Down House

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.

People’s assessed health and personal care needs were not always well met by the service. The care home supported mostly people with a higher level of nursing needs and the service was challenged by this intensity of demand. When people lacked capacity to make a specific decision the service had a process to ensure Deprivation of Liberty Safeguards (DoLs) and Best Interests decisions were made effectively so people’s rights were protected. Everyone had a care plan but we observed some were inaccurate or incomplete. Some people wanted to know more about their assessed needs, medication and the plan of their care, as some people had not been included effectively in the care planning process. People’s needs were not always well met, with a lack of social engagement and stimulating activities for people to take part in. The layout of the building, and that many people stayed in their rooms, meant staff did not address everyone’s needs frequently, thoroughly and without delay. Some people’s care needs and health needs were not being monitored enough as they spent all or most of their time in their rooms and so the number of interactions they had were fewer. However other people were being monitored more than necessary, for example, recording all their food and fluid intake when this was not needed.

The operations manager was acting on behalf of the registered manager at the time of the assessment. The service management had the active support of the provider. The management team led with integrity, and openness. The management team demonstrated their passion to improve the service and recognised there were areas that needed further improvement. The service had an organised approach to gaining feedback about the service but there were issues which had not yet been responded to. Staff training was good, and new staff were receiving the training they needed as part of their induction. Staff were overseen by the management team. Staff were pressured by the intensity of the needs of the group of people that used the service, but the provider had oversight of the staffing level necessary to meet the needs of people at the service.