Davers Court

The service had enough staff to keep people safe, but they were dependent on agency staff which impacted on the consistency of care. We have made a recommendation about ongoing monitoring of staffing levels. There were systems in place to monitor the quality of care and the safety of the service, but these had not been adapted to take account of the services dependency on agency staff and the impact on people.

Staff understood their safeguarding responsibilities and how to protect people from poor care and abuse. Care staff were recruited safely.

Staff assessed risks people might face and took steps to reduce the likelihood of harm. The environment was well maintained, and systems were in place to check equipment to ensure it was safe.

Staff supported people to take their medicines safely and as prescribed.

The provider had minimised the risks of infection, such as COVID-19. Relatives told us that they were made feel very welcome when they visited their family members.

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.

People's care plans were detailed and informative and reflected their needs. People and those important to them were involved in planning their care.

Staff enabled people to access health and social care support. They supported people to eat and drink in line with their preferences.

People felt able to raise concerns and were confident they would be listened to and action taken.

People told us that they were happy at Davers Court received care from kind and compassionate staff who respected their privacy and dignity.

People had access to a range of activities and social opportunities. Staff communicated with people in ways that met their needs.

The provider had a range of systems in place to ascertain the views of people, relatives and staff. This included resident meetings and satisfaction surveys.

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 outstanding (published 27 March 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from outstanding to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Davers Court 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.

We found the following examples of good practice.

• There was a separate day centre attached to the service with internal access, which was currently closed for usual business. This was being used for relative visits so they could be managed safely and relatives given more opportunities to visit.

• The wellbeing of the people was improved by use of social media for such things as live art demonstrations and creating links to the provider’s other home in the area, enabling people who used the services to keep in contact with each other. People sent cards they had made as a means of staying in touch with relatives.

• The staff team were innovative in their approach to enabling people to continue with activities that were important to them. For example, one person now walked the home’s dog, with staff support, rather than walking to the shops which they had previously liked to do.

• The staff team felt supported by management, not only by being accessible but by showing their appreciation through such initiatives as ‘gift of kindness’, care package bags of food/items and competitions

• Staff showed a person who used the service how a COVID-19 test was done on herself as they were unsure and anxious. The person was reassured by this and was then happy to have the test.

• The management team felt supported as the planning, implementation of the pandemic plans were discussed with the Regional Director at weekly meeting with managers from other services so that lessons could be learnt

• To help ensure the privacy and dignity of the people who used the service was upheld, there were small picture cards on bedroom nameplates to indicate requirements. For example, picture of icicle for isolation, butterfly for DNACPR in place, so that staff could discretely see important information relating to the person.

• The staff team had a good understanding and practice for using personal protection equipment (PPE).

Further information is in the detailed findings below.

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

At this inspection we found substantial evidence that demonstrated people received outstanding caring, kind and positive support. This was due to excellent leadership from the registered provider and registered manager as well as a strong, well trained team of staff.

Feedback from people, relatives, staff and healthcare professionals was consistently positive describing a service which provided exceptionally high-quality care and consistently worked to improve the experiences of people living in the service.

Care was personalised and met individual needs. Staff knew people very well, cared about them and understood their care and support needs as well as the risks people faced, and were motivated to support them to live full lives. People were always actively involved in managing risks associated with their care, support and in their environment. Where people chose to take risks. The service ensured they were fully informed, and actions were in place to mitigate the risk as far as possible. This resulted in people leading fulfilling lives doing the things they enjoyed.

The service supported people nearing the end of their life to have a comfortable and dignified death by working closely with health care services and through consulting people about their end of life wishes. Staff talked with pride about the care they were able to give to people in their final days. We received exceptionally positive feedback from relatives who had been recently bereaved about the care the service had given to their relative and to them.

There was a very strong emphasis on the provision of activities that were meaningful to the people living in the service. People told us they were happy with how they spent their time. Staff told us how they believed that being fulfilled and entertained promoted people's overall wellbeing. People were fully involved in the community of Davers Court. Involvement ranged from selecting a pet for the service, choosing the decoration and looking at safety.

Staff took great pride in creating an atmosphere that welcomed people and promoted their independence whilst respecting their privacy and dignity. The registered manager had developed a set of values specific to the service with the involvement of people and staff. Staff proudly told us about these values and how they supported them to provide high quality care on a daily basis. People, relatives and staff described Davers Court as a family.

People had support from safely recruited and appropriately trained staff. Staff understood their role and responsibilities to protect people from abuse. Staff were supported and encouraged to develop their careers within the organisation which supported increasing stall knowledge and a stable staff team.

People received their medicines when they were needed and in ways that suited them. We received exceptionally complimentary feedback from external pharmacist supporting the service.

Accidents and near misses were recorded and analysed to understand what had happened, identify trends, and help prevent them from happening again. There were quality assurance systems in place to enable the monitoring of the quality of care people received. There were quantitative and qualitive audits and checks carried out. Information from these was analysed and records showed where any issues or concerns had been identified, action had been taken to address these and this was continuously evaluated.

