This inspection took place on 15 and 17 November 2017 and was unannounced.

Duchesne House is a Catholic care home, providing personal care to sisters of the Society of the Sacred Heart religious order, in the London Borough of Wandsworth. The home is registered to for 22 people some of whom may have dementia. At the time of the inspection there were 13 people using the service.

The service was last inspected on 10 November 2015 and was rated ‘Good’.

The service had a registered manager in place. 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.

People were not always supported by staff that had undergone regular training to effectively meet their needs. Training in some mandatory areas was not up to date. We shared our concerns with the registered manager who took action to address our concerns. We were satisfied with the action taken by the registered manager.

People received their medicines as prescribed. Records management of medicines was not always accurate. We shared our concerns with the registered manager. After the inspection the registered manager put systems and processes in place to address our concerns. We were satisfied with the action taken.

People continued to be protected against the risk of harm, abuse and identified risks. The service had embedded systems and process in place that gave staff clear guidance on how to mitigate identified risks. Staff were aware of how to identify, report and escalate suspected abuse. Staff received safeguarding training.

People were supported by sufficient numbers of staff to keep them safe. Rotas were flexible to ensure people’s changing needs were reflected in staffing levels.

People were protected against the risk of cross contamination because the service had implemented systems and processes to ensure infection control was managed safely.

People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; the policies and systems in the service do support this practice. Staff had an adequate understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s dietary needs and requirements were met. People continued to be supported to make healthy choices and were given access to a wide range of healthcare professionals.

The service ensured people’s needs were being met by the design and adaption of the premises. Changes to the environment were done in consultation with people as far as practicably possible.

People continued to be treated with compassion and kindness. The service employed Pastoral officers to ensure people’s spiritual and emotional needs were catered to. People had their right to privacy and dignity maintained. The service placed emphasis on ensuring people’s end of life care was delivered in a way they chose. People receiving end of life care were treated with the upmost dignity and kindness.

Staff supported people to make decisions about their care and support. People were given information in a manner they understood to enable them to make decisions. People were able to raise their concerns and complaints, systems in place ensured those who may find it difficult to speak up, had a voice.

People received person centred care that was tailored to their needs. People were encouraged to be involved in the development of their care plans, which were reviewed regularly to reflect their changing needs.

People views about the service continued to be sought through regular house meetings, keyworker sessions and pastoral discussions. Issues identified through feedback received was then acted on in a timely manner.

People received care and support from a service tha

This inspection took place on 10 November 2015 and was unannounced. The provider knew we would be returning for a second day. At our previous inspection on 16 April 2014 we found the provider was meeting the requirements of the regulations we inspected.

Duchesne House is a Catholic care home, providing personal care to sisters of the Society of the Sacred Heart religious order. Some people who live at the home have dementia. The home has 22 beds, however at the time of or inspection there were 15 people using the service.

There was a registered manager at the service. 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.

People using the service told us that staff were caring towards them and treated them with respect. They were supported to maintain their independence and staff respected their privacy and maintained their dignity. There was a homely feel to the service and many of the people that lived there had developed close relationships with each other. They shared common interests and values based on their faith.

Care records included a pen profile which gave information on people’s daily and night routine, how they liked to spend the day, their level of independence and what they preferred to eat. Staff completed daily reports recording how each person spent her day. Risk assessments, including those for safe moving and handling were carried out and reviewed regularly to ensure that people were supported with the appropriate level of care.

The provider had robust staff recruitment checks in place which helped to ensure staff were suitable to work with people using the service. Staff told us they worked well as a team and had access to regular training. They told us there was an open door policy at the home and the registered manager listened to their concerns.

People received ongoing health care support and referrals were made when people’s needs changed and nursing or clinical care needed to be sought. A GP visited the home regularly to review people. People received their medicines safely and care workers had completed training in medicines administration.

Staff were aware of the importance of asking for people’s consent when supporting them. There were no restrictions in place for people so no formal applications were needed to lawfully deprive people of their liberty to keep them safe.

People were satisfied with the food they were given. We reviewed the weekly menus which showed that people were given a varied diet. The kitchen was clean and well maintained. People with specific dietary requirements had their needs met.

Quality assurance audits such as care plans audits and medicines audits took place on a regular basis. Incident and accident monitoring was done and follow up action was recorded and trends identified and addressed.

A single 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?

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

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

Duchesne House is both a registered care home and a residential community run by The Society of the Sacred Heart, a registered charity. The home provides care and support for up to 22 elderly sisters of the Society of the Sacred Heart religious order some of whom have dementia.

People were being cared for in a home that was clean, hygienic and well maintained. Rooms were of a good size and some bathrooms had been adapted for those with disabilities. We saw that all areas within the home were wheelchair accessible. People told us that the home was “a good place to be" and that they felt "safe."

