Dewdown House

We found the following examples of good practice.

• The care home was in 'lockdown' due to the significant outbreak of Covid-19 in the home. Health professional visits were undertaken only when telephone or video calls were not sufficient, and end of life visits from relatives were permitted, with safety protocols in place. Staff greeted visitors at the entrance to the home and explained the safety procedures in place. Visitors had their temperature checked on arrival and were provided with personal protective equipment (PPE) that included gloves, aprons and facemasks.

• People had been supported to maintain contact with their loved ones, through video and phone calls. People were being isolated in their rooms at the time of our inspection. Ancillary staff, such as catering, housekeeping and laundry staff were not going into people's rooms during this time. This was to reduce the contact between people using the service and staff to a minimum.

• The registered manager recognised the potential detrimental physical and emotional effects on people from being isolated. Some people were becoming less mobile and it had been noted that some people's food and fluid intake had reduced. The registered manager and staff team were providing additional support with nutrition, with the offer of additional snacks and smoothie drinks. People were encouraged to exercise and move around in their bedrooms. Additional televisions had been purchased to provide entertainment for people. Staff encouraged people to do puzzles and other games that they could complete on their own in their rooms. One person enjoyed using a voice command electronic device to listen to their favourite music and sounds.

• Regular testing for Covid-19 was being undertaken. Staff were tested weekly, and people using the service were tested monthly. For people who used the service that had a positive Covid-19 test, re-testing was planned to be undertaken 90 days after their positive diagnosis. This was in line with national guidance.

• Dewdown House had policies, procedures and contingency plans in place. Staff had received training and regular updates. A Covid-19 file with updated information, was available for staff to read. The registered manager told us they completed daily ‘spot checks’ to make sure staff understood and complied with the safe use of PPE and followed safe infection prevention and control practices.

• There was regular communication and weekly video conference meetings with the registered manager, and a team of health professionals, chaired by the local authority consultant in health protection. The minutes from the most recent meeting noted the registered manager was 'doing a good job of managing the outbreak'. The registered manager told us they were well supported by the team of health professionals, including their local GP, who completed fortnightly video calls.

Dewdown House is a residential care home. It provides accommodation and personal care for up to 40 older people, some of whom are living with dementia. At the time of the inspection there were 36 people living at Dewdown House.

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

The environment was homely, clean and well maintained. Thoughtful consideration had been given to how the environment could meet people’s needs and support people to remain independent.

People participated in a range of activities of their choice. Religious prayer and hymns were offered daily in line with the ethos of the organisation. People from any faith group were welcomed.

Care plans and risk assessments were individualised and showed how people preferred to be supported. People’s privacy and dignity was respected and maintained. People’s visitors were welcomed at the service and people were supported to retain social relationships.

Staff were kind and caring. There was a positive and happy atmosphere. Staff knew people well and spent time engaging with people.

Improvements had been made to quality monitoring and to the systems to support the identification and actions of safeguarding concerns, accidents and incidents. Care plans and medicines were regularly reviewed, and actions were taken in a reasonable timeframe around areas identified. The provider implemented measures to protect people around the risks from hot surfaces and water.

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. The service was well led and managed.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 3 January 2019).

At the last inspection a breach was identified in Regulation 18; Notification of Other Incidents of the Care Quality Commission (Registration) Regulations 2009. A recommendation was made in relation to managing the risks from hot water and surfaces.

At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 18 (Care Quality Commission (Registration) Regulations 2009). The recommendation had been met.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dewdown House provides care and support for up to 40 older people. At the time of our inspection there were 39 people living at the service. The service is situated overlooking the seafront in Weston-Super-Mare. It is located over three floors with communal lounges, a dining room and with access to an outdoor patio area in the centre.

At our last inspection we rated the service good. At this inspection the service was rated as requires improvement. You can read the report from our last comprehensive inspection by selecting the, 'All reports' link for ‘Dewdown House’ on our website at www.cqc.org.uk

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.

The provider had not ensured that governance systems identified all shortfalls or suitable actions had been taken to those areas found. This was of particular relevance because issues were highlighted to the provider regarding another service using the same systems. This included topical medicines records not being signed, care reviews and care plan updates not being actioned and the reviewing of incidents that may require further reporting or notifying to the Commission.

The provider had not routinely checked hot surfaces. Mixed feedback about the food provided by the service was received.

People were supported to engage in meaningful activities. Upcoming activities were displayed in the service and a newsletter shared information and events. Staff had additional time allocated to spend with people on an individual basis.

The environment supported people’s care needs and assisted people in remaining independent. The service utilised the location to ensure people enjoyed the sea views and had access opportunities within the local community.

People told us staff were kind, caring and friendly. There was a friendly and happy atmosphere at the service. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 by ensuring people’s choices were promoted and respected. Deprivation of Liberty Safeguards (DoLS) applications were made where appropriate and monitored by the service.

Care plans were person centred. People’s preferences were described. People were assisted to access healthcare when needed. People were supported to develop and maintain relationships that were important to them.

