Dean House

We found the following examples of good practice.

The provider had created a visiting 'pod' attached to the conservatory where people could meet and see each other behind glass doors with an intercom. This provided a way for people to meet visitors while they needed to self isolate or maintain distance.

The registered manager reported having good supplies of personal protective equipment (PPE) and we saw staff wearing PPE appropriately. There were multiple PPE supply points around the home with a safe system of disposing of used PPE.

There was a schedule of cleaning around the home which was monitored, the registered manager ensured audits and hygiene checks were carried out regularly.

There was regular testing in place for people and staff, government guidelines were being followed for this and test results were being monitored.

The last inspection took place on 5 September 2016. As a result of this inspection, we found the provider in breach of four regulations, in relation to person-centred care, need for consent, nutrition and hydration needs and good governance. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection on 18 October 2017, we found the provider and registered manager had taken appropriate action and these regulations had been met. As a result, the overall rating for this service has improved from 'Requires Improvement’ to ‘Good’.

Dean House is a residential care home registered to provide accommodation and care for up to 27 older people, some of whom are living with the early stages of dementia. At the time of the inspection, 23 people were living at the home. Dean House is situated close to the seafront in a residential area. Communal areas include a living room, dining room, conservatory and accessible gardens. A lift and two staircases provide access to the first floor.

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 told us they felt safe living at the home and that staff supported them well. Staff had been trained to recognise signs of potential abuse and knew what action to take in relation to any safeguarding issues. Risks to people were identified, assessed and managed appropriately. Risk assessments provided detailed advice and guidance to staff on how to mitigate risks. Staffing levels were within safe limits. Robust recruitment systems ensured new staff were vetted as needed before they came to work at the home. Medicines were managed safely.

Staff had a good understanding of the legislation in relation to mental capacity and protecting people’s liberty and put this into practice. Capacity assessments for people had been completed as needed and applications made to the local authority where it was felt people were deprived of their liberty. People received a choice in what they wanted to eat and drink. Nutritious meals were provided and people told us they enjoyed the food on offer. People had access to a range of healthcare professionals and services and spoke positively about the home. Staff had completed a range of training that enabled them to carry out their roles and responsibilities. They had regular supervision meetings and staff meetings also took place.

People were looked after by kind and caring staff and positive, friendly relationships had been developed. Staff engaged with people appropriately and had time to spend with them. People spoke highly of the staff who looked after them. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People were asked for their views in the organisation of activities and a range of activities was on offer. Some people felt there was a lack of outings into the community and told us they would like to go out more. This is an area that needs improvement. Care provided was responsive to people’s needs and delivered in a person-centred way. Care plans were detailed and contained information for staff on people’s personal histories, care and support needs. Complaints were managed in line with the provider’s policy.

People and their relatives felt the home was well run. People were asked for their views about the home through residents’ meetings and questionnaires. People felt involved in developing the service. The registered manager was popular with staff and staff felt valued working at the home. Staff were asked for their feedback through employee questionnaires. Systems were in place to measure and monitor the care delivered and the service overall.

Dean House is a residential care home providing accommodation, including respite care, for up to 27 people, some of whom are living with dementia or diabetes and who may require support with their personal care needs. On the day of our inspection there were 21 people living at the home. The home is a large property situated in East Preston, West Sussex. It has a communal lounge, dining room, conservatory and garden.

The home was the only home owned by the two providers and the management team consisted of a registered manager, an operations manager and a team leader. A registered manager is a ‘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 home is run.

People had variable experiences and we found several areas of practice that required improvement.

There were concerns with regards to people’s emotional and social needs being met. People told us that staff did not have time to spend with them and our observations confirmed this. Observations showed staff were very busy and task orientated and did not appear to make time to meet people’s social and emotional needs. One person told us, “There are enough of them but they are very busy, sometimes when you ask them something they are a little abrupt but it is just because they’re busy”. Another person told us, “The staff don’t have time to be friendly”.

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People provided mixed feedback with regards to the provision of activities. Some people told us that they enjoyed the external activities that were sometimes provided, however, felt that there wasn’t much to do to occupy their time and our observations confirmed this. People who spent time in their rooms were at risk of social isolation. Observations showed people spending extended periods of time alone in their rooms, only seeing staff when they were providing personal care or food and drink. One person told us, “There is not much to do here”. Another person told us, “I don’t get visitors’, I have no family, I get incredibly lonely, the only criticism I have is the boredom”. A relative told us, “There is not enough to occupy them, I feel a bit more one to one time with my relative could be an improvement”.

People’s health and physical needs were assessed when they moved into the home, these were reviewed on a monthly basis by care staff. However, there were concerns regarding the involvement of people and their relatives’ in the care plan reviews. One person told us, “I know I have a care plan but I’ve not had a review”. A relative told us, “I’ve not experienced a review in the last twelve months and I’ve never been informed of the outcome of an assessment my relative had some time ago, communication from the home is somewhat lacking”. Care plans did not contain sufficient information about people’s life history, background or social and emotional needs. The management team had recognised this and were in the process of developing a new care planning system, which was yet to be implemented, to address this. Reviews that did take place did not always reflect the good practice carried out by staff. For example, one person’s review failed to recognise that the person had been referred by the registered manager to a healthcare professional and that their support needs had changed. Observations showed that staff had implemented the necessary changes but this had not been sufficiently documented to ensure that the person’s care was consistent.

