Dapplemere Nursing Home is registered to provide accommodation and nursing care for up to 22 people. Some people may be living with dementia. At the time of our inspection there were 19 people living at the service.

At the last inspection in August 2016, the service was rated Good.

At this inspection we found the service remained Good.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People's needs had been assessed prior to admission at the service and individualised care plans took account of their needs however we found that there was a lack of information in relation to people’s preferences and wishes. This had been identified by the registered manager through care plan audits and was being addressed with the provider. People and their relatives felt involved in the care planning process and the care plans and risk assessments viewed had been regularly reviewed and updated.

People felt safe and were supported by staff who knew how to recognise and report any concerns. All members of staff had received safeguarding training and there were effective safeguarding procedures in place. Potential risks to people whilst receiving support and care had been identified and assessed.

The service had sufficient numbers of staff on duty to meet people's needs however some people did describe experiencing some delays in receiving care. Staff had been recruited safely, received ongoing training and were supported in their roles. Regular supervision and team meetings provided opportunities for staff to be involved in the development of the service and kept up to date with any changes.

People felt that staff were kind, caring and attentive to their needs. People felt that privacy and dignity was maintained and promoted throughout their care.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

People were satisfied with the meals provided to them and were offered a varied menu. People were supported to access the services of health and care professionals to maintain their health and wellbeing.

There was a system in place for receiving and investigating complaints. People we spoke with knew who they could raise concerns with and felt confident any concerns raised were listened to.

The service had a registered manager who was supported by a deputy manager. People, relatives and staff felt the service was well managed and spoke positively regarding the management team.

Quality assurance processes were in place to monitor the quality of the service. Feedback on the service and comments were encouraged and a satisfaction survey had recently been commenced. The registered manager used a variety of audits to monitor the service provided and took action where identified as required.

This focused inspection took place on the 3 August 2016 and was unannounced. We carried out this inspection in response to concerns we had received.

Dapplemere Nursing Home provides accommodation and nursing care for up to 22 older people, some of whom were living with dementia. At the time of our inspection there were 21 people using the service.

There was no registered manager in post, although the manager had applied to register. 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 safe and staff understood the ways in which they could be protected from any risk of avoidable harm. There were robust risk assessments in place detailing the control measures that could be used to reduce the risks associated with providing people’s care. Staff were trained in moving and handling and able to move people safely when required. Staffing levels were sufficient to meet people’s needs, and staff recruited to work in the service had the appropriate skills and experience to carry out their duties effectively. Medicines were safely managed, stored and administered by staff who were trained and assessed as being competent to do so.

Staff received training that was relevant to their role and enabled them to provide effective care to people. They were supported through an on-going programme of supervision and appraisal, and new staff completed a comprehensive induction program when they first came to the service. Staff had received training to understand how the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS) should be used to when supporting people in meeting their needs. Applications had been made to deprive people of their liberty where appropriate to keep them safe. People consented to receiving care and treatment from staff and were encouraged to make decisions where they had the capacity to do so. People’s healthcare needs were identified and the service worked closely with healthcare professionals where required. People had enough food and drink and enjoyed a healthy and balanced diet.

The service did not a registered manager in place, but a new manager had an application with the Care Quality Commission in progress. People, their relatives and staff were all positive about the changes made by the new manager. There were robust systems in place for quality monitoring and identifying any improvements that needed to be made. People, their relatives and staff had their views sought through surveys and regular meetings.

We carried out an announced inspection on 17 July 2015.

The service provides accommodation and nursing care for up to 22 older people some of whom may be living with dementia. On the day of the inspection, there were 17 people living in the home.

The service is required to have 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. The manager took up their post in May 2015 and was not yet registered with the commission. They were in the process of obtaining the necessary documentation to make their application.

People felt safe and they were protected against the possible risk of harm. Risks to individuals had been assessed and managed appropriately. However, people were at risk of developing pressure ulcers because their pressure reliving mattresses were not always set at the correct setting for their weight.

There was a robust recruitment process and there were sufficient numbers of experienced and skilled staff to care for people safely. Medicines were managed safely and people received their medicines, regularly, on time and as prescribed. However, records in relation to medicines had not been maintained as required.

People received care and support from staff who were competent in their roles. Staff had received relevant training and support from management for the work they performed. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. They were aware of how to support people who lacked mental capacity. People’s nutritional and health care needs were met. They were supported to maintain their health and wellbeing and had access to and received support from other health care professionals.

The experiences of people who lived at the care home were positive. They were treated with kindness and compassion and they had been involved in the decisions about their care. People were treated with respect and their privacy and dignity was promoted.

People’s health care needs were assessed, reviewed and delivered in a way that promoted their wellbeing. They were supported to join in activities provided at the home or outside the service. An effective complaints procedure was in place.

There was a caring culture and effective systems in operation to seek the views of people and other stakeholders in order to assess and monitor the quality of service provision.

When we visited Dapplemere Nursing Home in April 2014, we found that they were not meeting four of the regulations we reviewed. We checked to make sure they had made the required improvement and found that improvements had made been made.

In this report the name of a registered manager is recorded who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name has appeared because they were still a registered manager on our register at the time of this inspection.

The inspection team was made up of one inspector. We set out to answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with during our inspection said that they had confidence in the home’s complaints process and concerns raised were addressed appropriately. A family member said, “On one occasion I had to raise a concern and the owner, in my view took the appropriate action.” This demonstrated that the provider ensured that comments and complaints made by people were responded to appropriately.