Feedback was sought from people through meetings and surveys. People felt able to raise concerns. Complaints were investigated. Communication systems were in place through meetings and records for the staff team.

Staffing levels were safe. People said staff were responsive to their needs. The provider’s recruitment procedures were followed before staff started working at the service. Staff were supported in their role by an induction, supervision and ongoing training.

Infection control policies were followed and the service was clean, tidy and well maintained. Fire safety systems were monitored and procedures were in place for emergencies.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. We made one recommendation in regard to hot surfaces. You can see what action we told the provider to take at the back of this report.

Dewdown House is owned by the Salvation Army Social Work Trust and aims to provide care and support in accordance with Christian values and teachings. It is registered to provide personal care and accommodation for up to 40 people. The home specialises in the care of older people. At the time of the inspection there were 35 people living at the home.

The last inspection of the home was carried out in May 2014. No concerns were identified at that inspection.

There is a registered manager 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 benefitted from a registered manager who was enthusiastic about their job and committed to providing a safe and welcoming environment for people. They told us their aim was to provide loving care and create a happy home. They said they provided care to people of all faiths or none and everyone would be treated equally.

The provider ensured people who wished to practice their faith were enabled to do so. There was no pressure on people to take part in any activities which did not interest them. One person said “There is no pressure to take part in the prayers. Well there’s no pressure to do anything you’re not comfortable with.”

People praised the care and support they received at the home and the attention they received from the registered manager and staff team. One person said “I’ve been in other care homes and none of them have come close to this one. Nice place and nice staff.” Another person said “I am well cared for by lovely staff. The manager is lovely and always ready to listen.”

People felt safe at the home. They said staff were always kind and friendly towards them. People said staff were extremely obliging and always responded to requests for help or support promptly. Staff spent time talking and socialising with people as well as attending to their physical needs. One person who told us they liked to stay in their room said “Staff are always popping in for a chat. You could never be lonely here.”

People’s care needs were assessed and kept under review to make sure they received care and support which was responsive to their needs and wishes. Staff monitored people’s health to make sure they had appropriate care and treatment when required. People received their medicines safely from staff who had received specific training to carry out the task.

The provider had a recruitment process which minimised risks of abuse to people. Risk assessments were carried out to make sure people could take part in activities with minimum risk to themselves and others. Staff were pro-active in seeking advice and support from other professionals when they identified risks to people’s health.

Staff knew people well and were able to provide a service which took account of people’s lifestyle choices and their interests and abilities. People were able to make choices about all aspects of their day to day lives and follow their own routines. Activities were arranged in accordance with people’s interests and hobbies.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records that we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of people living in the home and members of the management team were available and on site.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place and relevant staff have been trained to understand when an application should be made and how to submit one.

One family member told us 'The place is lovely, the staff are super, they always have time for you and if I ring they are able to answer my queries without saying I need to look at the notes'. One person living in the home told us 'It was the place I wanted to come to, I like the care that they give.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. We observed staff interacting with people living in the home and treating them with dignity, respect and compassion. It was clear from what we observed and from speaking to staff that they understood people's care and support needs and knew them well. One person told us 'We have a joke and a laugh, they really are a grand bunch the whole lot, they really care'

Is the service caring?

People were supported by kind and attentive staff. We observed care workers were patient and encouraged people to maintain independence and supported their efforts. People told us they were able to do things at their own pace and our observations confirmed this, there was a relaxed and unhurried atmosphere. One person told us 'You never have to ask twice for anything, they bend over backwards to look after you'.

Is the service responsive?

People's needs had been assessed before they moved in to the home. Records confirmed that people's preferences, interests, and needs had been recorded and care and support had been provided that met their wishes. People had access to a wide range of activities that were important to them and had been supported to maintain relationships with their friends and families. One person told us 'I find it well here, no problems, I have seen my care plan and signed it' another person told us 'In a residents meeting we asked for a real fish and chip supper wrapped in newspaper and the following week we got it'

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and had access to comprehensive training in a variety of relevant subjects. People, family members, staff and visiting professional's views had been regularly canvassed and we saw evidence of changes made as a result of views expressed.

We observed a house newsletter with details of activities and events planned for the month ahead and welcoming new people to the home. People's person centred care plans are reviewed monthly with the individual.

Everyone we asked said there were no strict routines in the home and they continued to make choices about their day to day lives. Staff demonstrated a good knowledge of people's likes and dislikes and said they always tried to provide care in line with people's wishes. One member of staff said 'Everyone has choices and we fit in around what people want.' This showed that staff respected people's wishes and provided care in line with people's lifestyle choices.

Before the inspection we received concerning information about the food in the home. We were told that vegetables were not served with any meals. We found no evidence to substantiate this claim.

People said that they would be able to speak with a member of staff or the manager if they had any worries or concerns. One person told us 'The staff here always listen to you and act on what you say.'

There was a clear staffing structure in the home which ensured that there was always a senior member of staff on duty throughout the day and on call overnight. This ensured that there were clear lines of accountability and responsibility.

There were systems in place to effectively monitor the quality of the service offered and ensure the safety of people who lived at the home.