The lack of interaction and stimulation for people, as well the lack of involvement of people and their relatives’ to ensure person-centred care was provided are areas of concern.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their day to day care. The registered manager was aware of the legal requirements with regards to ensuring people who lacked capacity were not deprived of their liberty unlawfully. However, had not ensured that these were in place for all people who lacked capacity. For example, three people, who used bed rails and who lacked capacity to consent to their use, had not had their capacity assessed, nor had their legal representatives been involved in the decision making process to consent to their use. This is an area of concern.

People were happy with the choice, quality and quantity of food and had a positive dining experience. Most people had access to fluids and snacks throughout the day. However, for people who spent time in their rooms or who needed additional assistance to eat and drink, there were concerns regarding their intake of fluid. Food and fluid charts were implemented for people to enable staff to monitor their levels of intake, however, these were not always maintained, completed accurately nor monitored. Observations raised further concerns regarding some people’s fluid intake. For example, one person had two drinks left beside their bed, they were unable to reach their drinks and these were simply taken away two hours later. This is an area of concern.

Quality assurance systems were neither effective nor documented to enable the registered manager to have sufficient oversight and awareness of all of the systems and processes within the home. For example, audits that had been conducted had not recognised that some records and reviews had not been sufficiently completed. Records were not always completed sufficiently and this raised concerns over the care that people had received. The lack of quality assurance systems and the maintenance of records are areas of concern.

There were effective systems in place for the storage and disposal of medicines and people told us that they were happy with the support they received. One person told us, “I do get tablets morning and evening and they do see me take them”. Another person told us, “Yes, I do get my medication when I expect it, they trust me to take my medication”. However, there were concerns regarding the management of medicines. Some medicines, such as liquid medicines and creams, have a limited shelf life. Observations showed that several medicines, which had a limited shelf life, had been opened and no dates had been recorded on the containers to inform staff of how long the medicines had been in use. Therefore people were at risk of receiving out of date medicines that may be less effective or cause them harm. This is an area in need of improvement.

People and relatives’ provided mixed feedback about the cleanliness of the home and our observations raised concerns regarding the standard of cleaning. Observations showed that not all areas of the home were hygienically clean. Ceilings in two rooms, one of which was used by people, were covered in cobwebs, spiders and insects. When this was raised with the registered manager, they told us that they had not noticed this and would ensure that these were removed the following day. Some doors, handrails, banisters and floors were visibly soiled and sticky to the touch, as were some people’s own bathrooms and washing facilities. Results of a recent resident quality assurance survey contained comments from a person about their room, it stated, ‘On the odd occasion there has been food debris, stickiness and stains and the bin has not been emptied’. Observations showed that at certain times in the day there were strong, offensive smells within the home. Results of a recent relative quality assurance survey contained comments such as, ‘Not always odour free’ and ‘On the whole it is clean, although my relative’s room not always. It gets smelly at times and the bathroom gets neglected’. Not maintaining effective infection control could potentially have meant that people were at risk of developing and spreading infections and did not contribute to a homely and pleasant environment for people to live. This is an area of practice in need of improvement.

People were encouraged to be independent and undertake positive risks. Risk assessments had been completed to identify environmental risk as well as some risks that were specific to people’s needs. For example, a risk assessment had been completed for someone who chose to smoke. However, risk assessments in relation to social isolation and people’s emotional and behavioural needs were not completed. This is an area of practice in need of improvement.

There were sufficient numbers of staff to ensure that people’s care needs were met and that they received support promptly. Staff had a good understanding of safeguarding and people told us that they felt safe. Although the registered manager had informed us of some events and incidents in the home, they had had not informed CQC of two safeguarding investigations that had been conducted by the local authority. This is part of the registered person’s responsibilities. By not being informed of these incidents CQC were potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe. This is an area of practice in need of improvement.

Staff were suitably qualified, skilled and experienced to ensure that they understood people’s needs and conditions. Essential training, as well as additional training to meet people’s specific needs, had been undertaken. People told us that they felt comfortable with the support provided by staff. When asked if they thought staff had the relevant skills to meet their needs, one person told us, “Oh yes, the staff are good at what they do”.

People’s healthcare needs were met. People were able to have access to healthcare professionals’ and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services. One relative told us, “They reacted quickly last week to my relative being sick by calling the doctor”.

Positive relationships had bee

We observed a group of people in the lounge who were taking part in a game of bingo. We noted that there were positive interactions between people and staff who were on duty.

We spoke with three members of care staff, who were on duty. We found that they had a good understanding of their roles and responsibilities. They also demonstrated they knew what was expected of them to ensure people's needs had been met.

We also gathered evidence of people's experiences of the service by looking at a selection of records. We looked at care records. They did not demonstrate that people or their relatives had been involved with the planning or reviews of their care. We also found that care records did not always provided care staff with appropriate information to follow with regard to the delivery of care.

We also looked at a selection of records including staff recruitment and complaints that had been received. We found that the provider's recruitment practices were sufficiently robust to ensure care staff employed at Dean House were safe to work with vulnerable people. Complaint records demonstrated that they had been fully investigated and to the satisfaction of the person who made the complaint.