We carried out an unannounced inspection of Dercliffe Care Home on 15 and 16 January 2018.

Dercliffe Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and personal care for up to a maximum of 32 people. At the time of the inspection there were 26 people accommodated in the home.

The last inspection was carried out on 15 and 16 September 2015. Whilst we rated the service as overall “Good”, we found there were shortfalls in the recruitment of new staff and noted not all notifications had been submitted to the Commission in a timely manner. Whilst we found all actions had been completed during this inspection, we made one recommendation in respect to the use of the medicines room. The overall rating of Dercliffe Care Home remains good.

People living in the home told us they felt safe and staff treated them well. People were supported by enough skilled staff. The registered manager monitored staffing levels to ensure people’s needs were met. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and welfare had been assessed and preventive measures had been put in place where required.

People's medicines were managed appropriately. However, we recommended consideration was given to the multiple use of the medicines room.

Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and they were up to date with the provider's mandatory training. People were supported to make decisions about their care and staff sought people’s consent before they provided support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. There were appropriate arrangements in place to support people to have a healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and preferences. There were established arrangements in place to ensure the care plans were reviewed and updated regularly.

The service was responsive to people’s individual needs and preferences. People were given the opportunity to participate in social activities both inside and outside the home. People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with 4 people who use the service, 1 visitor, the registered manager, the registered provider and 5 care staff. We also reviewed records relating to the management of the home which included, 4 care plans, daily care records, medical administration records and 5 staff records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The premises were clean, well maintained and had procedures in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage and use of hazardous substances such as cleaning products and medication.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We saw safe techniques were used by staff when helping people with mobility difficulties.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A relative told us “Staff seem to be around all the time, engaging with the people.”

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about people's diagnosed health conditions and also their preferences. This meant they received care that protected their welfare and safety.

People and their relatives told us the food was good and there was plenty of choice at mealtimes. One person said, "There is good food, like salads and always two options."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "I like it here, they are all so friendly." We observed that staff providing people's care were gentle and encouraging.

We saw they used safe procedures for helping people to move around and to eat their meals.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person’s dignity. One relative told us, "Mum always has her own clothes on, they never get mixed up.”

Is the service responsive?

People’s needs had been assessed before they moved to the home. People’s records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a general practitioner or podiatrist.

People who lived at the home, and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive of both work and personal circumstances..

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager and changes were made to improve the service where required.

Staff had induction and appropriate checks in place. Staff felt listened to and supported by their team leader or manager.

People using the service, their relatives and other people involved with the service had completed satisfaction surveys and records showed action was taken where any improvements were required.

At the inspection we spoke with six people living in the home (residents) and two relatives. We spoke with two members of staff and the registered manager.

Residents said staff treated them properly and respectfully and told us they had sufficient choices in their daily routines such as times of going to bed and getting up. Residents made the following comments: "All the staff are very nice", "Most of the staff are very good, but some are better than others", "They (staff) all treat me properly" and "I can get up and go to bed when I want, no one makes you go to bed". A relative said, "The staff always seem kind". We observed staff caring for people in a patient, kind and respectful way.

People were involved in the development of their care and services through 'care reviews', discussions with staff, and through completing survey questionnaires.

Residents also said they were well cared for and had the care and support they needed. A resident said, "We are well looked after and I get the care I need". Another said, "They (staff) do their best". A relative said, "Dercliiffe is very homely, like home from home".

Staff told us they undertook appropriate training to enable them to do their work effectively. They also said they felt well supported by senior staff and through the staff team.

People told us they knew who to speak to if the were not happy with any aspect of the service and felt the manager had satisfactorily addressed any issues raised.

.

During the inspection visit we spoke with four people living in the home, two visitors and three members of staff, including the (new) manager.

People living in the home told us they had enough choices in their routines, such as in times of going to bed and getting up, and whether or not to spend time in their rooms. People said staff treated them respectfully and kindly and were mindful of some of their preferences. One person said, "We are able to get up and go to bed when we want". Another person said there was a good choice of food and told us, "I enjoy the food; I must do I eat it all". This person also said. "They (the staff) are all very good". We observed staff caring for people and supporting them in a patient and respectful way.

People living in the home were generally satisfied with the care they received. One person said, "I'm happy here". Another said, "Everything's alright, nothing to grumble about" and, "Staff are alright with you if you're alright with them". A visitor said, "We chose this home because it's homely and the staff are friendly and caring". Another visitor said, "Staff are very good".

Staff told us they were given appropriate training and supervision to enable them to do their work effectively. We were told there had been changes to the way shifts were organised, and that these were positive changes enabling them to work better as a team. However we had concerns staff recruitment procedures were not thorough enough to protect people.

Most residents that we spoke to said that the care they received was of a good or satisfactory standard, and the relatives we spoke to were also satisfied with the care and services in the home. People told us that in general staff were caring and attentive. Residents also felt there was sufficient choices in daily life, such as in the food served which was generally described as being of a good standard. Staff said that they felt well supported by the manager who was described as being supportive and approachable.

We carried out an inspection of Dercliffe Care Home on 15 and 16 September 2015. The first day was unannounced. We last inspected the home on 29 May 2014 and found the service was meeting the current regulations.

Dercliffe Care Home provides accommodation and personal care for up to 32 older people. The home is a detached property, located on the outskirts of Nelson. Accommodation consists of 24 single and 4 shared bedrooms, all of which have ensuite toilets and hand wash basins. There are a variety of communal areas. At the time of the inspection there were 28 people accommodated in the home.

The service was managed by 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.

During this inspection we found two breaches of the regulations related to recruitment of staff and the notification of incidents. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation in respect to the development of a robust safeguarding procedure.

People told us they felt safe and were well cared for in the home. Staff knew about safeguarding and we saw concerns had been dealt with appropriately, which helped to keep people safe. However, the registered manager had not notified us of allegations raised about the home in line with the current regulations. All allegations had been investigated by the local authority, with no concerns found.

As Dercliffe is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate mental capacity assessments had been carried out and one application had been made to the local authority for a DoLS. We noted staff had completed relevant training and had access to appropriate policies and procedures.

Staff had been trained to handle medication and records gave detailed information about people’s medication requirements. Records and audits were in place which ensured people received their medication in a safe manner.

Staff had completed relevant training for their role and they were well supported by the management team. However, we found the recruitment and selection policies and procedures did not fully reflect the current regulations and not all checks had been carried out before new staff started work in the home.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food.

People had opportunities to participate in a variety of activities and we observed staff actively interacting with people throughout our visit. All people spoken with told us the staff were caring and kind. We saw that staff were respectful and made sure people’s privacy and dignity were maintained. People and their relatives spoke positively about the home and the care they or their relatives received.

All people had a detailed care plan which covered their needs and any personal preferences. We saw the plans had been reviewed and updated at regular intervals. This meant staff had up to date information about people’s needs and wishes. Risks to people’s well-being were assessed and managed. However, we noted two staff carried out an inappropriate moving and handling technique. This incident was looked into by the manager and reported to social services under safeguarding procedures.

All people, their relatives and staff spoken with had confidence in the registered manager and felt the home had clear leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people living in the home, their relatives, staff and visiting healthcare professionals.