CQC report explained · a nursing home
What the CQC found at Down House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, February 2023
Down House is rated Good; inspectors found safer care, sound medicines systems and improved management.
This was an unannounced focused inspection on 13 January 2023. Inspectors spoke with 12 people, two relatives and four staff. They reviewed care records, medicines records, recruitment files and management documents.
The home was rated Good for Safe and Well-led. Inspectors found that risks were assessed and managed, medicines were given as prescribed, infection control measures were in place and staffing levels were being achieved.
The service had improved since the previous inspection, which was rated Requires Improvement and found breaches of regulations. The provider was no longer in breach. This inspection only assessed Safe and Well-led. The other ratings were carried forward from the previous inspection.
Improved risk management
People with conditions such as diabetes and epilepsy had specific risk assessments and care plans. Risks linked to pressure sores were also monitored.
“People living with long term health conditions such as diabetes and epilepsy had specific risks assessed and care plans in place” from the report
Medicines managed safely
People received medicines as prescribed. Records were accurate, and staff had training and regular checks of their competence.
“People's medicine administration records were accurate and reflected their prescribed medicines.” from the report
Staffing and recruitment
Planned staffing levels were being achieved, staff responded promptly and recruitment checks were in place.
“We observed, and staffing rotas showed that planned staffing levels were being achieved.” from the report
Better oversight
The provider had improved its quality assurance systems and had used an improvement plan following the previous inspection.
“The provider's quality assurance systems had significantly improved.” from the report
Positive culture
Inspectors found that people appeared relaxed and happy with staff. Staff said they could raise issues with the manager.
“Through our observations and speaking with people, staff and nurses, it was clear that the culture within the service was positive and constructive.” from the report
Manager registration
minorThere was no registered manager in post at the inspection. A new manager had applied to register, so families may want to check the progress of this application.
“At the time of our inspection there was not a registered manager in post.” from the report
Recruitment still ongoing
minorThe inspection found enough staff, but recruitment was continuing. It is worth asking how staffing is maintained when there is sickness or turnover.
“There were sufficient staff deployed to meet people's needs and staff recruitment was on-going.” from the report
- 01What is the current position of the new manager's application to become the registered manager?
- 02How do you maintain planned staffing levels when there is last-minute sickness?
- 03How are my relative's individual health risks assessed, recorded and reviewed?
- 04How will you make sure medicines remain accurate and are given on time?
- 05How can residents and relatives give feedback, and how is that feedback acted on?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 10 February 2023 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, May 2020
Rated Requires Improvement; inspectors found kind and responsive care, but serious problems with medicines, staffing, risk management and oversight.
This was an unannounced inspection on 10 and 14 February 2020. Inspectors spoke with seven people, three relatives and nine staff. They reviewed care records, medicines records, staff files and management records.
People generally said they felt safe and were treated kindly. Inspectors found good practice in staff training, consent, respecting people's choices, activities and complaints. The ratings for Effective, Caring and Responsive were Good.
However, risks were not always properly assessed or recorded. Some medicines were given late or missed, infection control was not always followed, and there were not always enough nurses on duty. The home's checks had failed to identify or correct these problems.
The overall rating was Requires Improvement. Safe and Well-led were also Requires Improvement. This was the second consecutive inspection with this rating, and the provider remained in breach of regulations.
Kind and respectful care
People said staff treated them with care. Staff knew people's preferences and supported their dignity, choices and independence.
“People were treated with kindness and compassion. People told us staff treated them with care.” from the report
Staff training and support
Staff had training, supervision and support. The manager had also introduced additional learning on areas such as diabetes and oral care.
“In addition to formal training, the registered manager had introduced a 'Topic of the month' to increase staff's knowledge and practice in key areas of the care they provided” from the report
People's choices
People were involved in decisions about their care. Staff supported people to make choices and gave alternatives when people were unhappy with something.
“People's views and preferences were valued by staff.” from the report
Activities and complaints
People said there was enough to do, with group activities and links to the local community. People knew how to complain and said action was taken.
“People's concerns and complaints were encouraged, investigated and responded to in good time.” from the report
Risks and care records
seriousCare plans and risk assessments did not always explain the support people needed or how staff should reduce risks. Records did not always show clearly that required care had been given.
“People's risks were not always managed safely. Some people had indwelling catheters.” from the report
Medicines
seriousSome medicines were given late or omitted, including time-specific Parkinson's medicine. Records did not always show when time-specific medicines were given, and omissions were not always reported or acted on.
“People's medicines were not always administered as prescribed. On the first day of the inspection there was only one nurse on duty” from the report
Nursing staffing
seriousRota records showed that only one nurse was scheduled for early shifts on nine days in January and nine days in February. Staff said this made it difficult to meet people's needs promptly.
“There were not always enough nurses on duty to ensure people's needs were met.” from the report
Infection control
seriousStaff did not always follow good infection control practice when cleaning and drying equipment. A communal bar of soap was also being used in one bathroom.
“The provider had not ensured staff were practicing correct infection control techniques.” from the report
Weak oversight
seriousAudits and checks did not identify all the problems found by inspectors. The provider did not have a clear system for checking records or confirming that care was delivered as planned.
“The governance arrangements in place in the service had not been effective in identifying the concerns highlighted during the inspection.” from the report
- 01How do you now make sure there are enough nurses on every early shift?
- 02How do you check that time-specific medicines are given on time and that any missed doses are reported and acted on?
- 03How have you improved care plans and risk assessments, including guidance for diabetes, catheters, repositioning and fluid restrictions?
- 04What infection control changes have been made since the inspection, and how are staff checks recorded?
- 05How do your current audits identify gaps in care records and confirm that planned care has actually been provided?
This was an unannounced planned inspection based on the previous rating and covered all five key questions, including the premises and the care provided. This explanation was written from the published report of 2 May 2020 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 Down House
9 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- February 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- February 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2017Requires improvementstayed Requires improvementResponsive: Good
- December 2016Requires improvementstayed Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- August 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 13 January 2011.
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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9 live-in carers within about an hour of Plymouth
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 9 years' experience on average.
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