Dean Wood Care Home

We found the following examples of good practice.

The service had appropriate procedures in place for visiting, including checking of COVID-19 passports for visiting professionals.

The registered manager has facilitated visits for people safely and regularly during the pandemic.

The service was clean and tidy throughout. There were robust cleaning schedules inclusive of high touch point areas, to promote safe infection control practices.

Staff had received all appropriate infection prevention and control training. This included the correct use of personal protective equipment (PPE), and donning and doffing safely. Staff were observed to be wearing PPE correctly.

The registered manager had managed risks to people from outbreaks through appropriate isolation and separation of areas within the service.

Dean Wood Care Home belongs to the large corporate organisation called Bupa Care Homes (CFChomes) Limited. Bupa provide nursing care services across England and have several nursing homes within the local area.

The service had a registered manager in place. 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 last inspection undertaken on the 13 and 14 September 2016 areas of improvements were found in relation to staff morale, lack of staff supervisions and further work required to embed the provider’s audits and action plans. Recommendations were made and at this inspection, we found improvements had been made. However, we identified new areas of care that needed improvement.

Systems and processes were in place for the provider to monitor compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014. Audits were undertaken on a regular basis and the provider was able to demonstrate how audits were utilised to drive improvement. However, the provider’s internal quality assurance framework was not consistently robust and further work was required to strengthen the provider’s internal quality assurance checks. For example, shortfalls and omissions with documentation had not consistently been identified as part of the provider’s internal quality assurance framework. We have identified this as an area of practice that needs improvement.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the service and people were encouraged to maintain relationships with family and friends. One person told us, “I’m very happy, I’m having a ball.”

People were protected, as far as possible, by a safe recruitment system. Staffing levels were based on an assessment of people’s individual care needs. Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people's freedom had been submitted. Staff had received training on the Mental Capacity Act 2005 (MCA) and worked in line with the principles of the Act.

People spoke highly of the food and said that they were able to make choices about what they had to eat. People received enough to eat and drink and risks associated with nutrition and hydration were managed effectively. People were supported to access the health care services that they needed.

The management of diabetes and catheter care was effective. Staff felt supported within their roles and staff morale had improved. The management team were dedicated to ensure staff’s and people’s voice was heard and acted on. Forums were in place for people and their relatives to give feedback on the running of the service.

People received care and support that was responsive to their needs. Care plans provided information on people’s day to day care and people participated in a wide and varied range of activities. Regular outings were organised and people were encouraged to pursue their interests and hobbies.

Systems were in place for the safe storage, administration and disposal of medicines. People told us they received their medicines on time and in their preferred manner. A complaints policy was available and people and their relatives felt confident raising any concerns.

People were treated with dignity and their rights and choices were respected. Observations showed people being treated in a respectful and kind manner. People's privacy was maintained; when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy was maintained. People’s religious, sexual and spiritual needs were respected and upheld.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas, however we identified further areas of practice that needed improvement.

Dean Wood Care Home is registered to provide accommodation and care, including nursing care for up to 80 people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is located in Woodingdean, East Sussex in a residential area. There were 77 people living at the service on the days of our inspections.

A registered manager was in post, however at the time of our inspection they were on planned leave. 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 and associated Regulations about how the service is run. Day to day charge of the home was taken by a support manager and the deputy manager, to provide consistent management cover until the registered manager returned to post. They are referred to as the manager in this report.

A formal supervision strategy for staff was yet to be fully established, as was a clear structure of one to one supervisions, as to who provides them and is accountable for them to be implemented. This issue had been identified through the providers own quality monitoring processes and systems have started to be put in place. However, this needs to be embedded, to ensure that the provider’s policies and good practice guidelines are being implemented.

The culture and values of the provider were not embedded into every day care practice. We received mixed feedback from staff in relation to whether they felt supported within their roles, and being able to approach management with issues and concerns. Mixed feedback was also received in relation to staff morale and feeling valued in their role.

Daily records used to monitor the assessed levels of air mattresses to help prevent pressure damage contained gaps in their recording, or were missing. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, the provider was unable to identify the specific actions from these audits and could not demonstrate improvement or impact for people over time.

The above issues have all been identified as areas of practice that need improvement.

People told us they were happy living at Dean Wood Care Home. One person told us, “The staff are helpful and kind”. A visiting relative said, “It’s brilliant care, they’ve really picked up on [my relative’s] personality”. People’s privacy and dignity was respected. Staff had a good understanding of people’s needs. They treated people with respect and protected their dignity when supporting them with personal care. One person said, “Staff are kind and considerate, they ask what I want to do”.

Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

There were sufficient numbers of staff to ensure that people’s needs were met and that they received care and treatment promptly. One person told us, “There seems to be mostly enough staff. They come when I call them and pop in to check on me”. A relative said, “I think there are enough staff, that’s the beauty of a big home”. People commented they felt safe living at Dean Wood Care Home. One person told us, “I feel safe, it’s secure here”. Safe moving and handling practices were observe throughout the inspection. Staff were aware of what actions they needed to take to raise a safeguarding concern. Policies and procedures were in place to safeguard people.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including caring for people with dementia, and training around the care of pressure damage. Staff were positive in their feedback of the training available. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

People spoke highly of the food. One person told us, “The food is nice, not bad at all”. Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

Care and treatment focused on the needs of the person and acknowledged their individuality and identity. There was a focus on meaningful activities to ensure people’s social and emotional well-being was fully promoted. There were activity co-ordinators in post who led on the provision of meaningful activities. A relative said, “My [relative] is not keen on socialising and games, they offer, but don’t push. They realised though that she likes watching the activities and they picked up on that”. People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff we observed had an understanding of the support needs of people who used the service. A member of staff we spoke with told us 'We get to know the residents and build relationships with them. I think we give care in a way that I would be happy for my own family to receive'. We found that the documentation used for care planning had been reviewed recently, was detailed and person centred.

Sound arrangements were in place for the safe ordering, storage, administration and disposal of medicines at the service. Staff had a good understanding of their responsibilities in relation to the safe administration of medicines.