We carried out an inspection of Daneside Mews on the 2 and 8 May 2018. The first day was unannounced with the second day announced.

Daneside Mews is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Daneside Mews provides personal care for up to 34 older people who have dementia. The home has single room en-suite accommodation over two floors. Each floor has a lounge, dining area and bathing and toilet facilities. There is access into the garden, which has seating and tables. At the time of our visit, 30 people were living at Daneside Mews.

The service had a registered manager. 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. The registered manager was present during the days of our visit. The manager had been registered with CQC since our last visit in February 2017.

We previously carried out an unannounced comprehensive inspection of this service on 7 February 2017. At that inspection we rated the service as requires improvement as we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

On this visit, we found that the two breaches identified at our last visit had been addressed.

During the last inspection in February 2017, it was identified that the registered provider had failed to take action following an investigation, in response to safeguarding concerns that had been raised. This had resulted in three safeguarding concerns of a similar nature over a period of six months because protective measures had not been identified and implemented. In addition there had been a delay of four days in reporting on safeguarding concern. This had failed to ensure people’s safety and demonstrated that systems had failed to identify this as an issue.

This visit found that staff were aware of the types of abuse that could occur and were clear about how to report any concerns and had received training. Aide memoires were in place summarising the action staff needed to take in the event of an allegation being made. They were confident that the registered manager would take action on this. In addition to this, body maps were in place which recorded any unexplained injuries or marks. These were audited by the registered manager and action taken. As a result, no safeguarding issues had been missed.

During our last visit in February 2017, we had also identified that the registered provider had failed to follow processes in relation to their own safeguarding policy. In addition to this, the quality monitoring systems used by the registered provider had failed to identify and address ongoing issues in relation to a safeguarding concern.

This visit found that the registered manager had introduced a clear auditing system for the reporting of all safeguarding concerns. Any referral to the local authority safeguarding team or CQC had been recorded and a clear process of accountability established. This accountability also extended to monthly reports that the registered manager submitted to the registered provider so that all safeguarding incidents would not be missed. As a result, people who used the service were better protected.

Staff were aware of how to raise care concerns using procedures the registered provider had established. This extended to informing external agencies such as CQC.

Recruitment processes were robust

The inspection was unannounced and took place on the 7 and 8 February 2017.

Daneside Mews is registered to provide accommodation and personal care for up to 34 people living with dementia. At the time of the inspection visit there were 24 people living at the service. The service is situated over two floors and people have access to a secure garden which is well maintained.

There was a manager in post within the service however they were not registered with the CQC. The current manager was acting as a 'turn-around manager', employed by the registered provider on a temporary basis to make improvements within the service. The service had been without a registered manager since November 2016.

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 in January 2016 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people’s care records and risk assessments did not contain accurate and up-to-date information. These issues had not been identified by auditing processes. Quality monitoring processes had also failed to identify and act on issues with staffing levels and a failure to follow disciplinary procedures where required. At this inspection we found that improvements had been made, however we identified issues in other areas.

During this inspection we identified repeated breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was identified that the registered provider had failed to take action following an investigation, in response to safeguarding concerns that had been raised. This had resulted in three safeguarding concerns of similar nature over a period of six months because protective measures had not been identified and implemented. In addition there had been a delay of four days in reporting on safeguarding concern. This had failed to ensure people’s safety and demonstrated that systems had failed to identify this as an issue.

You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we identified two occasions where the registered provider had failed to notify the CQC of safeguarding concerns that had occurred within the service. This is a legal requirement that is placed on the registered provider.

At the last inspection in January 2016 we found that staff did not have a good knowledge of the Mental Capacity Act 2005 (MCA) and that mental capacity assessments were not in place. At this inspection we found that staff had a good understanding of the MCA. Whilst mental capacity assessments had been completed as required, there were some outstanding. The manager told us that action would be taken to complete these.

At the last inspection in January 2016 we identified that care records and risk assessments did not contain sufficient or accurate information to enable staff to meet people’s needs. At this inspection we found care records had improved and risk assessments contained explicit detail around how people should be supported. Care records were personalised and contained details of people’s likes and dislikes. This helped to ensure people received the correct level of support.

At the last inspection in January 2016 people told us that they did not feel there were enough staff and there had been no staffing tool in place to determine the number of staff required. At this inspection there were enough staff to meet people’s needs, and a tool in place which showed that the registered provider had enough staff. Staffing rotas showed staffing levels to be consistent which helped ensure people were kept safe.

A

At the time of our visit there were thirty two people with dementia living at Daneside Mews. We used a number of different methods to help us understand their experiences. We spoke to thirteen people who used the service and four relatives, looked at records, spoke to staff and made observations of the support provided. We also asked relatives, professional visitors and staff to complete a survey. One survey was returned by a relative. The people we spoke to made positive comments about the staff and support received such as:

“They (the staff) are good to you.”

