Deepdene Court

Deepdene Court is a residential care home providing personal and nursing care to up to 35 people. The service provides support to people with a range of mental health needs, including complex and enduring conditions or addictive behaviours such as substance misuse. At the time of our inspection there were 34 people using the service.

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

People did not always follow the provider’s smoking policy and smoked within the premises putting themselves and others at risk. The registered manager and staff were aware of the disregard to the policy and had reiterated the policy to people at various meetings; however, a robust assessment of risk had not been completed to identify all risks and implications.

Checks and audits did not always highlight where some areas of the service required deeper sanitation. Where areas were identified as requiring deep cleaning, actions to address these were not always followed through. Some communal spaces were not included on the infection control audit and needed attention.

People told us they felt safe and could speak with staff or management if they have any concerns. A person told us, “I feel well cared for and safe.” Staff understood their roles and responsibilities to escalate any safeguarding concerns with the management team or to external bodies, such as, the local authority and CQC. People were given information to enable them to raise any concerns if required, both internally and externally.

People and staff gave mixed feedback about staffing levels. Comments included, “Yes, there is definitely enough staff, they are always available, and at night as well,” and, “Sometimes it can be a bit low on staff.” We observed enough staff supporting people and spending meaningful time with them. Staff were recruited safely, following recruitment they completed an induction period which included shadowing an experienced member of staff. Staff were trained to administer medicines, storage and record keeping of medicines were completed in line with current guidance.

People’s mental and physical health needs were assessed. People’s support plans detailed signs to watch out for in the event of a relapse in mental health. These were person-centred and included the level of support people required and how much staff intervention was appropriate depending on the circumstances. A person told us, “Staff are very supportive. They do activities with us, take us out for coffees. They comfort you if you are having a bad day.” We observed staff responding to an incident well with a person-centred approach during our inspection.

People contributed to their support plans and received person-centred care tailored to their needs. People were regularly asked for feedback and were listened to. People gave feedback through surveys, a suggestion box, at keyworker meetings and house meetings. The registered manager displayed a ‘you said, we did’ board which detailed people’s ideas and the outcome.

People were complimentary about the registered manager as they knew people using the service well and built trust with them. Comments included, “I know the manager, they’re very good, it is well run,” and, “The manager is cool.” Staff gave positive feedback about the registered manager, a staff member told us, “[Registered manager] is great, very supportive, gets heavily involved with the residents, couldn’t ask for better really.”

The registered manager was keen to develop themselves and staff to continually improve people’s experience of care. They worked alongside a regional manager and met with managers of the provider’s other services to share ideas and mutual support. The management team gave examples of lessons learned within the services and changes made to improve people’s support.

People had access to health and care services, visiting health and social care professionals mostly gave positive feedback about the service. We were told, “If we suggest something they are good at taking it on board and implement it,” and, “I can see theoretical downside, I know they are a large service with many complex people with differing support, but they manage it very well.”

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 18 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and following a review of information we had received from the service. A decision was made for us to inspect and examine those risks. 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 Deepdene Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to assessing and managing risks, infection prevention and control, and governance 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.

Deepdene Court is a residential care home registered to provide care and accommodation for up to 35 people who have a range of mental health needs, including people who have complex and enduring conditions or addictive behaviours such as substance misuse. The home is divided into two buildings, St Catherine's and Fielding's. St Catherine's accommodates people who also require nursing care. On the day of the inspection there were 31 people living at the home.

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

Risks to people’s health and safety were assessed and people were supported to stay safe. Care and support plans were person-centred, promoted independence and provided staff with clear guidance on how to support people. Staff were aware of their safeguarding responsibilities and knew how to report and escalate concerns.

Risks were appropriately reported by staff, investigated by the managers and action taken to mitigate risks and reduce the risk of reoccurrence. The manager and staff worked to maintain a safe and homely environment for people. Infection prevention and control practice was safe and in accordance with government guidance.

