CQC report explained · a residential care home
What the CQC found at David House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2022
Requires Improvement; inspectors found kind, personalised care, but staffing, supervision, recruitment and quality checks were not reliable enough.
The unannounced inspection took place on 15 and 17 February 2022. Inspectors spoke with four people, four staff members and the registered manager. They reviewed care, medicine and management records, including five staff files.
The home had staffing and management shortages after several staff left in November 2021. Inspectors found two staff had started without suitable references, and staff did not receive regular formal supervision. Quality checks identified some problems but did not always lead to action.
People's medicines, risk assessments, infection control and food safety were generally managed well. People described kind care. Their care was personalised, and staff supported their choices, dignity, independence, communication and relationships.
The overall rating was Requires Improvement. Caring and Responsive were rated Good. Safe and Well-led remained Requires Improvement, while Effective fell from Good to Requires Improvement. The provider was asked for an action plan and will be monitored and re-inspected.
Kind and respectful care
People told inspectors that staff were caring. Staff supported people to make choices and protected their privacy, dignity and independence.
“People told us the staff were caring and nice.” from the report
Personalised support
Care plans reflected individual needs and preferences, including different ways of supporting people with anxiety and communication.
“This meant the service was responsive and personalised in its support of people's anxieties.” from the report
Safe medicines and infection control
Inspectors found that medicines were given as prescribed and checked regularly. The home was also using protective equipment and infection control measures appropriately.
“People received their medicines safely and in line with the prescriber's instructions.” from the report
Support for choice and independence
People were involved in care decisions. Staff supported people to keep or regain daily living skills where this was part of their wishes and care.
“Staff supported people's independence in line with their care plans.” from the report
Recruitment checks
seriousTwo staff started work without appropriate references in place. This meant the home did not always follow effective checks to make sure staff were suitable.
“two staff did not have appropriate references in place before starting their roles.” from the report
Staff supervision
seriousFormal one-to-one supervision and appraisals were not happening regularly enough. Inspectors said this meant people were not always supported by appropriately supervised staff.
“The formal process of one-to-one supervision meetings and appraisals were not carried out regularly” from the report
Weak management oversight
seriousThe registered manager was carrying all leadership responsibilities while senior posts were vacant. Audits found issues but did not consistently ensure that they were put right.
“This meant oversight at the service was not sufficiently robust as to drive improvement.” from the report
Reduced activities
needs fixingActivities had reduced because of COVID-19 restrictions and staff departures. Inspectors recommended gathering more information about activities and bringing back the keyworking system.
“We recommend the service gathers more information about activities and re-introduces its keyworking system to facilitate people's participation in them.” from the report
- 01How many permanent care and management staff are now in post, and have the vacant senior roles been filled?
- 02How do you make sure every new member of staff has suitable references before starting work?
- 03How often do staff now receive formal supervision and appraisals, and can you show us recent records?
- 04What actions have you taken in response to the inspection action plan, and how do you check that they are effective?
- 05What activities are currently available, and has the keyworking system been reintroduced?
This was an unannounced inspection covering all five CQC key questions, with particular attention to concerns about staffing, environmental safety and food quality. This explanation was written from the published report of 5 April 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2021
David House was rated Requires Improvement; inspectors found infection-control risks, although medicines, staffing and some management systems were safer.
This was an unannounced focused inspection on 15 December 2020. Inspectors reviewed records, medicines, recruitment and safeguarding information. They spoke with people, the manager and staff.
The main safety problem was that staff were not wearing face masks while supporting people, including when within two metres or in physical contact. There were no risk assessments or other plans to manage this risk. This breached Regulation 12.
Inspectors found enough staff, safe recruitment, accurate medicines records and secure medicines storage. A new manager had also started improving care records, medicines processes and quality checks.
The overall rating changed from Good at the previous inspection to Requires Improvement. This inspection looked only at Safe and Well-led. The other ratings were carried forward from the earlier comprehensive inspection.
Medicines
Medicines were stored and given safely. Records were accurate, and new guidance for medicines given when needed improved safety.
“Staff maintained accurate medicines administration records which were checked by the manager” from the report
Staffing and recruitment
There were enough staff to meet people's needs. Recruitment checks were used to assess whether staff were suitable to provide care.
“The provider's recruitment processes included checks of staff employment history and checks of criminal records data bases.” from the report
Risk management
Individual risks were assessed and staff followed risk plans. Specialist checks were also carried out on the building and its safety systems.
“People's known, individual risks were assessed and staff followed the guidance in risk management plans to keep them safe.” from the report
Early management improvements
The new manager reviewed incidents and introduced changes to medicines and daily care records. Staff said they supported the changes.
“The manager was developing quality assurance process and had made improvements to medicines and care records.” from the report
Face masks were not used
seriousStaff were observed supporting people without face masks, including during close or physical contact. The report says this increased the risk of Covid-19 infection.
“At the time of our inspection we observed that none of the staff were wearing face masks whilst supporting people.” from the report
Risks were not assessed
seriousThe home said face coverings could make people agitated, but had not recorded risk assessments, best-interests meetings or professional guidance to support this decision.
“However, there were no risk assessments, best interests' meetings, guidance from healthcare professionals or risk management plans to support the decision for staff not to wear masks.” from the report
- 01How do you now make sure all staff wear masks when supporting people, including during close or physical contact?
- 02Which risk assessments or care plans are now in place for people who become agitated by face coverings?
- 03What evidence can you show that the infection-control changes made after the inspection are being checked regularly?
- 04How has the new manager's quality assurance plan been completed, and what problems has it found since the inspection?
- 05How are medicines given when needed recorded and checked under the new protocols?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 3 February 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of David House
6 rated inspections over 5 years: the service has held its Requires improvement rating throughout.
- April 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2017
Registered with the Care Quality Commission on 9 March 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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