Brighton care home ‘requires improvement’

A Brighton care home has been told it “requires improvement” after an unannounced inspection by the Care Quality Commission (CQC).

Dane House Care Home, in Dyke Road Avenue, Brighton, was good when it came to providing care that was safe, responsive and well-led, the CQC said.

But when it came to providing services that were caring and effective, the CQC’s verdict on Dane House was “requires improvement”.

The report on Dane House, part of the Four Seasons group, was published last week after an unannounced inspection last month.

The CQC said: “Dane House provides accommodation for up to 25 older people, some of whom are living with dementia and who may need support with their personal care. On the day of our inspection there were 19 people living at the home.

“The home is a large property, spread over two floors, with a communal lounge and a conservatory looking on to a large garden.

“Dane House belongs to the large corporate organisation called Four Seasons. Four Seasons provide nursing care all over England and have several nursing homes within the local area.

“We carried out an unannounced comprehensive inspection on (Thursday) 13 and (Friday) 14 March 2014. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found.

Dane House – Google streetview

“On (Monday) 2 March 2015 we carried out a focused inspection to check that they had followed their plan and to confirm that they were meeting legal requirements.

“At that inspection we found that significant improvements had been made, however, we continued to have concerns with the recording of mental capacity assessments, staff’s understanding of deprivation of liberty safeguards (DoLS), the opportunity for meaningful activities for people and involving people in the running of the home.

“At the inspection on (Tuesday) 12 July 2016 we found that significant improvements had been made, however, we continue to have concerns regarding the lack of staff training, knowledge and understanding in relation to the Mental Capacity Act 2005 (MCA) and DoLS.

“Further areas in need of improvement related to people’s dining experience and end of life care.

“People’s consent was gained before staff offered support. One relative told us, ‘They always inform me and ask my consent if needed.’

“There were good systems in place to assess people’s mental capacity and ensure that any decisions made on their behalf were made in their best interests and with people that were legally able to make decisions.

“However, there were concerns regarding staff’s training, knowledge and understanding in relation to (the) MCA and DoLS and we have identified this as an area of practice in need of further improvement.

“People told us that they were happy with the food and that they were able to choose what they had to eat and drink.

“Observations showed people being appropriately supported by patient and sensitive staff.

“However, people’s dining experience was poor. Most people ate their meals in their rooms, whereas others were in the communal lounge.

“People ate their meals on lap tables in the armchairs that they had spent most of the day in. This didn’t aid their independence or enable them to orientate to time and place and know that it was time for lunch.

“The registered manager recognised that this needed to improve and told us that there were plans to redecorate the conservatory area to create a ‘fine dining’ experience for people. This is an area in need of improvement.

“One person was receiving end of life care. They were treated with compassion and kindness by staff and their health and physical needs were met.

“However, there was a lack of holistic care and the person spent their time in bed with minimal stimulation or possessions near to them.

“People were not asked their preferences in regards to how they wanted to be supported at the end of their lives.

“The registered manager recognised that this was an area that needed further improvement. They had already made contact with the local hospice and planned to implement advanced care plans for people.

“The management team consisted of a registered manager and a deputy manager. 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 home was well-led and managed well. People, relatives and staff were complimentary about the leadership and management of the home and of the approachable nature of the registered manager.

“One person told us, ‘I can talk to the manager. In the past there was a rapid turnover of staff but this has all changed.’

“Another person told us, ‘The deputy manager is excellent. They are keen and enthusiastic and will talk to you anytime.’

“There were quality assurance processes in place to ensure that the systems and processes within the home were effective and ensured that people’s needs were being met and people were receiving the quality of service they had a right to expect.

“People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety.

“Risk assessments ensured that risks were managed and people were able to maintain their independence.

“There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

“Sufficient numbers of staff ensured that people felt safe and their needs were met. There were suitably qualified, skilled and experienced staff to ensure that they understood people’s needs and conditions.

“Essential training, as well as additional training to meet people’s specific needs, had been undertaken and used to improve the care people received.

“People and relatives told us that they felt comfortable with the support provided by staff.

“People’s healthcare needs were met. People were able to have access to healthcare professionals and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services.

“Positive relationships between people and staff had been developed. There was a friendly and homely atmosphere and people were encouraged to maintain relationships with family and friends who were also able to visit the home.

“People were complimentary about the caring nature of staff. One person told us, ‘they always have time for a chat and will do anything you ask. I can’t fault them at all.’

“People’s privacy and dignity was respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this.

“Residents’ meetings enabled people to make their thoughts and suggestions known. People’s right to make a complaint was also acknowledged. The registered manager welcomed feedback and used this as opportunity to develop the service provided.

“People received personalised and individualised care that was tailored to their needs and preferences.

“Person-centred care plans informed staff of people’s preferences, needs and abilities and ensured that each person was treated as an individual.