What life was like for people using the service:

Since the previous inspection Davenham Hall has undergone some refurbishments. The unit manager for The Barns (specialist dementia unit within Davenham Hall) told us of their plans to create an environment that was meaningful for people living with dementia; some of these plans had already been implemented during our inspection.

The atmosphere within Davenham Hall was calm and homely; the management team and staff had developed strong, familiar and positive relationships with people and family members. Throughout the inspection the registered manager, management team and staff were observed to be warm and affectionate towards people and often displayed intimate physical contact that was appropriate and accepting from people.

Staff showed a genuine motivation to deliver care in a person centred way based on people’s preferences and likes. People were treated with kindness, compassion and respect. Staff used techniques to help relax people with positive outcomes. Everyone we spoke with told us Davenham Hall was a homely place to live and visit and staff told us it was like ‘home from home’.

People told us they felt safe living at the service and family members were confident their relatives were kept safe. Risks that people faced were identified and assessed and measures put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received medication at the right time. The environment was safe and people had access to appropriate equipment where needed.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. Only agency staff employed by the registered provider were used to cover any shortfalls in staffing levels to ensure that consistent staff were used to support people. Staff received a range training and support appropriate to their role and people's needs.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent at what they did. People received the right care and support to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the registered manager as supportive and approachable. The management team showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals in order to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 11 January 2016)

About the service: Davenham Hall is situated approximately half a mile from Davenham village centre. The main house has 31 single bedrooms and four shared rooms. A separate unit named The Barns, provides care for people living with dementia. This has 27 single bedrooms all with en-suite facilities.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good over

Our visit included talking to people as well as observing care practice. Comments we received from people living at Davenham included:

"I have no worries, I feel safe here"

"I always get my medicines when I need them and they never miss"

"The staff are great, I feel they listen to me"

"I have nothing but praise for the staff"

"They are a dedicated staff team"

Our observations of care in the dementia unit found that people were supported in a respectful and dignified manner. The work of staff was centred on the needs of people. Staff were able to create a stimulating and lively environment to which people responded well.

This visit found that people had their needs met through the care planning process and the interventions made by staff in promoting their health. People were safe from harm. The management of medicines promoted the wellbeing of people. We found that the service acted on complaints swiftly and people were protected by an effective and accurate system of record keeping.

We found that people’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person who uses the service said, "We have resident's meetings and no major problems come up. I am quite happy. Most people are quite happy. The care and support is first class."

People experienced care, treatment and support that met their needs and protected their rights. Almost everyone we spoke with liked living there. One person who uses the service said, "I like it here very much. The care is excellent, especially the nursing care. I have nothing but praise"

People who use 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.

There were enough qualified, skilled and experienced staff to meet people’s needs. One person who uses the service said, "The staff are very good." Another said, "The staff are very sympathetic, helpful and cheery."

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. One family member said, "I think it's brilliant. We can talk to the staff or managers any time."

We spoke with people who living at Davenham Hall and they all said they had been asked what their needs were and the registered manager had discussed with them the care the home could provide. One person said “They consult me and treat me with respect.”

One relative said that they are fully involved in their relatives care and that staff discuss everything with them both.

When we visited we spoke to people who use the service. All said they received the help they needed. One person said “I’ve been here for a year and I’ve never had any complaints about the care given to me and my relative who lived here with me. Myself and my family have been supported by all the staff. They couldn’t have done any more for me.” Another said “I am well cared for by the staff and I like living here”. All those we spoke with said that the meals were lovely and that they were given a good choice.

We asked people who used the service if they would know how to raise a concern about something that was worrying them. They told us that they knew who to speak to if they were worried and said that if they had a problem they would be able to discuss it with the registered manager and that it would be taken seriously.

When asked did they feel safe in Davenham Hall people said they did.

People who live at the home spoke highly of the staff team. Comments included “the home was lovely and that the staff are very kind.”” I am very happy here. The staff are good to me”.

All residents spoken with said the staff treated them well and that there were enough staff to support them.

The inspection was unannounced and took place over two days on the 15 and 30 October 2015.

Davenham Hall is situated approximately half a mile from Davenham village centre. The main house has 31 single bedrooms and four shared rooms. A separate unit named the Barns, provides care for people living with dementia. This has 27 single bedrooms all with en-suite facilities.

The service has 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 felt safe using the service and staff were able to tell us how they would protect people from harm and knew the signs and indicators associated with abuse. Staff knew what processes to follow if they had any concerns. People told us that whilst they felt safe within the service they also felt that more staff were needed. At the time of the inspection we did not have any concerns about the number of staff, however this information was fed back to management.

Effective recruitment processes were in place, and staff received ongoing training to ensure that their knowledge was kept up-to-date and in line with best practice.

People’s medication was effectively managed, and processes were in place to ensure these were securely stored and audited on a regular basis.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). We saw that policies and procedures around the Mental Capacity Act 2005 and DoLS were in place to ensure that people’s rights were protected in line with legislation and guidance. Applications had been made to the local authority to assess people’s eligibility for DoLS. Mental capacity assessments had also been completed which outlined what decisions had been made in a person’s best interests and why this had been necessary.

People liked the food that was available. They were offered alternative options where they did not like what was offered, and appropriate options were available for people with specialist dietary requirements.

Staff adopted a kind and caring approach towards people using the service and offered reassurance and support where needed. Staff were responsive to people and families told us they felt confident their relatives were being well looked after. We observed that the atmosphere in the dementia unit seemed flat and that there was a lack of stimulation of people. The television was on, however people did not appear to be watching this, and staff did not seem to have time to talk with people. We raised this with the duty manager who told us they would take this into consideration.

There were a range of activities on offer which included one-to-one and group options. People told us that they enjoyed the activities.

Management had made attempts to engage with residents and their families and had made changes following recommendations being made. People told us that they would complain if they felt they needed to and felt confident that they would be listened to.

The registered manager completed quality audits of the service which produced an action plan on changes that needed to be made. This contributed towards the delivery of good quality care and support.