Medicines were managed safely and people received their medicines as prescribed and in the way they preferred. People prescribed as required medicines (PRN) had detailed care plans to guide staff when PRN medicine should be administered.

The service had experienced some issues with staffing levels due to the global pandemic. Although the service continued to have vacancies, the manager was in the process of recruiting new staff. Agency staff were used to ensure there was a safe level of staffing to meet peoples needs. Staff had completed appropriate training relevant to the needs of the people they were caring for.

Staff knew people well and showed in depth knowledge and understanding about people and their care. People spoke warmly and positively about staff. One person told us, "The staff here are really friendly", another described staff as, “kind and caring”. One staff member said, "We all know how difficult it can be living with mental illness, we want to support people. The job doesn't stop here for a lot of us, I've gone above and beyond to support people."

People and staff spoke positively about the manager and senior staff team. There were effective management systems in place to monitor the quality of the service. When shortfalls were identified, changes were made to improve. Accidents and incidents were analysed to learn from and drive improvements throughout the service. Staff had established close links to the community and worked effectively with external teams and agencies.

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 02 November 2017).

Why we inspected

This was a planned, focussed inspection based on the previous rating.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

Deepdene Court is a residential care home registered to provide care and accommodation for up to 36 people who have a range of mental illnesses, including people who have complex and enduring needs as well as substance misuse needs. The home is divided into two buildings, St Catherine's and Fieldings. St Catherine's accommodates people who also require nursing care. On the day of the inspection there were 34 people living at the home.

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

People were supported to make choices about how they lived their lives. People were able to access the community when they wished were encouraged to follow current COVID-19 guidance by wearing face coverings. People told us that they could talk to staff and that they felt safe living in the home. Staff were respectful of people’s choices and rights. Care and support documents were detailed and written in a person-centred manner.

Safeguarding concerns had been appropriately identified and escalated in line with the provider’s policy. Staff had a good understanding of safeguarding and the processes they followed.

The manager confirmed that the service had been experiencing challenges which had impacted on the delivery of care. The manager had been supported by the provider and they had a detailed action plan that they were working through. This had identified areas to improve, this included the management of medicines. People were being supported to have medicines in accordance with guidelines, however, information about medicines that people have as and when required (PRN) was not detailed. This increased the potential risk that people might not receive PRN medicines when needed. We did not find any evidence that harm had occurred and were assured by the measures the provider had put in place in response to this feedback.

We looked at Infection Prevention and Control as part of this inspection and observed staff not always wearing masks in accordance with the current guidelines. We informed the manager who addressed this with the staff concerned. The service had staff who were responsible for maintaining the hygiene of the home, we observed them showing a good awareness of the need to maintain records along with understanding the need to manage chemicals safely.

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 24 October 2018). The overall rating for the service has not changed following this targeted inspection and remains good.

Why we inspected

The inspection was prompted in part due to concerns received about risks to people’s safety, medicines and infection control. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We have found evidence that the provider needs to make some improvement. Please see the Safe sections of this full report.

The provider had identified areas in need of improvement as part of its internal auditing process and had an effective action plan that was mitigating the risks it had identified. This inspection identified further actions around Infection Prevention Control (IPC) that the provider had acted on following this inspection to mitigate risks.

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

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

The home had a registered manager who was present throughout the 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.

At the previous inspection on 21 and 23 June 2016, the overall rating for the service was Requires Improvement. We found a number of areas of practice that needed to improve and one breach of regulations. This was because the provider had not ensured risks to people were fully assessed and action taken to mitigate those risks. The provider sent us an action plan explaining how they would meet the requirements of the regulations by 30 November 2016. At this inspection we found that they had taken actions to address the breach of regulations and the quality of the service had improved.

