Archived: Davie House

Updated 16 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 20 September 2016. We returned on 21 and 22 September 2016 to complete the inspection.

The inspection was completed by one adult social care inspector.

Prior to the inspection we reviewed the Provider Information Record (PIR) and previous inspection reports. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.

We spoke with four people receiving a service and eight members of staff, which included the registered manager. After our visit we spoke with one relative.

We reviewed two people’s care files, two staff files, staff training records and a selection of policies, procedures and records relating to the management of the service. Before and after our visit we sought feedback from health and social care professionals to obtain their views of the service provided to people. We received feedback from two professionals.

Updated 16 November 2016

This unannounced inspection took place on 20 September 2016. We returned on 21 and 22 September 2016 to complete the inspection. At our inspection in June 2015 Davie House was rated ‘requires improvement’ overall. There were four breaches of the Health and Social Care Act (2008) due to insufficient recruitment practices, discrepancies of medicine dosages, record-keeping in general was not robust and there were maintenance issues of the building. We received an action plan from the organisation detailing how they would be meeting the regulations which were in breach. This inspection found some improvements had been made. However, we found further breaches for medicines management, an inconsistency of staff to support people appropriately to meet their individual needs and issues with how the service was managed.

Davie House is registered with the Care Quality Commission (CQC) as 33 and 34 New Park which is located in the village of Horrabridge close to Dartmoor National Park. The two properties consist of number 33 and 34, which are adjacent semi-detached houses on a residential housing estate. It is registered to provide accommodation with personal care for up to eight people over the age of 18 who have a diagnosis of a learning disability. When we inspected Davie House in both June 2015 and September 2016, we were told that Davie House only consists of number 34 New Park. Number 33, which is owned by HF Trust Limited, provides supported living for people, but is not registered for the regulated activity, personal care. No one was receiving personal care in number 33 at the time of this inspection. We established that the organisation was in the process of amending their registration address to just being number 34. At the time of our inspection there were four people living at Davie House.

There was a registered manager in post. 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. However, the registered manager informed us that 23 September 2016 was to be their last working day for the organisation. Therefore after this date there would be a registered manager vacancy at Davie House. A regional manager informed us that they had two applicants for the position and were due to commence the interview process.

A high use of agency staff due to the inability to recruit permanent staff had impacted on people. Some people had found this had increased their anxiety due to unfamiliarity and an inconsistency of support and approaches. This had led them to have challenging behaviour at times.

Medicines management was not robust. A medicine cupboard did not conform to the Medicines Act 1968 and certain medicines requiring refrigeration were not kept securely. There had been gaps in medicine records but these had been picked up and dealt with by the registered manager. Where a person was prescribed insulin it was not on the medicine record.

Agency staff did not have access to computerised records. They had access to people’s care plans and risk assessments to help them support people appropriately, but did not have access to daily notes. This meant that if there was only agency staff on shift, they were reliant on receiving a thorough handover and paper versions of notes about key information. This posed a risk they would not be aware of certain information if it had not been handed over.

Methods used to assess the quality and safety of the service had not picked up the issues with medicines management and how the use of agency staff had at times impacted on people’s behaviours and anxieties.

Where relatives had completed surveys, actions had not been followed up by the service.

People felt safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. Staff relationships with people were caring and supportive.

There were effective staff recruitment and selection processes in place. Staff received training and regular support to keep their skills up to date in order to support people appropriately.

Permanent staff spoke positively about communication and how the registered manager worked well with them.

We found three 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 this report.