About the service:

Damfield Gardens is a purpose-built care home in Maghull that offers residential care for older people and specialises in care for those living with dementia. The service can accommodate up to 67 people. Following our last inspection, the provider voluntarily stopped admissions, but recently commenced this again and when we visited there were 42 people living at the service.

People’s experience of using this service:

At the last inspection in November 2018 we asked the provider to make several improvements. This included the management of medicines and risks to people’s safety, governance and record-keeping, levels and consistency of competent staff, as well as person-centred care. The provider met with us following the inspection and sent us an action plan as well as regular updates. At this inspection we found some actions had been completed, but others required further improvement.

Although the provider had made good improvements to the management of people’s medicines, there were still some aspects that were not always safe. The management of known risks to people’s safety, the planning around this, as well as record-keeping, governance and quality assurance processes were still not always effective.

We recognised that staff had worked well together and as a team had made noticeable improvements to the quality of the service and ultimately people’s experience of it. Through getting to know and understand people better and developing their own skills and confidence, the service demonstrated clear progress. The provider had focussed on improving person-centred care and the quality of people’s service through an increased offer of meaningful activities and a better dining experience. There were now more consistent levels of competent staff, although some aspects needed further attention. We made a recommendation regarding this.

People told us they felt safe living at the service and we read relatives comments that stated, “I can sleep at night now knowing [my relative] is in safe hands.” Staff told us they had previously been worried about the service, but they were not now. People and their relatives praised the staff team and we observed warm, caring and patient interactions in a noticeably more relaxed atmosphere. Staff felt well supported and told us how much they enjoyed working with the people living at Damfield Gardens. People, relatives and staff were involved in the development of the service through regular meetings that had been introduced.

Rating at last inspection:

At the last inspection (20 November 2018) we rated the service as Inadequate for Safe, Requires Improvement for all other key questions and therefore Requires Improvement overall. At this inspection, we found the provider had made improvements which led to a better rating for Safe, Caring and Responsive. The overall rating remained unchanged.

Why we inspected:

This was a planned inspection, based on the service’s previous rating. We inspected to check whether necessary improvements had been made.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service through the provider’s action plan updates, notifications and conversations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 6 and 7 November 2018. The first day of inspection was unannounced.

Damfield Gardens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Damfield Gardens opened in April 2018 and is a newly-built care home providing accommodation for up to 67 people. The service is laid out across three floors, with two floors dedicated to people living with advanced dementia. The service is situated in a residential area of Maghull, with nearby facilities including shops and public transport. At the time of the inspection, there were 51 people living at the home.

The service had a registered manager. A registered manager is a person who has registered with 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.

This was our first inspection since the service registered with CQC in April 2018. The registered provider and registered manager were open and honest about the difficulties they had encountered, as well as the improvements they were aware needed to be made.

During this inspection we found breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what actions we told the provider to take at the end of the full report.

People, relatives and professionals told us there were not always enough staff to meet people’s needs and keep them safe. The service had identified staffing as a main difficulty themselves.

The knowledge and confidence of staff, including agency staff, to provide safe, person-centred and specialist care to people needed to be developed.

The management of people’s medicines was not always effective, which meant some people did not receive their correct medicines or did not receive them on time. The provider was changing to a different medicines management to make it more effective.

Risk monitoring and assessment processes were not always effective to keep people safe. Aside from other injuries, four people had fallen and sustained fractures in less than three months. Quality processes and audits were not always effective at leading to improvements and ensuring safer, better quality care for people.

The service did not always meet people's individual needs.

Feedback from people using the service, their friends and families, staff and visiting professionals was mixed. We heard about things the service did very well, but equally about concerns. However, all those who had concerns agreed that they had confidence that, given time and support, the service would make the necessary improvements. We heard comments about a warm, caring and open culture that had developed and we observed this during our inspection.

Staff knew safeguarding procedures and had confidence managers would address any concerns. Safeguarding concerns were referred to the local authority, but the service’s recording of these needed to be clearer.

Care files showed staff had completed risk assessments to assess and monitor people's health and safety. These had not always been reviewed following accidents and incidents to show what lessons had been learned.

Recruitment checks for permanent staff was robust. The service had not always received all relevant information about agency staff before they worked within the home.

Regular health and safety checks of the premises were in place. We discussed with the service checks that needed to take place more often, as well as improvement needs to the building.

We found the environment to be generally clean and bright. Staff were knowledgeable about good infection control practice