There were enough staff on duty to meet the needs of the people living at the home and all staff had been recruited following appropriate recruitment procedures and the completion of relevant police checks. Staff had a mix of qualifications, skill and experience and told us that they “felt supported” in their roles and that they received adequate supervision. Staff told us “it’s nice working here, we’re a good team” and that it “feels like being part of a family."

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. No applications had been submitted at the time of our visit. Relevant staff have been trained to understand when an application should be made and how to submit one.

There were measures in place to deal with foreseeable emergencies. All staff had received training in basic first aid and were aware of their roles and responsibilities should an emergency arise.

Is the service effective?

People told us that they were happy living at the home. We found that people were involved in decisions about their care and support and saw that most staff understood people’s care and support needs, were kind and thoughtful towards them, and treated them with respect. People told us that the staff are "all very caring and patient" and "get on well amongst themselves."

Each member of staff had received an induction before starting work and completed core training in subjects such as first aid and health and safety. Not all staff had completed up-to-date training in areas such as safeguarding and caring for people with dementia. The registered manager told us that they were planning to organise further training in these areas.

Is the service caring?

We saw that people living at the home enjoyed being part of a wider community where friendships were encouraged and visitors warmly welcomed. We saw that staff treated people who use the service with kindness and respect. One person told us that the "staff take very good care of my needs." We saw staff engaging well with people during coffee time and supporting people to eat their meal during the lunchtime period. People told us they were satisfied with the standard and variety of meal choices and one person told us that they had "a very good cook."

People were encouraged to pursue their own interests, to go out locally to participate in activities, join exercise classes and to use the library and computers. Spiritual needs were of great importance to the people living in the home and most people attended a daily service in the on-site chapel. We were told that special occasions such as birthdays and religious holidays of different faiths were always celebrated in the home.

People were able to meet regularly with volunteers and a pastoral co-ordinator visited every day to talk to people using the service and facilitate coffee morning sessions and other activities. People's guests were permitted to stay in the home in rooms specifically allocated to them. We saw that visitors were also invited to take part in activities and join people at meal times.

Is the service responsive?

People's needs had been assessed before they moved into the home and a full medical history recorded on arrival. Each person using the service had been allocated a named key worker who was responsible for monitoring and reviewing their care and well-being.

We saw that care plans were stored appropriately and were separated into sections covering support and health needs, risk assessments, likes and dislikes, medical conditions and end of life plans in the form of a living will. The manager was aware that not all care plans contained up to date information and agreed that more frequent review of care records will help to ensure safe and effective care.

There was an appropriate complaints policy in place and information about how to make a complaint posted on the notice board in the reception area. The registered manager told us that the most of the people living at the home were very capable of voicing their concerns either to herself or other members of staff or directly to the Management Committee.

Is the service well-led?

The home had a registered manager in post. People told us that the manager was "excellent" and that "she knows how to recruit good staff." Staff had a good understanding of the ethos of the home and quality assurance processes were in place. The manager told us that there was an open door policy in operation and that people using the service and staff could talk to her at any time. There was a monthly community meeting where people could come together to discuss any issues relating to the home, care and treatment.

One person told us that "taking all things into consideration we are very fortunate to have such a lovely place to live."

The home was a purpose built single storey building surrounding an internal garden. People who use the service have free and open access to all parts of the building and garden; we found several lounge areas, study rooms, a library, a chapel, conservatory, small personal kitchen areas and a communal dining room.

People who use the service were preparing for coffee time and the celebration of one of the residents birthdays. We joined the coffee time and were asked to give an explanation of the role of the Care Quality Commission (CQC) and the inspection process. A microphone and speaker system was used to enable everyone to hear what was being talked about. One person told us, “If you travel the whole country you won’t find a place better than this”.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, joined by a practicing professional and another CQC inspector to assist.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. There were a number of people at Duchesne House who found it difficult to communicate verbally.

We spoke with people who use the service and their relatives. All people spoken with were very positive about their experience of living at the home. They told us that they were well cared for and that it felt like their home. They could choose how they spent their day and that the manager listened to their concerns. They told us the food was good and that they could choose what they ate and where they liked. People told us that staff treated them with dignity and respect. One person said "you won't find a better home". Another person described staff at Duchesne House as "absolutely fabulous".

There were 16 people living at the home at the time of our visit. We spoke with eight of these people and six members of staff.

The women living at Duchesne House told us that they were happy at the home and that their religious, social and care needs were well met. Everyone we spoke to commented that the staff were kind and caring. One woman said the staff “couldn’t be nicer”. Staff told us that they felt part of the home and that they were well supported. We observed that the manager was well respected by the people who live at the home and staff.