CQC report explained · a nursing home
What the CQC found at Downlands
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were identified and managed, medicines were given safely, and there were enough staff. The home had safe recruitment, infection control and emergency arrangements.
- Effective?
- Good
- People's needs were assessed broadly, staff had relevant training and support, and staff understood consent and capacity requirements. People had enough food and drink and were supported to access health services.
- Caring?
- Good
- Staff were gentle, respectful and patient. People were involved in their care, supported to remain independent and treated with dignity.
- Responsive?
- Good
- Care plans were personalised and updated when people's needs changed. People had activities and social contact, and complaints were recorded and addressed.
- Well-led?
- Good
- The manager provided visible leadership and staff understood their roles. Quality checks, feedback and action plans were used to identify and make improvements.
What inspectors found, September 2018
Rated Good; inspectors found safe, kind and personalised care, with improvements sustained since the previous inspection.
The inspection was unannounced and took place on 8 May 2018. One inspector and an expert by experience spoke with people living at the home, relatives, a visitor, staff and the manager. They observed care and checked care records, medicines records, staff files, accident records and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines arrangements, suitable training, kind and respectful care, personalised care plans and effective checks on quality.
The previous inspection in April 2017 had found problems with risk management, dignity, care plans and keeping improvements in place. At this inspection, the provider had followed its action plan and inspectors found these improvements had been addressed and sustained.
Risks managed safely
The home had improved its approach to identifying and managing risks since the previous inspection. Care plans gave staff clear guidance, including for pressure wounds and falls.
“At this inspection on 8 May 2018 we found that the provider had followed their action plan, risks were being managed safely and this breach of regulations had been addressed.” from the report
Kind and respectful care
Inspectors saw staff protecting privacy and dignity, taking time with people and supporting their choices. People and relatives spoke positively about the staff.
“I don't feel rushed, the staff are very respectful and always kind.” from the report
Personalised support
Care plans covered people's health, emotional, spiritual and social needs. Staff knew people's preferences and supported communication, activities and independence.
“Care plans were detailed and person centred. They reflected the physical and mental health needs of people as well as their emotional, spiritual and social needs.” from the report
Quality improvement
The home used audits, feedback, complaints and incident records to find problems and make changes. Inspectors found that earlier improvements had been maintained.
“Quality assurance systems and processes were consistently used to identify shortfalls and drive improvement.” from the report
One vacant post
minorThere was one vacant staff post at the time of the inspection. Agency staff were used to cover vacancies or absences, although inspectors said this use was minimal.
“There was some use of agency staff to cover for vacancies or staff absence but this was minimal.” from the report
Occasional call bell waits
minorOne person said call bells sometimes took a while to be answered. Inspectors observed that people were not waiting longer than they should for their care needs.
“We have to wait awhile sometimes but usually it's fine.” from the report
- 01Has the vacant staff post mentioned in the report been filled, and how much agency staff is now used?
- 02How quickly are call bells answered, and how is this checked?
- 03How are risks such as falls, pressure wounds and diabetes monitored and reviewed?
- 04What renovations have been completed since the report, including the carpets and hallway decoration?
- 05How are people's care plans reviewed when their needs or choices change?
This was an unannounced inspection of the overall quality of the home, including the premises and care, and it assessed all five key questions. This explanation was written from the published report of 4 September 2018 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, June 2017
Rated Requires Improvement; inspectors found kind staff and some good care, but risks, records, dignity and management checks were not consistently good enough.
This was an unannounced inspection on 11 April 2017. Two inspectors spoke with people living at the home, relatives, staff and a visiting health professional. They also checked care records, medicines, staff files, accident records and quality checks.
The home had improved since the previous inspection. People were offered more choices and care was more person centred. However, inspectors found problems with wound care, environmental safety, mental capacity decisions, care records and the way some meals were provided.
The overall rating and all five question ratings were Requires Improvement. This means the home was not consistently meeting the expected standard. One regulation was breached, relating to safe care and treatment.
Kind staff
People and relatives spoke positively about staff. Staff knew people well and supported them to express their views.
“The staff are very kind, couldn't be nicer.” from the report
Safe medicines
Inspectors observed medicines being given safely. Medicine records were completed consistently and guidance was in place for medicines given when needed.
“People's medicines were administered, recorded and disposed of safely.” from the report
Food and health support
People could choose what to eat and received enough food and drink. The home supported people to see health professionals when needed.
“People had enough to eat and drink and were supported to access health care services when they needed them.” from the report
More choice
The earlier problem with person centred care had been addressed. People were offered more choice about meals, and when they got up or went to bed.
“At this inspection we found that there had been a number of improvements and the breach had been addressed.” from the report
Good staff morale
Staff said they worked well as a team and understood their responsibilities. Inspectors found strong links with local health and social care professionals.
“We found that staff morale was good and that staff were clear about what was expected of them.” from the report
Wound care records
seriousDressings were not always changed as advised, and records did not always show what had happened. This created a risk that wounds would not receive safe and appropriate care.
“Staff were not always sure that dressings were being changed in line with the recommendations to maximise healing and safe care of people's wounds.” from the report
Environmental safety
seriousA bathroom used by people was being used for storage. It was cluttered, had a trip hazard and had an insecure, rusty support rail.
“The room was cluttered and untidy and this posed a trip hazard for anyone using the bathroom.” from the report
Emergency evacuation
seriousThe home had not assessed the risks when few staff were on duty, such as at night. Equipment needed to help people downstairs during a fire was not in place.
“They did not have equipment such as evacuation chairs, in place that would enable staff to assist people downstairs in the event of an emergency.” from the report
Out-of-date care plans
needs fixingSome care plans did not match people's current needs. This included diabetes monitoring and insulin information, creating a risk of inappropriate care.
“This meant that this person was at risk of receiving inappropriate care because records had not been updated to reflect changes.” from the report
Dignity at mealtimes
needs fixingSome meals were provided in a task-focused way. People were not always offered choices about aprons, seating or the room atmosphere, and staff interaction could be limited.
“These observations showed that staff were focused on the task and not on providing a positive experience for the person.” from the report
Complaints not always heard
needs fixingSome relatives felt their concerns received a defensive response or were not acted on. Some concerns were not recorded, so the home could not show what action had been taken.
“Two relatives told us about complaints that they had raised where they felt staff considered them to be "moaning” from the report
- 01How are wound dressings checked and recorded now, and who reviews them when a dressing is missed?
- 02What changes have been made to the downstairs bathroom and to the home's emergency evacuation arrangements?
- 03How do you make sure care plans and medicine records are updated promptly when a person's needs or treatment changes?
- 04How will staff protect people's dignity and choice during meals?
- 05How are complaints and informal concerns recorded, investigated and used to make improvements?
This was an unannounced inspection covering all five CQC questions and checking whether the provider had addressed the previous breach about person centred care. This explanation was written from the published report of 28 June 2017 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 Downlands
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- September 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2015
Registered with the Care Quality Commission on 3 February 2015.
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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46 live-in carers within about an hour of Brighton and Hove
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Most charge £1,020 to £1,280 a week. 37 can care for a couple. 10 years' experience on average.
“Lottie showed incredible patience and empathy, adapting her routine to fit in with Mum's moods. Most importantly, Lottie's cheerful manner helped Mum to get some enjoyment out of life.”
“He was infinitely patient with them and got on very well with us to the extent that we now regard him as a personal friend.”
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