About the service: Devonshire House provides accommodation and personal care for up to 25 people, some of whom were living with dementia or learning disabilities. On the day of our visit there were 22 people using the service.

People’s experience of using this service:

People's risk assessments did not consistently cover all potential areas of risk, such as the risk of pressure damage and aggression and did not consistently mitigate risks. We looked at the systems in place for medicines management and found they did not always keep people safe. People felt safe in the care of staff members and were happy with staffing levels. However, staff were not utilised effectively. The provider had appropriate systems in place to support staff to raise any safeguarding concerns. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection. Premises continued to need work to become safe.

People told us they received effective support. Systems were in place to ensure that staff received appropriate supervision to support them in their roles. Staff felt they were trained to the right level to effectively work with people. Checks were made on the ongoing competency of staff. People were supported to eat meals of their choosing and were supported to access health professionals when necessary. Where people wanted to remain independent with personal care the lack of a shower prevented this.

People told us care staff were caring and kind. People's privacy and dignity needs were not always maintained by staff members caring for them. We could not evidence people were receiving regular baths.

Care plans contained lots of information on people’s life history, likes and dislikes. However, every person had the same index of which care plan was included whether this was needed or not. Activities were taking place but needed more work to either involve people as a group or on a one to one basis.

The providers systems and processes in place to monitor and audit the service continued to require improvement. Records management needed improvements regarding medicines, risk assessments and quality monitoring of the service.

The service continued to meet the characteristics of requires improvement but had deteriorated to inadequate in well led.

More information in the full report.

Rating at last inspection: Requires improvement, (published March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At the last inspection in January 2018, we asked the provider to take action to make improvements. Some action had been completed however further improvements were required. This is the second consecutive time the service has been rated Requires Improvement.

Follow up: We will request an action plan from the provider to understand what immediate action they will take to improve the quality and safety of care provided to people. We will also meet with the provider to discuss this action plan.

This service has received a rating of 'Inadequate' in one or more domains and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent en

This inspection took place on 23 January 2018. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Devonshire House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 23 people living at the service.

A registered manager was in post at the time of the inspection visit. They were registered with the CQC in December 2004. A registered manager is a person who has registered with the CQC 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 service was last inspected in August 2016 and received a rating of Good.

We could not evidence people received their medicines as prescribed due to poor recording. Medicines were stored safely.

Risks to people arising from their health and support needs and the premises were not always assessed and plans were not always in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However, two out of three bath hoists were broken and water temperatures were low. The last electrical safety certificate stated it was unsatisfactory and needed work, but there was no record to show the work had been done. The gas boiler service certificate was sent after inspection and showed that suitable checks had been carried out.

We saw day staff had received fire drills three times in 2017; however the records did not document what time the drill took place and how long it took to evacuate. Night staff had never received a fire drill and no staff had practised a full evacuation. We have made a recommendation regarding this.

There were concerns with infection control as staff were not adhering to good practice and the laundry room had no facilities to wash hands after handling infected/contaminated linen.

Staff had received all the training they needed to carry out their roles effectively. However, we saw evidence to show that they were not always putting this training into practice. We have made a recommendation regarding this.

Staff were fully supported from supervisions and a yearly appraisal.

People enjoyed the food provided and were offered choice. Staff were aware of people’s dietary needs, however records needed updating.

People who lived at the service were safeguarded from abuse and potential abuse. People told us that they felt safe at the service. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable.

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.

We found there was sufficient staff employed to support people with their assessed needs. However, the registered manager should look at how these staff were deployed.

Staff knew people and their life history’s well. However we found that not all staff knowledge was recorded in people’s care files. Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Care plans had information of people’s wishes and preferences; however there was noth

This inspection visit took place on the 26 August 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. This was a follow up visit to look at issues we found on our visit to Devonshire House on 15 January 2016.

We had visited the service on the 15 January 2016. We had found that medicines were not stored and administered in a consistently safe manner. There was a risk that people were not receiving their medicines as prescribed due to poor record keeping. We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, on how they intended to mitigate and address the breach of Regulation 12 of the Health and Social Care Act 2014 in managing medicines safely. The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found.

