Denecroft Residential Care Home

Denecroft Residential Care Home is a care home which provides residential care for up to 15 people. The service provides support to older people and people living with dementia. At the time of our inspection, 11 people were living at this service.

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

People were very happy with the care provided and felt staff always went above and beyond in delivering the care. Relatives and people felt the service was delivering holistic and compassionate care, which enabled people to enjoy a good quality of life. Staff were passionate about providing good care outcomes and took ownership of their practice.

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. Staff had received a range of training around the Mental Capacity Act 2005.

Risk assessments were clear and identified how to reduce the risks to people. Staff were familiar with these documents and the actions they needed to take. The provider was in the process of changing to electronic care records and we discussed how enhancements could be made as staff transferred the paper records to the new system. Medicines management was effective and closely monitored. Staff who administered medicines had the appropriate training. Staff adhered to infection control and prevention guidance.

The management team ensured there was always enough staff to support people. Recently, when more people had needed 2 staff to support them the team had found it difficult to complete the work in a timely manner. The compliance manager had reviewed the provider’s dependency tool to ensure it was far more sensitive at highlighting when more staff would be needed to be on duty. Recruitment practices met legal requirements.

The systems the provider had in place allowed the registered manager to review the service and proactively looked at how improvements could be made. The compliance manager was in the process of reviewing all aspects of the service and had introduced some innovative new practice which embedded a person-centred value base into care practices and ensured staff understood how to provide good quality end of life care. Staff told us the registered manager was approachable and listened to their views. People felt the registered manager was running a good service.

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 this service was good (report published 15 August 2018).

Why we inspected

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

This report only covers our findings in relation to the key questions safe and well-led. For those key questions 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 Denecroft Residential Care Home 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. 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.

People we spoke to told us they were happy living at Denecroft Residential Care Home. They were all complimentary about the care they received, specifically the support they received from staff. Staff we spoke to were passionate about delivering high quality care and were supported and trained appropriately within their role.

People had choice in the food they received. The cook was passionate about the menu and explained they had the freedom to modify the menu to suit people’s needs and preferences.

There was no dedicated activities coordinator at the service, however staff described to us how they made activities part of everyday life. People also told us about events that had been arranged within the service, such as a yearly fate, and external visitors such as pet therapy, exercise groups and entertainer and singers.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff we spoke to were knowledgeable about the mental capacity act and described how they would always encourage people to make choices.

The registered manager had a thorough quality audit process which included regular audits, surveys and spot checks. We noted the system was designed to not only identify errors but also areas for improvement.

Further information is in the detailed findings below.

We last inspected Denecroft Residential Care home in March 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

Denecroft provides accommodation and personal care for up to 13 people. Care is provided to older people, some of whom are living with dementia or dementia related conditions. Nursing care is not provided.

A registered manager was in place. ‘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.’

People said they were safe and staff were kind and approachable. There were sufficient staff to support people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Systems were in place for people to receive their medicines in a safe way. People had access to health care professionals to make sure they received appropriate care and treatment.

Denecroft was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Best interest decisions were made appropriately on behalf of people, when they were unable to give consent to their care and treatment. The environment was mostly well-maintained but some areas required attention to ensure they were designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation with regard to this aspect of the environment.

Appropriate training, supervision and support were provided to staff to help them meet any specialist needs of people. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected by Denecroft staff.

People received a varied diet. There were activities and entertainment available for people. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

The provider had taken action to comply with the warning notice we set. During this visit we found people were protected from the risk of inappropriate care and treatment because accurate and suitable records were maintained.

The provider had taken action to comply with the compliance action we set concerning the planning and delivery of care and treatment to people who used the service. During this visit we found people's care and treatment was planned and delivered in a way that protected them from the risks of unsafe and inappropriate care.

The provider had taken sufficient action to comply with the compliance action we set about making sure that where people lacked capacity, the relevant legislation was followed. During this visit we found action had been taken to assess people's capacity to make decisions where this was relevant.

We found the provider had put in place suitable arrangements for the storage and administration of medicines. People's medicines were safely stored and administered, and staff had had their competency to administer medicines assessed and verified.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. We found the provider had taken steps to address concerns identified by the local fire service.

We found evidence, in the majority of records we looked at, that appropriate checks had been carried out before staff began working at the home.

We found the provider had not taken steps to comply with the Mental Capacity Act (2005) when staff at the home made a best interest decision on behalf of a person who used the service. We also found appropriate records had not been kept.

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider failed to ensure people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

The provider complied with the compliance action we set regarding the premises. We found improvements had been made to the premises. People who used the service, or others working at or visiting the home, were protected against the risks of unsafe or unsuitable premises.

The provider complied with the compliance action we set regarding the provision of effective supervision for the registered manager. The arrangements for making sure that people were cared for by staff who were supported to deliver care and treatment safely, and to an appropriate standard, were satisfactory.

We found the provider had made good progress in complying with the compliance action we set regarding some people's personal records being inaccurate and not up-to-date. We have decided to re-issue the compliance action we set following the last inspection, in order to give the provider additional time to achieve compliance.

Appropriate care plans and risk assessments had not been devised. Staff had not kept sufficiently detailed records of the care delivered to people who used the service. This meant that people had been placed at risk of receiving inappropriate care because staff did not have access to suitable information about how to care for them and safeguard their welfare.

People who used the service, or others working at or visiting the home, were not fully protected against the risks of unsafe or unsuitable premises. Some areas of the home, including external spaces, had not been adequately maintained.

There were enough qualified, skilled and experienced staff to meet people's needs. Although a senior member of staff was not always provided on each night shift, a suitable on-call system was in place which staff said worked satisfactorily.

The arrangements for making sure that people were cared for by staff who were supported to deliver care and treatment safely, and to an appropriate standard, were not fully satisfactory.

People's needs had been assessed and care and support was planned and delivered in line with their individual care plan. The expert by experience told us, 'residents were treated respectfully and essential needs were catered for and, importantly, residents all seemed happy'.

People made positive comments about the way their medicines were managed. They told us, 'I have no complaints. I get all my medicines properly'.

People experienced care and support that met their needs. One person said, 'I'm well looked after. They're great. The food is good. I don't want for anything'. People were cared for in a clean and hygienic environment. One person said, 'The home is always spotless. They look after my room and keep it clean'.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The provider had systems in place which enabled staff to regularly assess and monitor the quality of service provided. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.