The inspection visit took place on 09 May 2017 and was unannounced.

The Downes is a care home for up to 17 people, some living with dementia and a learning disability. The service is set in the heart of Hayle close to the towns of Redruth and Camborne. The service is close to local amenities and a transport network. The service is a historic grade 2 listed property set over two floors. It has been adapted to accommodate people who may require specific aids and adaptations for their health and wellbeing. There are extensive grounds surrounding the property which are not overlooked. At the time of the inspection visit there were 17 people living at the service.

At the last inspection in October 2014 the service was rated overall ‘Good’. At this inspection the service remains overall good but requires improvement in Safe.

Recruitment procedures were in place and being followed. However they were not always robust in recording decisions regarding the level of risk where a disclosure of information was made. The registered provider and registered manager verbally recognised the need for a monitoring programme when employing someone about who concerns had been raised. However, there were no records to demonstrate what strategy was being used to help ensure people’s safety. We have made a recommendation to ensure that when employing somebody where there may be potential risk this is documented.

There were systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff understood how to safeguard people and keep them safe.

There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service and people’s needs were met in a timely manner. Staff were friendly and compassionate in their approach to people. People commented; “Carers are all very good here, no complaints,” and “I can talk to them (staff) and they meet my care needs, yes.”

Risk assessments were in place with information to guide staff on how to protect people from any identified risk. Where we identified a window without a restrictor the registered manager agreed to address it immediately. There were no risk assessments in place where mobile heaters were in people’s rooms to provide additional heating if requested. Following discussion about the potential hazards and risks the registered manager immediatley put individual risk assessments in place to ensure personal safety was being monitored.

We observed staff supporting people in a safe way when they were helping to move them from their chair to a wheelchair. People’s assessments were reviewed and updated regularly to help ensure they reflected their changing needs.

People told us they received their medicines as prescribed. The system for storing medicines was safe. There were suitable storage systems for keeping medicines safe and secure. Only staff with responsibility for medicine administration had access to medicines. It was clear from the medicine records that people received them as prescribed. Regular medicines audits were taking place to identify if any errors occurred.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. 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.

Staff supported people to be involved in and make decisions about their daily lives. People chose where they spent their time, when they got up and when they went to bed. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

C

This was an unannounced inspection which took place on 29 October 2014.

The Downes Residential Care Home provides care without nursing for up to 17 people, most living with dementia. The service has 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe and their rights and dignity were respected.

Suitable arrangements were in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.

People received the support they needed because there were enough suitably qualified and experienced staff. We saw the staff on duty had time to spend socially with the people in their care and could undertake their tasks supporting people without feeling rushed.

Systems to administer and manage medicines were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place. People told us they received their medicines at the times they needed them.

Staff were positive about working for the provider and felt well supported. They received regular training to make sure they had the skills and knowledge to meet people’s needs.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to them between meals to ensure they received adequate nutrition and hydration.

People living at the home had freedom of movement both inside and outside the home. They were involved in decision making about their personal care needs. We saw no restrictions on people’s liberty during our visit. However, the main stair lift was not in operation due to mechanical failure which meant some people living on the first floor of the service were unable to come down to the ground floor. The provider had taken action to address the issue and informed people to whom it affected most.

The provider had their own quality assurance and auditing processes in place to monitor the provision of care. However people’s views about their experience of the service were not recorded. People told us the manager spoke with them on a regular basis both individually and in a group setting about their care and support but the home did not have a formal quality assurance system to evidence what people thought of the standards of care and treatment.

We looked at the recruitment and selection procedures the provider had in place to ensure people were supported by suitably qualified and experienced staff. We looked at two staff records and found all checks were taking place prior to employment to ensure staff were suitable to work with people who may be vulnerable.

People were provided with information about the home including how to raise concerns and complaints. The procedure clearly explained how a complaint should be made and reassured people these would be responded to appropriately.

The registered manager and staff members were both clear about their role and responsibilities and were committed to providing a high standard of care and support to people who lived at The Downes Residential Home. A computer based mobile care monitoring system was being used which enabled staff to register any form of care and support provided to people using a ‘fob key pad’. This was centrally recorded and gave a complete audit of the care and support provided.

We spoke with six people who lived at The Downes Residential care Home. We also spoke with the registered manager, senior carer (trainee) two care assistant staff and the cook.

People who lived at the home told us “it’s lovely here”, “the food is great” and “my room is lovely”. People who used the service could not identify any areas for improvement to their care or the environment. We spoke to a person who had come to the home for a short stay. They told us they were anxious about coming to The Downes but the “staff welcomed me…. I would come to stay again”.

We undertook observations of staff interacting with people who used the service. We saw staff respond and approach people in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people.

At the previous inspection we identified a breach in regulations in the outcome area of records. We therefore visited the Downes to monitor if the service was now compliant with this outcome. We found that they had reviewed people’s care plans so that they met the persons individual care needs. In addition all records in relation to a person’s care, for example the completions of diet and fluid charts were now maintained. We also found that the persons care plan was reviewed monthly to ensure that it reflected the current care needs of the person.

Staff told us they found the care plans “easy to understand”. They also told us they “loved” working at the home and found the manager and colleagues were “supportive” and told us they “work as a team”. Staff could not identify any areas for improvement in the service provided at The Downes.

As part of our inspection we spoke with people who lived at the Downes Residential Care Home. We also spoke with staff who worked at the home, a visiting relative, the deputy manager and the registered manager.

People, who lived at the home, told us “we are never made to feel a nuisance”, “you can’t find fault with any of them”. People described the staff as, “very good” and “kind”.

A relative told us, the place was “brilliant” and the staff “very good” and “very helpful”.

We found, people experienced care, treatment and support that met their needs and protected their rights and people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

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.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people received and appropriate checks were undertaken before staff began work.

However, we found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

At the time of the inspection the home accommodated people who were over 65 years of age. People who lived in the home needed help due to frailty, physical disability and/ or as they had dementia. There were some people living in the home who had a learning disability.

On the day of the inspection, we spoke with 11 of the people who lived at The Downes. People were positive about the care and support they received. Comments regarding the care included “very good,” “lovely” and the home was “homely…spacious and clean…and the care staff are attentive and nurturing.” Other people we spoke with all made similar remarks. People said the food was to a good standard, the home was always clean and they felt safe living there. People said there was a relaxed atmosphere, there were no fixed routines and choice was encouraged regarding what people wanted to do and eat.

When we inspected the home was clean and odour free. The home was furnished and decorated to a good standard.

Staffing levels were to a good standard. Staff were observed as working professionally with the people living in the home. There was evidence that suitable recruitment checks were completed. Although there were some gaps, overall, staff training was to a satisfactory standard. Quality assurance systems were satisfactory.

We had conversations with people who reside at The Downes, and all confirmed they were happy and felt well looked after. There were no concerns expressed and all said they would feel able to do so if they had any. We used observations and information received before and after the visit to decide whether the service meets peoples’ preferences and choices. We observed that privacy and dignity were respected during our visit. We saw that people get visitors frequently. We observed people moving around the home with no restrictions. People were seen to interact with staff and each other in a free, spontaneous manner.

Some of the people using the service were not able to comment in detail about the service they receive. We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people using the service or by staff. People who use the service were moving freely around the home and staff were seen to interact well with them. We saw that people who use the service were very happy to approach any member of staff at any time.

We saw that the routines being observed during the site visit showed that people are able to get up when they want and have choices about where they spend their time.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People were engaged with staff during personal care, when being assisted with meals and drinks and in group and individual activities throughout the day.

People we spoke with said they couldn’t praise the home highly enough and they felt they could approach staff with any questions or concerns.