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.

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 30 August 2017).

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.

However, there were still outstanding breaches in other areas reported in the report resulted from the inspection done on 16 and 17 February 2016, so the overall rating of the service remained requires improvement. Those concerns included there were not always enough staff on duty. Nor was the service proactive in managing everybody’s health needs and people’s dignity was not always protected. During this inspection we found that the service had taken the necessary action to be rated as a good service.

The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 37 people living in the service. The service was divided into four almost identical wings. One wing was a nursing unit, which the providers had closed to enable the service to focus on bringing the service up to standard. They had found it difficult to recruit nurses. The service was in the process of actively recruiting to open the nursing wing.

At this inspection of 12 and 14 July, people who lived in the service told us that they felt safe and well cared for. They believed that the care workers knew what support they needed and that they were trained to meet those needs and to keep them safe. There were enough staff on duty, including senior staff, catering and housekeeping, to protect people from harm. Risks to people were assessed and steps had been put in place to safeguard people from harm without restricting their independence unnecessarily. People’s medicines were managed safely.

People were asked for their consent by staff before supporting them in their day to day care. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. 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.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people who lived in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They took steps to investigate complaints and to make any changes needed.

The service was well led by the registered manager who felt they were well supported by their line manager, the regional director and the organisation. People using the service and the staff they managed told us that the registered manager was open, supportive and had good management skills. There were systems in place to monitor the quality of service the organisation offered people. 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. Statutory notifications received showed us that the registered manager understood their registration requirements.

Further information is in the detailed findings below

We carried out this focused inspection on 26 May 2016 to check that the service had met the legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Davers Court on our website at www.cqc.org.uk.

Davers Court provides accommodation for up to 60 people, some of whom are living with dementia, who require care or nursing care.

The service is currently without a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run. The recently appointed manager is planning to register with CQC.

At our focused inspection on 26 May 2016 we found that the provider had made the required improvements and was no longer in breach of the regulation with regard to the management of medicines.

We looked at how information in medication administration records and care notes supported the safe handling of medicines.

Medicines were being stored safely for the protection of people who used the service. Audits were in place to enable staff to monitor and account for medicines. Records showed people were receiving their medicines as prescribed and there were clear records showing why people did not receive their medicines for any reason.

Medicines which were given on a when required basis needed some further information in place to help guide staff to clearly know the expectations of the provider.

The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 56 people resident. The service is divided into four almost identical wings. One wing was a nursing unit and had ten designated beds for people who had been discharged from West Suffolk Hospital for temporary care.

The service had had six managers since opening in August 2014. A registered manager was not in post at the time of our inspection. 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.

Medicines were not always well managed and some medicines had not been administered as people were asleep or refused. Records related to medicines were not accurate. We also found that stock control methods did not monitor tablets accurately which meant any administration errors would not be obvious to staff. Staff altered records related to medicines which meant they did not represent an accurate and contemporaneous record.

Staff were trained in safeguarding people from abuse and they understood their responsibilities with regard to keeping people safe and reporting suspected abuse.

Risks were assessed but the service was not always proactive about managing risk. The service carried out audits to monitor health and safety but we had been previously informed of an incident in which a section of coving had come down causing injury to a person who used the service. We have found that several sections of coving had fallen since the service opened and we are continuing to investigate this matter.

There were not enough staff who had the required skills, knowledge and experience. Agency and newer staff did not demonstrate that they knew people well, although permanent staff were found to be skilled and competent.

Staff received the training and induction they needed to carry out their roles effectively but some agency staff did not receive a comprehensive induction.

We saw that staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS) and the service acted in accordance with them. The MCA ensures that people’s capacity to make decisions is assessed. Where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People who used the service were not always positive about the food and the service had worked hard to engage with people and improve this aspect of the service. People identified as being at risk of not eating enough were referred to the dietician and monitored to ensure no further unplanned weight loss. People were also supported to access other healthcare professionals when they needed them although we had concerns about one person who we observed did not receive prompt healthcare support during the course of our inspection.

Staff were caring, passionate about their work and committed. We saw that some staff demonstrated innovative practice and acted as excellent role models for newer members of staff. People were treated respectfully and their dignity was maintained in most cases but we did also see some examples of very poor practice that impacted on the dignity and wellbeing of two people in relation to personal care needs.

People were involved in assessing and planning their care but were not always supported to follow their own interests and hobbies. Some people living with dementia had very little stimulation or activity. We saw no evidence of ‘Activity Based Care’ which is a Care UK initiative to involve people in the everyday life of the service.

Formal and informal complaints were managed well. People who used the service, and their relatives, were consulted about the running of the service but the management team did not always listen to people and change did not always follow. Staff understood their roles and were positive about the current management team.

Systems to monitor the quality and safety of the service were not robust and did not always protect people effectively.

We found several breaches of regulation during this inspection. You can see what action we have told the provider to take at the back of this report.