Downs House

Updated 1 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, one medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Downs House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Downs House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 27 July and ended on 18 August 2022. We visited the service location on 27 July and 28 July.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to 10 people and relatives about their experience of the care provided. We spoke to the nominated individual, the general manager, the registered manager and 10 members of staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of documents which related to the running of the service. These included five people’s care plans and risk assessments, 19 medicines administration records and associated care plans and risk assessments, staff recruitment files, policies, audits, maintenance certificates and quality assurance records.

Updated 1 October 2022

About the service

Downs House is a residential care home which provides accommodation and support to up to 49 people, including people living with dementia. Care is provided in one adapted building and people have access to several communal spaces and an outdoor area. At the time of our inspection there were 35 people using the service.

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

The provider did not always manage medicines safely. Risks related to the premises were not always safely managed, this included risks related to fire safety, fire exits, window restrictors and storage of hazardous substances. There were enough staff in place to meet people’ needs. Staff recruitment checks were completed as required.

We found that the provider was not always following the principles of the Mental Capacity Act 2005, for example in relation to the use of bed rails. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff did not always receive training or training updates in line with their role. There were significant numbers of staff who required or were overdue updates in key areas such as medicines, mental capacity act, first aid, fire safety, infection control, safeguarding, food hygiene, diabetes and health and safety.

The leadership and governance of the home required improvement to ensure audits were effective in promoting improvement and identifying risks. The registered manager has acted upon feedback from this inspection and were putting plans in place to address the issues identified.

The home is spacious and light, suitable for people’s needs. There was a coffee bar in the dining room that provided a social area where people and their relatives could get drinks and snacks.

The staff were caring and supportive to people who used the service, observations showed their needs being met in a kind and caring way and people were treated with dignity and respect.

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

Rating at last inspection

The last rating for the service was good (published on 7 September 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s specific medical needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Downs House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found breaches in relation to consent, safe care and treatment, good governance and staffing at this inspection.

You can see what action we have asked the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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