“They’re (the staff) very good. They’re nice people.”

“You can do what you want, you can walk about, you can sit outside in the summer.”

“I’m happy. Lovely girls (the staff).”

“I was poorly this morning so I went to the staff. They told me to lie down. They put Tom Jones on for me. I like Tom Jones. I’m fine now.”

The relatives we spoke to were happy with the support and care provided. They said people’s individuality and dignity was promoted. They said their relatives saw health care professionals when needed and that the staff were generally good at keeping them informed about any changes to needs. Some comments made were:-

“I’m here every day. The staff are very co-operative. I couldn’t wish for better.”

“The staff treat people as individuals.”

“In my experience I have always found that the home provides good care. The staff are very compassionate and caring and give understanding to those that are in their care. They are treated with respect and dignity.”

We spoke to four staff who said that a good service was provided and that people were well looked after.

We observed positive interactions between the people who used the service and the staff. Staff were attentive, had a caring attitude and were supportive.

We found that there were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

The staff were provided with the support they needed to enable them to meet the needs of people with dementia.

We found that the service involved and communicated with health and social care professionals when they were needed to ensure the needs of the people who used the service where appropriately met.

There were systems in place to monitor the quality of the service for people who had dementia.

Our observations indicated that staff were attentive and had a caring attitude towards the people who used the service. There was a good rapport between the people who used the service and staff.

We spoke to five people who used the service. They said they were well looked after and happy with the service received. They were positive about the staff who supported them.

The information we gathered from relatives and visitors indicated that they were happy with the care and support provided. They described the staff as caring and attentive.

We spoke to one health professional who supported people who used the service. They said that a good service was provided at the home.

There were practices in place to ensure that the people who used the service were respected and that they were involved in the delivery of the service they received as far as this was possible.

Records showed that people had been assessed before they began to use the service. They had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

The staff were provided with the support they needed to enable them to meet the needs of the people who used the service.

There were systems in place to monitor the quality of the service.

We asked LINKs and Cheshire West and Chester Council for information about how the service operated. LINKs had no current information and no information of concern was reported by the Council.

The inspection was unannounced and took place on the 26 November 2015.

The service was last inspected on the 26 February 2014 and we found that the service was meeting all the regulations we reviewed.

Daneside Mews provides accommodation and personal care for up to thirty four older people living with dementia. The service has single room en-suite accommodation over two floors. Each floor has a lounge, a dining area, bathing and toilet facilities. There is a garden to the rear of the service, which has seating and tables and can be accessed by people who use the service during periods of good weather. At the time of the inspection there were 28 people using the service.

The service had a manager in place who was in the process of applying to the CQC to become registered. 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 this inspection we found that whilst there were some elements of good care and practice, there were a number of 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.

Staff were not always clear about what to do if they had a safeguarding concern. They told us that they would go to the registered manager with any concerns, however some staff were unsure of what to do if the registered manager was unavailable or if they were involved in the concerns. This meant that people may not receive the support they need to address safeguarding concerns.

The registered manager did not have a system in place for assessing the number of staff required which meant that people were at risk of not receiving the correct level of support.

There was a robust recruitment process in place which ensured staff were suitable to work in a care setting.

There was a disciplinary procedure in place, however we found that this was not always used appropriately, for example some essential staff training had been out of date for up to five months, despite a request from the registered manager that this be completed.

Medication was stored securely and an audit system was in place to ensure that medicines were being administered correctly. .

Staff were not clear on the principles of the Mental Capacity Act 2005 and care plans gave unclear information around people’s mental capacity. Mental capacity assessments and best interest decisions for people were not always made in line with the Mental Capacity Act 2005 code of practice. This increased the risk that decisions were being outside of the legal framework which would impact upon people rights.

Some staff had received formal supervision and the registered manager had a schedule in place for those staff who had not yet been supervised.

People’s privacy and dignity was respected and staff treated people with respect. People’s rooms were kept clean and tidy and people were happy with the service they received.

Care plans were reviewed on a monthly basis, however this was not always a thorough or accurate process, for example some care plans contained unclear and conflicting information about people’s needs. There were examples where people’s dietary and mobility needs were not clearly recorded. This meant that care staff may not always know how to deliver appropriate care and support.

Staff felt supported by the registered manager and positive changes had been implemented. An external professional told us that they had seen positive changes within the service since the registered manager had come into post.

There was system in place for checking the quality of the service people received, however it was not fully effective, for example we saw that one of the audited files contained conflicting and unclear information which had not been identified.