People told us they felt safe living at Deepdene Court. One person said, “It is safe here, they look out for us.” Another person told us they felt “protected,” by the staff. Risks to people were assessed and managed to support them to stay safe. Staff demonstrated a firm understanding of their responsibilities with regard to safeguarding people. One staff member said, “Anything at all that was worrying I would report to the nurse on duty or to the manager.” People’s medicines were managed safely and people were protected from risks of infections. There were enough staff on duty to care for people safely and there was a calm atmosphere in the home. The provider had robust systems for recruitment and staff had a thorough induction before starting to work with people. Incidents were recorded, monitored and analysed to support development of the service.

Staff received the support they needed and training was relevant to the needs of the people they were caring for. There were effective systems in place to support communication between staff and with other professionals involved in the care of people at the home. Feedback from professionals described positive partnership working with staff at the home. People were supported to access health care services when they needed to.

People’s needs and choices had been assessed in a holistic way to include consideration of all aspects of their life. Risk assessments and care plans reflected people’s diverse needs including their cultural needs and religious beliefs. People spoke highly of the food provided at the home and we observed that the lunch time meal was a positive social experience for people. Staff supported people and offered choices including about when and where they wanted to eat. Specific dietary needs or preferences were accommodated.

Staff demonstrated a firm understanding of their responsibilities with regard to the Mental Capacity Act 2005. Consent was sought before providing care and where people lacked capacity to make specific decisions mental capacity assessments and best interest decisions had been recorded in line with the legislation and guidance.

People spoke highly of the staff at the home their comments included, “They are all very helpful,” and, “They are really kind and they do a good job.” Staff treated people kindly and respected their right to privacy. Staff had developed positive relationships with people and knew them well. Staff spoke compassionately about people, one staff member said, “I know about certain events that had a real impact on them, they tell me about things and I know the signs when they are low.” People told us they had been included in developing their care plans and records showed people’s views and preferences were reflected. Staff supported people to remain as independent as possible. One staff member said, “The idea is that we support people, enabling rehabilitation and recovery so they can move on. We might help them with some things but it’s about encouraging them and keeping them motivated towards their goals.” People who had communication needs were supported to access information that they needed.

People’s care plans guided staff to provide care in a personalised way. Staff were able to tell us about numerous small details that demonstrated that they knew people well and we observed that people were receiving care that was personalised according to their needs and wishes. People were supported to make plans for their future including for end of life care. Staff recognised when changes indicated a decline in people’s mental or physical health and took appropriate action to adjust care or to seek advice from health care professionals. People told us that they knew how to make a complaint and were confident that their concerns would be listened to.

People spoke positively about the registered manager. One person said, “The manager is brilliant,” another person said, “They are very good.” Staff said that the home was well run and described clear management structure and visible leadership. The aims and objectives of the service were embedded within staff practice and staff demonstrated a clear understanding of their roles and responsibilities. There were effective management systems and processes in place to monitor the quality of the service. The registered manager used analysis of incidents and accidents to learn and drive improvements. Staff had developed positive links with the local community and worked effectively with other agencies.

Deepdene Court is registered to provide care and accommodation for up to 40 people who have a range of mental illnesses, including people who have complex and enduring needs as well as substance misuse needs. The premises were divided into two buildings: St Catherine’s and Fieldings. We identified the service’s registration details did not match the facilities as set out in the service’s Statement of Purpose which said the service could accommodate up to 36 people. This was also different from what the registered manager said, that St Catherine’s accommodates up to 18 people who may require nursing care and Fieldings up to 17 people. We discussed this with the provider who agreed that they needed to amend their registration details with the Commission to ensure it reflected the correct number of people they could accommodate. At the time of the inspection there were eight people living in St Catherine’s and 14 in Fieldings.

Each of the two properties had communal lounges and dining areas as well as gardens which people used. All bedrooms were single and all bedrooms in St Catherine’s had an en-suite bathroom and four had this facility in Fieldings. The home had a staff team of 20 care staff and eight registered nurses plus additional staff for cleaning, maintenance and cooking.

