Dauntsey House

Dauntsey House is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to adults over 65 years and people living with dementia. At the time of our inspection there were 21 people using the service.

Accommodation is provided on three floors accessed by stairs and a lift. People had their own rooms and access to communal bathrooms, lounge and dining room. There were enclosed, secure gardens accessed on the ground floor.

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

People’s medicines were not always being managed safely. Whilst staff received training on administering medicines, we found they were not always following the provider’s medicines management policy.

Risks to people’s safety were not being managed robustly which put people at risk of harm. Incidents between people living at the service had not always been reported appropriately to the local authority safeguarding team. It was not clear what action had been taken in response to incidents to mitigate risks and prevent reoccurrence.

Staff had not been recruited safely. The required pre-employment checks had not been carried out. The registered manager took immediate action to address this.

A new registered manager had started prior to our inspection. They had identified some shortfalls such as poor incident management and had taken steps to carry out improvements. However, quality monitoring and governance systems at the service were not robust or effective and had not identified shortfalls found during this inspection.

Systems were not in place or established to continually monitor practice and make sure staff were working safely. Systems had not identified shortfalls in people’s records or shortfalls in staff recruitment records to make sure the provider had accurate oversight of the service.

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.

People and relatives all told us they were happy living at the service. Despite the shortfalls people appreciated the staff approach and told us there were enough of them. Relatives were able to visit, and we observed family members visiting people during our inspection.

Staff wore personal protective equipment and there was stock available around the service. Staff had received training on infection prevention and control and guidance was in place to work safely. Posters were up on walls at the service to demonstrate good hand washing techniques and to give guidance on COVID-19.

The home was clean, and people told us they were happy with the cleanliness of their rooms. We identified two areas which required repair which we shared with the provider. They told us they would take action to address the concern.

Staff had training on safeguarding and told us they would not hesitate to report any concerns. Staff were able to have meetings to discuss ideas or share concerns. Staff told us the new registered manager was approachable and visible at the service. People and relatives also told us they knew who the registered manager was and felt able to raise any concerns.

People’s health needs were met by local healthcare professionals. During our inspection we observed one healthcare professional visiting who told us they had no concerns about the care delivered.

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 11 August 2018).

Why we inspected

We received concerns in relation to incidents of safeguarding taking place but not being managed or reported to the local authority, records not being completed and people living with dementia not having the right support when they were distressed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

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 in relation to medicines management, risk management, incidents and accident reporting and quality monitoring at this inspection. Please see the action we have told the provider to take 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.

We found the following examples of good practice.

Stocks of PPE exceeded current government guidance levels. PPE stations had been established throughout the service to help ensure staff had access to it when required.

People who did not feel comfortable with face masks use visors instead.

Clear procedures and risk assessments for people, staff and visitors had been developed to maintain good practice in relation to infection control and to provide safe care.

Due to an outbreak, people tested covid-19 positive were isolated in their rooms. No visitors were admitted at the time of our inspection with the exception of end of life visits.

An extra member of staff was brought in to assist people who tended to walk around. This action aimed to prevent mixing of the residents.

Changes had been made to the home environment to help promote social distancing. Furniture in the communal areas had been arranged to provide more space and ensure people were seated at a safe distance.

There was a testing programme in place for staff and people living in the service. Staff were being tested weekly and people living at the care home monthly.

Staff training in infection control and personal protective equipment (PPE) was up-to-date. Staff were observed wearing PPE correctly. Regular checks of staff practices were carried out.

The provider had appropriate infection control policies and procedures in place. These had been developed in line with current government guidance and fully implemented in the service.

Dauntsey House accommodates 21 people in one adapted building, some of who are living with various degrees of dementia. At time of the inspection there were 21 people living there. Dauntsey House has 19 single and double bedrooms spread over two floors with access to a communal lounge, dining room and conservatory on the ground floor.

The inspection took place on 6 and 7 March 2018 and was unannounced.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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, relatives and visiting professionals spoke very highly of the care people received at Dauntsey House. People told us they felt safe and appeared comfortable around staff.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring.

People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. At all times during the inspection, staffing levels meant people were well supported.

There were safe medicine administration systems in place and people received their medicines when required. Only senior staff who had received medicines administration training and had been assessed as competent, were able to administer medicines.

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.

Staff told us they were able to provide unrushed care and were able to spend time talking to people.

Staff showed concern for people’s wellbeing in a caring and meaningful way, and they responded to their needs quickly. People told us they were able to make choices about their daily routine.

Care, treatment and support plans were personalised. The examples seen were thorough and reflected people’s needs and choices. We saw care plans included background history and what was important to people, for example what careers people used to do and what hobbies and interests they had.

Complaints and concerns were taken seriously and used as an opportunity to improve the service. People and their relatives were given information on how to make a complaint, however relatives told us they had not needed to make any complaints.

There was an active programme of entertainment and activities daily. We observed people taking part in singing and dancing. Dauntsey House had a busy and happy atmosphere.

Staff spoke positively about management and told us they felt supported. The registered manager also told us they valued their staff team. Relatives said the manager’s door was always open.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

One person living at the home said 'staff are so nice, there is never any difficulty, they are always willing to help'. One person's relative said 'it's first class, they are good at encouraging people to interact with activities in the home and locally'.

There were effective systems in place to reduce the risk and spread of infection.

There were enough qualified, skilled and experienced staff to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People had clear care plans, which staff followed. All people's care plans had been agreed with them. Care plans were updated when people's needs changed. Staff knew about people's individual needs in detail.

Staff told us they were trained to carry out their roles, including safeguarding vulnerable people. Staff said they felt supported in their roles. A care worker told us the new manager 'listens to what we say.'

The new manager was working through action plans to improve the home environment. These plans had started with the kitchen and would now move on to other areas, such as developments to the call bell system.