This inspection was carried out on 24 September 2015. Dene Place provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 30 people. On the day of our inspection 24 people lived at the service. The accommodation is arranged over two floors.
There was a registered manager at the service on the day of 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.
There was not always enough staff deployed around the service to meet people’s needs. People were at times left for long periods of time without support from staff. People did not feel that there was always enough staff. One person said that there were usually enough staff but said that on the day of the inspection they seemed short staffed.
Staff did not always have the knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Safeguarding referrals were not always made to the local authority where necessary. However people did say that they felt safe with staff.
Risks were not always managed appropriately for people around concerns that had been identified. Accidents and incidents were not always recorded to identify any trends or minimise reoccurrences. Other risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm.
Staff were not always knowledgable about their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes.
Staff were not kept up to date with the required service mandatory training or supervisions and there was a risk that people were not receiving the most appropriate care from skilled staff. However staff told us that they felt supported in their roles.
People’s nutritional needs were not always being monitored appropriately in relation to referrals to health care professionals. Other aspects of food and nutrition were good. One person said “The chef is great, they would do anything for me” Nutritional assessments were carried out as part of the initial assessments when people moved into the home.
There were occasions where staff were not as caring as they could be and did not always treat people with dignity. However people and relatives felt that staff were kind and caring. One person said “Staff seem to care about me, they check I have washed and help me with my clothes.” We observed some kind and caring interactions with staff and people.
People’s records did not always include sufficient information to enable staff to provide appropriate care and support. Whilst we were at the inspection we identified that people had not always had the most appropriate care for their needs. We found that not all of the records at the service were accurate and complete for each person.
There were no effective systems in place to ensure the quality of the service. Audits did not always identify the shortfalls in the service.
People said that they understood what medicines they were receiving. Medicines were stored appropriately and audits of all medicines took place. People received their medicines appropriately.
In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and made them safe.
People were safe because the provider carried out the necessary checks on staff to ensure that only suitably qualified staff were recruited to support the people that lived here.
People had access to other health care professionals in a timely way. For example the GP, opticians, community dentist and physiotherapist visited the service.
People told us that before they moved in the manager undertook a pre-assessment of their needs. One person told us that they were visited at home by the manager (with their family present) to assess their needs.
People and relatives said they felt involved in the planning of their care. One person told us that they were very much involved and they also chose to have their family involved as well. Relatives told us that they felt involved in the planning of care for their family members.
There was a complaints procedure in place for people to access and people knew how to make a complaint. One person said “If I wanted to complain I would tell the care assistant or the manager.”
People and relatives were complimentary of the activities that were on offer. One person said “The activities are great.” There was a wide range of activities on offer for people which included room visits for people, hand bells, musical workshops, manicures and crosswords However people told us that they would like to go out more on day trips but that this wasn’t always possible due to the service not having a vehicle.
People and staff felt supported by the manager. One member of staff said “I find her very approachable, everyone gets on well here.”
The registered manager had informed the CQC of significant events in a timely way. This meant we could check that appropriate action had been taken.
During the inspection we found breaches 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 the report.