The home had 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection report for an inspection on 2 and 4 February 2015 made two requirements where we found breaches of the regulations:

• Measures to fully protect and safeguard people were not always in place

• The premises were not adequately maintained in Fieldings

The provider did not submit an action plan to say how and when these requirements would be met. An action plan was submitted after two further requests by the Commission, and more than nine months from the initial request. The shortfalls we found regarding measures to protect people have been addressed but we found risk assessments and care plans to protect people were often incomplete, unclear or absent.

At this inspection we found many improvements had been made to the environment and there were further plans to repair and refurbish bedrooms and communal areas.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care. However, we found where people lacked capacity to consent to their care and treatment this was not fully assessed. An application had not been made to the local authority for a DoLS where someone was not free to leave the premises, did not have mental capacity and expressed a wish to leave . This was addressed immediately by the registered manager; by the second day of the inspection mental capacity assessments had been completed where people did not have capacity and DoLs applications made to the local authority where needed.

People told us they felt safe at the service and health and social care professionals reported that staff took action to report any concerns to them including those subject to supervision under the Mental Health Act 1983 and other statutory orders. Staff were aware of safeguarding adults procedures and their responsibilities to report any concerns they had.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People’s medicines were safely managed and guidelines were recorded when staff needed to support people with medicines they needed on an ‘as required’ basis.

People told us they were supported by staff who were well trained and competent. Staff had access to a range of relevant training courses and said they were supported in their work. These included training in specific care needs such as epilepsy and mental illnesses. We found staff were not trained in some care needs related to the needs of the older people at the service such as in nutrition and pressure area care where people were at risk of damaging their skin due to prolonged immobility.

People were supported to eat and drink and to have a balanced diet. There was a choice of food and people said they liked the food. Meals were nutritious and fresh fruit and vegetables were provided. Special dietary needs were catered for. Nutritional assessments were not always completed in full; this meant staff may not have sufficient guidance to support people to have enough to eat and drink.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

Staff treated people with kindness and had positive working relationships with people. People were consulted about their care and said they were listened to. Staff acknowledged people’s right to privacy and people were supported to develop independent living skills. People said staff treated them in a way which did not stigmatise those with a mental illness.

Care needs were reassessed and updated on a regular basis. Care plans were completed for each person and reflected how people liked to receive care. There was an activities coordinator who engaged people in activities such as going out in the community.

The complaints procedure was available in the home. A record was made of any complaints along with details of how the issue was looked into and resolved.

People and staff described the registered manager as “friendly” and approachable as well as being a good and responsive leader. Staff worked with people in a way which promoted people’s rights and was person centred. The registered manager and staff encouraged people to communicate with them regarding the running of the service.

A number of audit tools were used to check on the effectiveness of care plans, medicines procedures, and, the environment.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with two people who were accommodated there. They told us they were very satisfied with the care and support provided. They also told us the care staff were able to provide the support they needed. One person said, 'I can do what I like. I can have my friends and family to dinner. I can go out when I choose. I am quite happy, thank you!'

People we spoke with informed us they were satisfied with the standard of cleanliness of the premises. One person said, 'It's a very clean home.' Another person observed, 'Its alright, the cleaning is done regularly.'

We also spoke with three members of staff who were on duty. They demonstrated they were knowledgeable with regard to the needs of identified people and the levels of support each person required to meet them. They also confirmed they had been required to undergo an interview and that appropriate checks had been made about them before they were appointed.

The atmosphere throughout the visit was good. It was calm, friendly and homely. Care staff were observed to have a good relationship with the people living there. When talking to people, they were friendly and professional.

We also noted care staff on duty provided support skilfully, sensitively and competently.

The registered manager had resigned since our last visit. The new manager had yet to submit an application to register with the Commission.

People we spoke with confirmed they have been satisfied with the care provided. One person told us, 'This place is better than the last home I was at. The staff give me the support and assistance I need."

People we spoke with confirmed that they believed care staff were competent and skilled when delivering the care and support people they needed. One person told us, "The staff are okay. They are not too bad. They help me when I am feeling anxious." From observation we noted provided staff support skilfully, sensitively and competently.