Down House

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People felt safe and were protected from the risk of harm and abuse. Systems kept people safe. There was a safeguarding policy, staff had safeguarding training and told us how they would report any concerns. Staff said they were confident all concerns would be dealt with appropriately. Risk assessments were completed to promote independence and minimise risks to people.

Where people did not have capacity, all necessary actions had been carried out under the Mental Capacity Act including making applications under the Deprivation of Liberty Safeguards (DoLS). Keypad locks on exits prevented those people who lacked capacity from leaving the home without an escort. However, we saw people who did have capacity going out of the home whenever they wished.

Care and treatment plans provided guidance to staff to keep people safe. However, some people had not been involved in their care planning.

People’s medicines were well managed. However, one person had not had their pain relief needs met in a timely manner, and they did not have a plan for the administration of their pain medication.

The provider assessed the overall demand of the needs of the patients as a group to ensure they were providing adequate staffing. This service had a high proportion of people with high levels of nursing and care needs and staff were under pressure. However, we found there were sufficient numbers of safely recruited staff on duty, who had received appropriate training, to meet people’s needs.

Incidents and accidents were reviewed and investigated by the manager and the management team. They reviewed individual accidents and incidents to check all necessary action had been taken to make people as safe as possible.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they had moved into the home in a satisfactory way. Any issues with transfers into the home were due to issues in the health system and not due to any practice from the care home.

Many of the people using the service had been discharged directly from the nearby hospital as they needed continuing nursing care. Managers told us they trusted the hospital to give them a complete assessment of the person’s needs enabling the service to make an informed decision as to whether they could provide the care needed. Managers told us they had a working relationship with other parts of the health and social care system but at times relationships had been strained because of the pressures within the system.

We previously received negative feedback on the quality of this service from local partners within the health and social care system due to concerns that had been raised by relatives. However, during the assessment partners told us they feel the service has improved and was providing satisfactory care and support.

There were established systems to work with other parts of the health and social care system and well established links with the local hospital.

People were safeguarded from abuse and avoidable harm. People we spoke with said they felt safe living at the service. People and their relatives knew who to speak with if they had concerns. They told us managers and staff were approachable and would listen to any concerns. People’s human rights were respected. The service was working within the principles of the Mental Capacity Act 2005. We saw staff supported people to make as many of their own decisions as possible. Staff knew about people’s capacity to make decisions.

Staff had a good understanding of how to protect people and all said they would not hesitate to raise a safeguarding alert if they suspected abuse.

We observed kind and respectful interactions between people and staff. We did not observe any care that would lead us to believe that people were not safe.

Staff received safeguarding training to help them understand and identify possible signs of abuse and the appropriate action to take. The provider’s safeguarding policy gave guidance for staff about how to raise a safeguarding alert. When people had been assessed as lacking mental capacity to make a certain decision, assessments and decisions about the person’s mental capacity were recorded. Where needed, appropriate legal authorisations were in place to deprive a person of their liberty.

Some people told us they were not involved in the assessment, care planning and risk assessment of their needs. One person told us they had not had their medicines discussed with them and they would like to know what they were receiving and to discuss their treatment plan.

Service managers agreed that some people had not been involved in discussions about their needs and planning of their care or treatment.

People were supported by staff who knew them well. During the inspection we observed staff supporting people safely in a kind and caring manner.

Service managers agreed people and their relatives should be involved in discussions about people’s needs and their care and treatment, however, this was not always taking place.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people told us there were not enough staff and the staffing level was overstretched to meet peoples’ needs. However, we observed good numbers of care staff available to meet people’s needs.

Some staff told us they felt stretched to meet peoples’ needs. We were told some days could be very busy and people would have to wait but that people’s support was never rushed. Managers felt there were enough staff but that sometimes it was very busy. One staff member said, “There are some mornings where it can be manic, but no-one gets left behind and even if personal care is delayed it gets done”.

A period of recruitment had taken place and management felt they now had a full staff team. Newer staff members told us they were well supported in their training. One staff member said, “I think the training is good. When I first started, I was really well trained and if I am ever unclear I will check with someone.” Managers said they had developed a stable staff team at the home with low staff turnover at the time of our assessment.

During the assessment there were appropriate numbers of staff to meet peoples’ needs. However, we saw and heard about occasions when peoples’ needs were not met as quickly as they needed to be, and the level of engagement that some people were getting with staff was low.

Approximately half of all the people using the service had needs assessed by the service as high and another quarter as medium level. Peoples’ needs as a group were high and therefore the staff were inevitably under pressure to meet everyone’s needs immediately all of the time. We saw there was a ratio of approximately one care staff to 4 people in the morning and 1 care staff to approximately 5 people in the afternoon and evening. We assessed that there were enough staff, but they would be under pressure due to the high level of dependency at the service.

Staff received adequate training, and nurses were given time to complete their revalidation training. Staff were supported by regular individual supervision meetings with their line manager.

People’s feedback was positive and did not highlight any concerns with the cleanliness of the service. However, a relative said the cleaning in the service increased after our visit.

Staff told us they had access to Personal Protective Equipment (PPE to minimise the risk of cross contamination. One staff member said, “we wash our hands after every care task, and we use PPE and we have cleaning equipment”.

We observed all communal areas were clean. We observed PPE was available around the home. Staff were wearing PPE, both aprons and gloves, while carrying out tasks. However, we observed a soiled laundry sack was open on a cleaning trolley in a corridor. We also noted clean medication pots were left to dry on an open corridor radiator outside one of the medication storage rooms. These were removed as soon as we raised the issue. These were not best hygiene practices.

The service had an infection, prevention and control policy and specific cleaning staff were employed to ensure the home remained clean.

People told us they were happy with how staff supported them with their medicine. We saw people were being administered their medication with respect and compassion.

However, we saw one occasion when ‘as required’ pain relief was not delivered to a person quickly enough to relieve their pain. There was also no plan for the delivery of this medicine.

People received their medicines from staff who had received appropriate training. Medicines were administered by the nursing staff who were present in the home all day and night. There were appropriately trained staff always present to make decisions to administer ‘as required’ medicines. Staff member’s ability to administer medicines was checked by the service to ensure they were competent.

Medicine administration records were complete and accurate. We saw medication storage facilities in different parts of the home. We checked for medication administration planning and found that ‘as required’ medicines plans were kept with medication administration records and were generally up to date and complete.