Dementia Matters

Dementia Matters is a care home providing accommodation and personal care for up to 10 people living with a mental health condition, learning disabilities and/or autism in one building. At the time of inspection there were 9 people living at the service. In addition to this care home, the service also provides a domiciliary care service to older people living in their own homes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 12 people received the regulated activity of personal care in their own home.

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

Care Home

Not all areas of the home were well maintained or clean and there were outstanding actions on the Legionella risk assessment. We also identified shortfalls relating to the maintenance of fire safety records. An effective safeguarding system was not fully in place. Prior to our inspection, a safeguarding allegation had not been referred to the correct agencies to ensure the appropriate action was taken. Records did not always demonstrate safe recruitment procedures had been followed. Medicines were not managed safely. An effective system was not fully in place to ensure there were sufficient staff deployed to meet people’s needs and ensure the cleanliness of the home.

Records did not show how people’s needs were assessed before they came to live at the home to ensure their needs could be met. Care records did not always show whether essential care tasks such as oral care had been carried out. An effective system to ensure staff were trained and supported was not fully in place. Records to evidence new staff had completed induction training were not always available. There were gaps in the provision of training including food hygiene. The design and décor of the home did not fully support people’s dignity, orientation or wellbeing. Not all areas of the home were well maintained. Records did not fully demonstrate how staff were following the principles of the MCA.

Relatives spoke positively about the caring nature of staff. One relative told us, “Staff are friendly and caring and have a good sense of humour and are very attentive. The atmosphere is warm and welcoming with helpful admin staff.”

Care plans did not always reflect people’s needs. In addition, an effective system to review people’s care and support needs was not fully in place. Records did not fully demonstrate how people’s social and emotional needs were met. Several relatives told us they had raised a complaint/concern. Records relating to concerns and actions taken were not available.

An effective system to monitor the quality and safety of the service was still not fully in place. We identified shortfalls across many areas of the service which had not been identified by the providers quality monitoring system.

Domiciliary Care Service

An effective recruitment system was not fully in place. Records did not always demonstrate that safe recruitment procedures had been followed. Medicines were not managed safely. We identified shortfalls with medicines records. Risks were assessed and monitored. One relative raised concerns about infection control which we passed to management staff. Safeguarding systems were followed by staff. One relative said, “Never any sign of abuse, I can hear them with him, very chatty and friendly.” There were enough staff deployed to meet people’s needs. Relatives told us there were sufficient staff and the same staff provided care and support.

Relatives spoke positively about the caring nature of staff. One relative told us, “The quality of care and the staff are wonderful, there’s not one of them who has not been considerate.”

An effective system to ensure staff were trained and supported was not fully in place. There were gaps in the provision of training. Staff appraisal, supervision and competency checks had not been carried out as planned to ensure staff were supported in their job role. Information relating to consent was recorded in people’s care plans.

People’s needs were assessed. Most relatives told us that care and support was delivered in line with people’s needs and choices. Records did not always evidence the number of complaints received and actions taken.

An effective system to monitor the quality and safety of the service was still not fully in place. We identified shortfalls which had not been identified by the providers quality monitoring system.

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 requires improvement (published 9 May 2023). There were breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This is the second time the service has been rated requires improvement.

Why we inspected

We carried out an unannounced focused inspection of this service in December 2022 and January 2023. Breaches of legal requirements were found in relation to safe care and treatment, good governance and duty of candour. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. Prior to this inspection, we also received concerns in relation to the management of medicines and safeguarding allegations.

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.

We have found evidence that the provider needs to make improvements. Please see the full report below.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dementia Matters on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 9 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to safe care and treatment, safeguarding people from abuse and improper treatment, premises and equipment, person-centred care, dignity and respect, recruitment, staffing, duty of candour and good governance.

Please see the action we have told the provider to take at the end of this report.

We are also following up outside of the inspection process the provider’s failure to ensure all notifiable incidents were reported to CQC. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan and meet with management staff and the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dementia Matters is a care home providing accommodation and personal care for up to 10 people living with a mental health condition, learning disabilities and/or autism in one building. At the time of inspection there were 8 people living at the service. In addition to this care home, the service also provides a domiciliary care service to older people living in their own homes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 12 people received a regulated activity in their own home.

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

A system to ensure regulatory requirements were met was not fully in place. We identified shortfalls in areas of the service including the assessment of risk, management of medicines, infection control, duty of candour and governance. In addition, incidents had not always been notified to CQC in line with legal requirements.

Systems were in place to recruit staff safely. However, there were inconsistencies in the recruitment records for 1 member of staff. We have made a recommendation about this. A range of risk assessments were in place to help ensure the safety of people and the environment. However, all the risks people were exposed to had not been fully assessed or action taken to mitigate known risks. Medicines were not always managed safely.

Systems were in place to safeguard people from abuse and incidents had been appropriately reported to the local authority. We observed staff responded to people quickly during the inspection, although we received mixed feedback about staffing levels. We have made a recommendation about this. Staff displayed kind and caring attitudes towards people during their interactions.

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 design and décor of the care home did not fully meet people’s needs. We have made a recommendation about this. Records confirmed the nutrition and hydration needs of people were met and systems were in place to work with health care professionals to ensure the physical health needs of people were met.

