw respectful and caring interactions between care workers and people. Care workers were patient and caring and showed interest in people.

The home had a varied activities programme available to people which included art and crafts, music therapy, floor basketball, sitting netball, bingo and movie night. People and relatives spoke positively about the activities available in the home.

The home had a clear management structure in place with a team of care workers, senior care workers, kitchen staff, domestic staff, the deputy manager and the registered manager. People and relatives spoke positively about management in the home and said that they had confidence in the registered manager. They said that the registered manager was approachable and always willing to listen. There was a system in place to deal with complaints appropriately.

Staff told us that the morale within the home was good and that staff worked as a team well with one another. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

We spoke with three people who used the service, the service manager, the registered manager, the deputy manager, three staff members and four relatives. We reviewed the care plans of four people.

This is a summary of what we found:

Is the service safe?

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have the capacity to give consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw people were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required. Five applications had been submitted and all of them had been authorised.

Systems were in place to ensure staff learned from events such as accidents and incidents. This reduced the likelihood of people being at risk. We saw systems were not in place to protect people from the risks associated with medicines. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the administration and recording of medicines

Is the service effective?

We spoke with staff and observed how they communicated with people who used the service. We found staff had an understanding of people's care and support needs and knew them well. Staff assessed each person's health and care needs with the person. Staff told us care plans provided appropriate information to assist them to meet each person's care needs.

Staff received regular training, supervision and a review of their performance through an appraisal. This provided an opportunity to identify any training needs and support staff so they could deliver effective care to people.

Is the service caring?

People told us they felt safe in the care of staff. One person said, 'Staff are fantastic,' another person said, 'Staff are pretty good.' One relative said, 'Staff are first rate, very patient.' Another relative said, 'Staff are very helpful, they empathise (the ability to understand and share the feelings of another person) with people. I cannot fault staff and staff turnover is low.'

All the people we spoke with and the relatives we spoke with told us they could speak with staff if they had concerns or were unhappy about their care.

Is the service responsive?

People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with the wishes of people using the service.

All the people we spoke with and the relatives we spoke with told us they knew how to make a complaint. We saw there was a process in place to respond to any issues of concern.

Is the service well-led?

This service had various internal quality assurance systems to identify and address issues. People who used the service and their family members were asked to complete a detailed questionnaire annually.

Visiting relatives told us that they were impressed with the standards of cleaning maintained in the home. One person said, 'We can't fault the staff and the care and cleanliness of the home.'

We spent some time observing the interactions between staff and people using the service in the communal areas of the home. Staff gave each person individual attention and called them by their name when speaking with them. They assisted people sensitively when they required personal care. People we observed in the communal areas were alert and showed interest in their surroundings and other people.

We looked at the care plan files for five people who live in the home. The assessments and support plans included each person's wishes and preferences, and were signed by the person or their relative.