Down House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s assessed health and personal care needs were not always well met by the service. The care home supported mostly people with a higher level of nursing needs and the service was challenged by this intensity of demand.

When people lacked capacity to make a specific decision the service had a process to ensure Deprivation of Liberty Safeguards (DoLs) and Best Interests decisions were made effectively so people’s rights were protected.

Everyone had a care plan but we observed some were inaccurate or incomplete. Some people wanted to know more about their assessed needs, medication and the plan of their care, as some people had not been included effectively in the care planning process.

People’s needs were not always well met, with a lack of social engagement and stimulating activities for people to take part in.

The layout of the building, and that many people stayed in their rooms, meant staff did not address everyone’s needs frequently, thoroughly and without delay. Some people’s care needs and health needs were not being monitored enough as they spent all or most of their time in their rooms and so the number of interactions they had were fewer. However other people were being monitored more than necessary, for example, recording all their food and fluid intake when this was not needed.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had a care plan, but some people did not know what information it contained. We saw everyone had a care plan based on an assessment made by the service or from an assessment made by a trusted discharge coordinator within the local acute hospital. However sometimes these care plans were incomplete. For example, we noted one care plan was inaccurate and did not have a plan to assess the need for pain relieving medication.

People’s need for social engagement and stimulating activities had not been well assessed and therefore was not being addressed in care planning.

We raised issues with the lack of meaningful activities during our assessment. The manager accepted this and had begun a survey of people’s preferences for activities. Managers said they intended to fully address this issue using all available resources.

The care planning system was comprehensive but there were occasions when care plans were not fully up to date and social, emotional and stimulation needs had not been adequately assessed.

People using the service had high dependency nursing needs, their needs changed frequently, and reviews of care plans were not happening often enough to ensure care plans remained accurate and up to date. Communication processes with people and their relatives did not ensure that they always knew what support was being delivered to the person.

Most people told us they felt their quality of care was good and staff were doing their best to meet their needs. However, we saw after 10.00am some people were sitting in soiled clothing, had not been shaved, and one person had not had the plates given the night before taken from their room.

People with capacity were able to exit the building on their own without restriction . Some of these people smoked and needed to go outside the building to have a cigarette. We saw a small number of mobility scooter users gathered in a corner outside the building in the rain. There was no shelter or hospitable facility for people to use outside the building to smoke in.

Managers of the service told us the service was doing as much as they could to address people’s needs as quickly as possible. Staff told us they had review meetings with people weekly to talk about their care and what they needed. However, some people’s experience did not support this.

The service provider told us further investment in the facilities at the service would not be possible until 2025. However, this did not impact day to day maintenance of the facilities.

Records showed, and staff confirmed, they received training updates in subjects such as safeguarding and moving and handling. Staff had been trained in best practice in delivering care.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We found people were not experiencing enough contact with other people and staff, often staying in their rooms on their own for long periods of time. Stimulating group or individual activities for people were limited and the largest communal lounge was largely unused. There were limited opportunities to socialise and take part in activities being delivered in the dining room.

Some staff were not able to speak confidently about the care they delivered. Due to the overall dependency level within this nursing service the service had become more task focused. When the need for more social contact and stimulating activities was raised to the acting manager, they recognised the importance of this to prevent people becoming socially isolated. Immediate action was taken by the acting manager to find out people’s social needs and preferences so that activity could be delivered that would interest them and they would find enjoyable and encourage them to leave their rooms.

People were generally supported to see appropriate health and social care professionals when they were needed to meet their healthcare needs. We saw evidence of health and social care professionals’ involvement in people’s individual care on an on-going and timely basis. For example, GPs, community nurses and social workers. These records demonstrated how staff recognised changes in people’s needs and ensured other health and social care professionals were involved to encourage health promotion. However there were occasions when people were unsure that their appointments with health professionals outside the home would be made and supported.

Some people did not see staff often enough and on occasion this meant people did not get their health needs responded to quickly enough. For example, a person was left in severe pain without staff being aware of their need for pain relief medication. Another person complained they had inappropriate pillows to meet their nursing needs, and they were not repositioned in bed often enough as they could not do this by themselves.

Some people told us their need for external health contact was not always well supported by the service. For example, one person told us they weren’t sure they would be supported with a hearing test appointment. They wanted an occupational therapy appointment to discuss their own wheelchair. They were concerned they were missing follow up outpatient appointments in the hospital.

Managers told us staff did see people often enough to meet people’s needs. However, it was evident that some people needed more frequent contact and greater administrative support from the service to address both their immediate needs and to support their general health needs where external health resources were needed.

Managers told us nurses only sometimes visited people in addition to the medication administration rounds during the day. Therefore, the service’s nursing staff who administered all daytime medication, were potentially unaware if someone needed PRN medication between medication rounds. The service managers told us they would ensure nursing staff were aware of people’s pain levels and would respond quickly to address these as necessary.

The structure of the care home building with one long ground floor corridor leading away from the main building, and the main building bedrooms being widely dispersed over multiple floors, meant staff struggled to see people frequently enough to monitor their wellbeing. It was difficult to monitor everyone’s needs effectively when almost all people spent time in their own bedrooms.

People’s food and fluid intake was monitored and recorded. However, some people did not need to have their fluid and food intake monitored in this way as they had a stable weight. They needed less intrusive monitoring of their health needs.

All care staff on duty had handheld devices to enable them to record all their actions and people’s well-being directly onto care records. We were told these were about to be upgraded so staff would be able to contact staff elsewhere in the building. This meant assistance to meet people’s health and welfare needs may be more easily delivered in future.

People were seen being offered choice to consent when staff prepared to carry out tasks with them. We saw some people’s views and wishes were taken into account in the delivery of their care. However, some people told us hey had not been involved in, and therefore did not understand, their care plan.

The needs of people with dementia were not being well met due to the lack of stimulating activities.

Managers at the service told us people were asked if they consented to their care tasks. They also told us mental capacity was assessed and applications for Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 (MCA), were made routinely. We saw a comprehensive and accurate list of all those who required a DoLS to be in place to protect their rights, which detailed when applications had been made, and when approved.

Risk assessments were used to ensure people’s safety, and to protect people’s rights under the MCA.