Archived: Dene Holm

Updated 30 September 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

This inspection was carried out by three inspectors 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

Dene Holm 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. Dene Holm is a care home without nursing care. The Care Quality Commission (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 CQC 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 although they had not been present in the home for over three months.

Notice of inspection

This inspection was unannounced. Following the first day of inspection we informed the service we would return but did not give a date or time.

What we did before 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 with seven people who lived at Dene Holm and gained feedback from seven relatives about their experience of the care provided. We spoke with 16 staff members, including members of the service management team, catering staff and domestic staff. We reviewed a range of records. This included 14 people's care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We looked at training data and quality assurance records.

Updated 30 September 2022

About the service

Dene Holm is a residential care home providing accommodation and personal care to up to 47 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 38 people using the service.

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

Although the feedback from people living at Dene Holm and their relatives was mainly positive, we found systems to monitor people’s safety and well-being were not robust. Risks were not always identified and acted upon. Accidents and incidents were not effectively reviewed and monitored to minimise the risk of them happening again. Safeguarding concerns were not consistently shared with the local authority and The Care Quality Commission (CQC) to enable thorough investigation. Systems to monitor people’s medicines were not robust which meant people may not receive their medicines as required.

People were not always supported by sufficient, skilled staff. Due to staff shortages the provider employed a large number of agency staff who did not know people and the routines of the home as well as more permanent staff. Staff did not have comprehensive and accurate guidance around people’s care needs as records were not updated regularly and contained contradictory information. The environment was not set up to meet the needs of those living with dementia and areas of the home were in need of refurbishment. This resulted in some areas being difficult to clean.

People’s health was not always managed well, and people experienced delays in referrals to healthcare professionals. 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. There was a lack of activities, and people who were cared for in their rooms were at risk of social isolation. People had limited opportunities to go out unless supported by their family or friends.

Systems to monitor the quality of the service people received were not effective. Action plans lacked detail and timescales for completion were not met. Audit systems were not robust and did not identify concerns. The provider did not have adequate oversight of the service and did not ensure staff in positions of responsibility had the induction, training and support they required.

People told us they enjoyed their food although people’s dietary needs were not always managed well. People and their relatives told us that staff were kind and caring in their approach. Permanent staff knew people’s needs well and individual interactions with people were pleasant.

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 (published 13 December 2017)

Why we inspected

The inspection was prompted in part due to concerns relating to safeguarding, management of risk, staffing and provider oversight of the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found further serious concerns. The scope of the inspection was widened to include all key questions.

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.

Enforcement and Recommendations

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 identified breaches at this inspection in relation to the management of people’s safety, the reporting of safeguarding concerns, the care people receive, consent, records how complaints were responded to and the governance of the service. You can see the action we took at the end 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.