We found that the home demonstrated a good understanding of the requirements of the Mental Capacity Act 2005 and had put them into practice to protect people’s safety. This was because people had provided written consent for staff to support them with their care and treatment. Where people’s liberty may have been deprived; the provider had submitted Deprivation of Liberty Safeguards (DoLS) applications to the supervising body in line with the current legislation and was waiting to find out if they had been approved.

Where people were at risks of developing pressure damage and poor nutritional intake appropriate risk assessments were in place to promote their well-being. This ensured that care and treatment was planned and delivered in a way that was intended to promote people's safety and welfare.

Is the service effective?

We found that care plans had been signed by the person receiving care or a family member. The plans included information on people’s medical condition and how they wished to be cared for. This meant that people were involved in the development of their care plan.

We saw that the care plans included information on people’s preferred needs, how they wished to be addressed, their ethnicity and religious needs. This showed that the home promoted people’s diverse needs and values.

Is the service caring?

We spoke with five people who were being supported by the service and five family members. We asked them for their opinions about the staff who supported them. Comments from people were positive. People said that staff were kind and caring. A person who used the service said, “Staff are kind and make my family feel welcome.” A family member said, “Staff are kind and helpful.” It was evident people felt staff were caring and had confidence in the care they provided.

Is the service responsive?

We found that people’s care plans were reviewed monthly or as and when required. This was to ensure that the care and support provided to them met their diverse needs.

We found that the provider regularly sought the views of people who used the service and their relatives about their care and treatment and they were acted on. This meant that people and their relatives were encouraged to provide feedback on the quality of the care provided.

Is the service well-led?

We found that the home did not have a registered manager in post. The provider was standing in as the interim manager. Staff spoken with said that they felt supported by the interim manager and that they operated an open door policy. They also said that regular staff meetings were held and they were listened to and enabled to make suggestions and influence how people’s care should be provided. A staff member said, “I feel well-led. The provider is approachable and helpful. If I have a query or concern, I don’t hesitate to discuss it with her.” It was evident staff felt supported and well-led.

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with all said that they felt safe living at the home. People told us that they felt their privacy and dignity were respected. We saw evidence that risk assessments had been undertaken to help minimise the risk to people living at the home. The home had a complaint policy and procedure in place and people we spoke with all knew how they could make a complaint.

The provider had an infection control protocol that staff followed, which ensured that the home was kept clean. There were systems in place to reduce the possibility of cross contamination within the laundry area of the home.

Is the service effective?

We looked at the care records of five people who lived at the home. We found these provided details of what support people needed. However, we noted that the care plan did not always show people’s preferences on whether they were supported by a male or female carer. People told us that they were happy with the care that they had received. One person told us, “I find the staff extremely caring”

The provider had not undertaken mental capacity assessments where it was deemed by the manager that people did not have the capacity to make decisions about their care and treatment. The provider did not have a clear protocol in place for dealing with the deprivation of liberty safeguards.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care and treatment of people to ensure their needs are appropriately assessed, planned and reviewed.

Consent had not been obtained from people and/or their relatives for the care and treatment that was documented in peoples care plan.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to gaining people's consent for the provision of their care, treatment and support.

Is the service caring?

During our inspection we saw that staff were supporting people to undertake tasks. People we spoke with all stated that staff were caring and helpful. A relative we spoke with said “The care is fantastic”. A service user we spoke with said “I find the staff extremely caring”.

Is the service responsive?

People we spoke with all told us that they did not have to wait long for staff to respond to their call for assistance once they had pressed their call buzzer. They felt that staff had attended to their call in a timely manner.

A relative we spoke with told us that the home always kept them informed of any changes to their relatives care and treatment.

Is the service well-led?

The service did not have a robust quality assurance system in place. Audits had been undertaken in a number of areas. However concerns were not always addressed in a timely manner and information recorded on some audits were not accurate and/or correct.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service provision.

Records were not always being stored in a secure way and some records were left accessible to anyone who entered the home.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records being kept securely and which could be located promptly when required.

People we spoke with were happy with the service that they received. We observed that staff interacted with people in a positive manner and listen to their needs. We also observed that when staff supported people to walk this was done at a pace that was suitable to the person.

A relative we spoke with was happy with the service that their relative had received. They felt that the staff were ‘excellent’ and found staff to be friendly and welcoming.

We reviewed a number of care plans and found that they did not demonstrate that family had been involve in the care planning. We noted that risk assessment did not always inform staff on how to minimise the risk.

Some staff felt that more staff were needed in the mornings, the provider told us that the staff rota was based on the needs of the people who used the service and was regularly reviewed.

The home did not have a robust infection control system in place to monitor and check the infection control of the home.

We looked at audits which had been undertaken by the home, we noted that there were no action plans following the findings of the audits. We also looked at relative questionnaires and found also that there was no analysis or action plan. This meant that there was not a robust system in place to monitor the quality of the service.

People we spoke with who used the service and their relatives told us that they were generally happy with the care and support they had received from the home. Comments from people included “Staff are lovely” and “The food is very good”.

During our observation we noted that interactions between staff and people who used the service were positive. We saw that staff supported people to move around the home and they responded to people’s needs in an appropriate manner.