Training deemed mandatory by the provider was delivered to staff. Training was not provided in relation to the specific needs of all people. For example, training had not been provided for staff in relation to supporting people who were diagnosed with learning disabilities or autism.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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 12 February 2018).

Why we inspected

We received concerns in relation to safe working practices and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there were overall governance issues, so we widened the scope of the inspection to also include the key questions of effective.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 Dementia Matters on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, good governance and duty of candour. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Notification of other incidents.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response in relation to the failure to notify CQC of events at the service is added to reports after any representations and appeals have been concluded.

We have made recommendations in relation to staffing, recruitment and the environment. Please see the safe and effective key questions for further details.

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.

At this inspection we found the service remained ‘Good’.

Dementia Care provides a range of services for people living with dementia and other degenerative neurological disorders in the Newcastle area. These include domiciliary care services, a respite unit, and small independent supported living homes.

At the time of this inspection, three registered managers were in place. However shortly after the inspection visit the provider advised us that due to a restructure this was would to be reduced to one. 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 showed a strong commitment to sourcing in-depth, high quality, varied staff training to equip staff with the skills and understanding to meet the wide range of needs of people with dementia. Training was delivered using in-depth and innovative methods. Staff described facilitated workshops which incorporated reflection and consideration of real life practical examples. Staff were animated when describing a virtual dementia tour which let them experience how sensory disturbances might make people with dementia feel and respond to situations. Staff received good induction and on-going training in all relevant areas. Any training needed to meet the individual needs of people using the service was identified and carried out promptly.

Staff received a programme of planned, varied and competence based formal support. Staff spoke highly of the support by the Dementia Care management team. They told us they took pride in their work and felt valued and respected.

Mealtimes were an enjoyable social experience for people in the supported living and respite service. People were given choices; kitchens were integrated into dining spaces so food was prepared in front of people and therefore see and smell it whilst it was being cooked. People’s nutritional needs were fully understood and met.

The environments were designed to be 'dementia friendly' and we could see further improvements were continuously being researched and introduced into the service. Within the respite service an innovative interactive projector was used designed to stimulate movement and social engagement. Staff told us it was very popular.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the service unaccompanied.

People using the service and their relatives said they felt safe and protected by staff. Staff had a good understanding of the safeguarding process. Risk assessments showed a positive response to risk taking where it enriched people's lives. People were supported to be independent and any risks were assessed with mitigating actions identified to ensure people's care was delivered as safely as possible. Medicines were well managed, with processes in place so people received their medicines as prescribed.

There were enough staff to operate the service safely and to meet people's needs. Staff recruitment systems remained thorough, and protected people from the risks of unsuitable workers being employed.

People told us they were very well cared for, and that staff were kind, patient and treated them with respect. They said their privacy and dignity were respected at all times, and they were consulted about their care and given the necessary information to make decisions. We observed staff members knew people well, and that people were relaxed in staff's company.

People and their families were fully involved in the assessment of their needs, and their wishes and preferences about their care were sought and recorded. Detailed, person-centred care plans were drawn up to meet those needs and preferences.

Dementia Care provided other services outside of the regulated activities, including employing a specialist dementia nurse and 'dementia guides' who could offer people and their families information on the services and support available from a multitude of organisations. Staff within the regulated activities could refer people to this service. Detailed information booklets were also available for people and relatives about how to live well with dementia.

Systems were in place for responding to complaints and other matters of concern. Complaints records were well maintained and showed the provider's policy had been followed. They used such feedback to improve the service.

The registered managers and management team continued to provide strong leadership to staff. Following our inspection visits a member of staff told us they felt the service had displayed poor financial management and raised concerns over a new proposed staff structure. The provider gave us details of the new structure and shared independent auditors reports, which provided assurances that the changes were well considered and that there was no evidence of poor financial management.

All staff we spoke with displayed a commitment to the Dementia Care mission statement which was to provide the best possible quality of life for people with dementia. The service was open and responsive to feedback and new ideas, and had robust systems in place for monitoring its progress in meeting its goals. The provider continued to enjoy excellent links with the local community, and since our last inspection had been involved in setting up a monthly dementia friendly cinema event at a local cinema. They had also been awarded an award providing a commitment to 'showing the highest level of care, compassion and courage in one of the most important, yet challenging industries'.

The provider had not sent us some notifications of safeguarding incidents which are a legal requirement of their registration. We discussed this with the registered manager who told us this was due to temporary change of the staff member responsible for submitting notifications. They advised us they would update their policy to ensure it was clearer that the Care Quality Commission needed to be promptly notified of all incidents of a safeguarding nature. We will follow this up outside of the inspection process.

There were effective systems in place to reduce the risk and spread of infection. Staff reported they had been told what measures they should take to prevent the spread of infections in people's homes. They said they had access to the personal protective equipment they needed to keep themselves safe,.and said they had received appropriate training as part of their induction.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The partner of one person said, 'They (staff) always make sure he is prompted to take any medication he needs to have. I have no concerns at all.'

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks were undertaken before staff began work.

People were made aware of the complaints system. People who used the service, and their representatives, told us they knew how to complain if they needed to and who to go to if they had any concerns.