We carried out an unannounced inspection of Danesmoor Residential Care Home on 19 and 20 May 2015. Danesmoor Residential Care Home provides accommodation and personal care for 24 older people. The service does not provide nursing care. At the time of the inspection there were 15 people accommodated in the home.
Danesmoor Residential Care Home is an older detached house situated in a residential area on the outskirts of Haslingden in Lancashire. It is on a main bus route and close to local amenities.
The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection. The Care Quality Commission has however received an application from the home manager to register as registered manager. 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.
At the previous inspection on 19 December 2013 we found the service was meeting all standards assessed. Since our last inspection visit there had been safeguarding concerns raised regarding cleanliness, mealtimes and the delivery of people’s care. Improvement meetings had been held with the registered persons and the manager, Care Quality Commission (CQC), the safeguarding team and commissioners of services.
Individual risks had been identified in people’s care plans and kept under review. However, the process of identifying the level of risk was not accurate and the action to be taken by staff to reduce or eliminate the risk had not always been documented. This meant people could be placed at risk of receiving inappropriate care. You can see what action we told the registered provider to take at the back of the full version of the report.
People had mixed views about the staffing levels but overall considered there was enough staff. People living in the home told us, “Staff are lovely; they always come when I call” and “Staff have never not come yet when called.” Visitors said, “There are enough staff and they are always busy”, “Buzzers are always answered properly; people aren’t left waiting” and “Staff are lovely but they are stretched to the limit at times.” We made a recommendation that the service seeks further advice about the provision of appropriate staffing levels taking into account the needs, dependency and numbers of people using the service and the layout of the building.
Prior to the inspection the home had been visited by the local authority infection control lead nurse and a number of recommendations had been made. We noted some action had already been taken, audits had been completed and an improvement plan was in place. We generally found the home was clean and odour free although we noted some areas were in need of attention. We made a recommendation the service followed appropriate advice and guidance regarding infection prevention and control matters.
People’s medicines were managed safely and staff had received appropriate training in this area. We found a safe and fair recruitment process had been followed for staff and appropriate checks had been completed. Staff had access to a range of appropriate training and induction to give them the necessary skills and knowledge to help them look after people properly. Most staff had achieved a recognised qualification in care. Staff told us they received the training and support they needed and spot checks were completed on their practice to ensure they were following safe procedures.
Danesmoor Residential Care Home is an older style property set in its own gardens. The home was comfortable, bright, spacious and well maintained. Improvements were ongoing and from looking at records we saw equipment was safe and had been serviced. People told us they were happy with their bedrooms and some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. The gardens were safe, accessible and well maintained.
During this inspection people told us they enjoyed the meals. They told us, “I get sufficient food; it is very nice” and “There is a good choice of meals; there is always a cup of tea and something to eat available”. A visitor said, “They are given lovely meals; always well prepared and nicely presented.” The menus were varied and nutritionally balanced and the meals looked nutritious and appetising. Fresh fruit and hot and cold drinks and snacks were served throughout the day. People were offered a choice of meal and staff were aware of their likes and dislikes. The atmosphere was relaxed with friendly banter and encouragement throughout the meal between staff and people living in the home. People’s dietary preferences were recorded. Any risks associated with people’s nutritional needs were monitored and appropriate professional advice and support had been sought when any changes had been noted.
People living in the home told us they did not have any concerns about the way they were cared for. People said, “I am looked after properly”, “The girls are very kind; I am treated very nicely” and “Staff are gentle with me.” Staff had an understanding of abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. Staff had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered.
Records had been made of healthcare visits, including GPs, district nurses and the chiropodist. We found the service had links with health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care. A visitor said, “They work closely with GPs and specialists.”
People who we spoke with told us they were happy with the approach taken by staff. People said, “I’m well cared for; it is beautiful, really beautiful here”, “I am looked after really well” and “Staff are very gentle.” A visitor said, “Staff are very caring and helpful.” People were able to make choices and were involved in decisions about their day and about the care and support they needed and wanted. Staff we spoke with had a good understanding of people’s needs. We observed people being treated with respect and supported to be as independent as possible, in accordance with their needs, abilities and preferences.
Each person had a care plan that was personal to them which included up to date information about the care and support they needed. We noted care records were stored at a work station in the lounge which meant information about people could potentially be seen by others. We discussed this with the manager who gave us assurances people’s information would be stored securely.
People were encouraged to discuss any concerns during meetings and day to day discussions with staff and management and also as part of the annual survey. People told us they had no complaints about the service but felt confident they could raise any concerns with the staff or managers.
People were supported to take part in activities such as dominoes, ball games, reading and discussing the newspaper and current events, church services, pamper sessions, and one to one sessions. People told us they enjoyed the gardens in the warmer weather. People told us about the ducks and alpacas and how they were involved in feeding them. We heard both serious and amusing conversations between staff and people living in the home.
People described the manager as ‘approachable’, ‘supportive’ and ‘willing to listen. The manager worked at Danesmoor Residential Care Home three days each week and at Jalna Residential Home two days. We were concerned this may result in a lack of consistent leadership; however, a senior carer took responsibility for management duties in her absence. People confirmed the owners monitored the day to day management of the home on a regular basis.
There were systems in place to assess and monitor all aspects of the quality of the service and regular checks on systems and practices were completed by the manager and the owners. We found the records did not always clearly identify which records had been checked and how identified shortfalls had been acted on. The manager and owners assured us the auditing records would be reviewed to ensure all details were recorded clearly.
There were systems in place to seek people’s views and opinions about the running of the home. People’s views were taken into consideration and there was evidence changes had been made as a result of this.