Devonshire House is situated in the village of West Auckland close to all amenities. It currently provides residential and respite care, nursing care and care for people with dementia and people with physical disabilities. There are 21 single occupancy rooms and 2 double occupancy rooms. Three of the rooms within the home have en-suite facilities. The service is family owned and it has a close knit, family feel to the home.

There is 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. The registered manager was a registered nurse and had worked at the home before they applied to be the registered manager.

On this visit we were met with a registered nurse who showed us how medicines were stored, dispensed, ordered and returned. They explained the checks they carried out to ensure medicines were administered correctly. They also showed us the new policies the service had written which staff had read and signed. This nurse told us the service had reviewed how it dealt with medicines and had discussed this in meetings and in supervision sessions with the registered manager.

We saw medicines were stored and administered safely.

The inspection visit took place on the 15 January 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Devonshire House is situated in the village of West Auckland close to all amenities. It currently provides residential and respite care, nursing care and care for people with dementia and people with physical disabilities. There are 21 single occupancy rooms and 2 double occupancy rooms. Three of the rooms within the home have en-suite facilities. The service is family owned and it has a close knit, family feel to the home.

There is 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. The registered manager had just completed their registration prior to our visit and was a registered nurse and had worked at the home before they applied to be the registered manager.

All people we spoke with told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns. We saw safeguarding incidents were very well recorded, investigated and managed by the registered manager.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The service did not have many people subject to a DoLS safeguard and it had an open door policy. The registered manager agreed that they may need to make further applications subject to a capacity assessment if they needed to secure the front door on a more permanent basis.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of older people such as end of life care and dignity. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other.

Medicines were not stored and administered is a consistently safe manner. There was a risk that people were not receiving their medicines as prescribed due to poor record keeping.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home and people were able to visit local shops and facilities.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. People told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had a complaints procedure and staff told us how they could recognise if someone was unhappy and how to report it.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and

During our last inspection we found the provider non-compliant. This was because there was no evidence of quality assurance checks being carried out. We also saw individual care plans and risk assessments for all the people who used the service were not always regularly reviewed and visits from people like opticians, dentists and chiropodists were not recorded. We also saw the records of people who had previously used the service were not properly stored and were accessible to anyone in the home.

During this inspection we saw the provider had put various quality control checks in place. These included carrying out assessments in relation to medications practice, charts for cleaning and monitoring people who used the service but preferred to stay in their rooms.

We looked at the area where the records of people who previously used the service were kept and saw this had now been closed off to the public with the use of a locked door.

We saw the care plans and risk assessments of people who used the service had been regularly reviewed and the provider had put a system in place to ensure this was done on a monthly basis.

We saw people's care records now contained details of appointments they had with healthcare professionals such as the GP and district nurse as well as a record of hospital out-patient appointments and admissions.

We saw people in the home were treated with respect and dignity at all times. People were asked if they wanted assistance and help was provided in line with these requests.

We saw people who lived at the home were looked after by people who had the appropriate training to carry out their work. Staff said they were happy in their work and felt they gave the best level of care they could.

The provider had sent some questionnaires to service users, staff and families of people who used the service, but had failed to take account of what had been said.

The provider has failed to maintain accurate records with regards to people who lived at the home and has failed to ensure the records of previous service users were stored securely prior to disposal.

People who used the service, their families and professionals who worked with them were given appropriate information and support regarding their care or treatment. People were given brochures about care that could be provided and were invited to care planning events meaning care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

We spoke to three people who used the service. One person said “They said I could go to another place, but I like it here.” Another person told us “We came to look around first and I liked it.”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spoke to people who used the services and they told us staff were very good. One person said “Staff are brilliant” and another said “They (the staff) are nice people.”

The staff felt they cared for people who use the service appropriately and felt they were able to speak openly to both manager and owners. One person told us “I would always say if I felt there was something wrong with the way people were being treated.”