CQC report explained · a residential care home
What the CQC found at Downside House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from avoidable harm. Staffing, recruitment, risk management, medicines, infection control and accident reporting were all found to be satisfactory.
- Effective?
- Good
- People received suitable care, food, drinks and healthcare support. Staff training was not always updated on time, but an action plan was in place.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People were involved in decisions about their care and supported to remain as independent as possible.
- Responsive?
- Good
- Care was personalised and reflected people's needs, preferences and communication requirements. People could make everyday choices and take part in activities and relationships that mattered to them.
- Well-led?
- Good
- Inspectors found an approachable management team and effective checks on care, medicines, falls, infection control and the environment. The service had improved since the previous inspection.
What inspectors found, December 2019
Rated Good in all five areas; inspectors found safe, kind and personalised care, with some staff training updates still needed.
Inspectors made an unannounced visit over two days. They spoke with people living in the home, relatives, staff and healthcare professionals. They observed care and checked care plans, medicines records, recruitment files and management records.
People told inspectors they felt safe and were happy with the care. Staff numbers were considered sufficient, medicines were managed safely, and the home was clean and maintained. People received support with food, drinks, healthcare, activities and communication.
Staff were described as kind and respectful. Care plans recorded people's preferences and choices. Inspectors found that the home had improved since the previous inspection, when it was rated Requires improvement and breached three regulations. There were no breaches at this inspection.
Enough staff
Inspectors found sufficient, consistent staff. They saw staff respond promptly and support people without rushing them.
“People were supported by appropriate numbers of consistent, permanent staff.” from the report
Personalised care
Care plans contained detailed information about people's lives, preferences, health and emotional needs. People said they were involved in planning their care.
“People were involved in planning their care and the support they received.” from the report
Kind and respectful staff
Staff built positive relationships with people and supported them in a calm and respectful way. Inspectors saw staff checking that people were comfortable and happy.
“Staff were friendly and polite. Interactions between staff and people were natural and showed positive relationships had been developed.” from the report
Improvement since the last inspection
The home improved from Requires improvement to Good. The previous three regulatory breaches had been addressed and were no longer present.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Overdue training updates
needs fixingNot all staff had completed training updates according to the provider's schedule. The manager knew about this and had an action plan to address it as a priority.
“However, we found that not all staff had completed all training as per the provider's training schedule.” from the report
Patterned communal carpet
minorInspectors said the heavily patterned carpet could be confusing for people with visual or mental impairments. The home planned to replace some areas.
“However, the main communal area of the home and connecting corridor continued to have a heavily patterned carpet in place.” from the report
- 01Which staff still need training updates, and when will all overdue training be completed?
- 02What progress has been made on improving access across the garden for people using wheelchairs or walking aids?
- 03When will the planned replacement of the heavily patterned carpet be completed?
- 04How are you checking that people's choices about when to get up, go to bed and receive personal care continue to be respected?
- 05What happened as a result of the formal complaint that was being investigated at the time of inspection?
This was an unannounced planned inspection covering all five CQC questions, including the care and the premises; no one was receiving end of life care at the time. This explanation was written from the published report of 25 December 2019 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, December 2018
Rated Requires Improvement; inspectors found kind care and enough staff, but identified risks, consent and management problems.
This was an unannounced comprehensive inspection on 9 and 11 October 2018. Inspectors spoke with people living at the home, relatives, staff and professionals. They observed care and checked care records, staff files, complaints, incidents and quality checks.
People generally felt safe and were positive about the care. Staff were kind, respected privacy and dignity, responded to changing needs, and supported meals, activities and healthcare. There were enough staff on duty, and the home was clean.
However, inspectors found important shortfalls. Risks from some equipment were not fully assessed, some cream and as-required medicine guidance was unclear, and Mental Capacity Act records were incomplete. Some people were woken and given personal care very early without evidence this was their choice. Quality checks had not reliably found or fixed these problems.
Kind and respectful care
Inspectors saw friendly, positive interactions. Staff listened to people, protected their privacy and encouraged them to do things for themselves.
“Staff treated people with dignity and respect. Staff understood the importance of respecting people's privacy.” from the report
Enough staff
Staffing levels were sufficient during the inspection, and staff responded quickly in a relaxed and unhurried way.
“There were sufficient numbers of staff on duty to meet people's needs.” from the report
Food and healthcare
People had choices of food, support with eating when needed, and access to health professionals. Nutritional risks were monitored and referrals were made when appropriate.
“People were supported to have enough to eat and drink.” from the report
Activities and relationships
People could choose from activities such as games, crafts, music and reminiscence. The home also supported contact with important people and some community activities.
“People had access to a range of activities and people told us they enjoyed the activities on offer.” from the report
Risks and emergency plans
seriousRisks from bedrails and unrestricted upstairs windows had not been fully assessed or addressed. Personal evacuation plans were out of date, although these were updated during the inspection.
“Risks to people were not always managed effectively and risks posed by equipment had not always been considered.” from the report
Consent and legal safeguards
seriousCapacity assessments and best-interest decisions were missing or incomplete for some care decisions, including the use of bedrails. Several applications to deprive people of their liberty had not been followed up promptly.
“This meant that staff could be providing care and support to people without lawful consent.” from the report
Medicines guidance
needs fixingInstructions for applying some topical creams were unclear, including which cream to use and when. Records for as-required medicines also lacked enough detail to guide staff safely.
“There was not individual guidance available to staff as to when, where and how these creams should be applied.” from the report
Weak quality checks
seriousAudits did not reliably identify problems with daily records, consent, supervision or topical creams. Some improvement actions were late, incomplete or not sustained.
“The systems and processes in place to monitor the quality and safety of the service, were not always robust or effective.” from the report
Limited personal information and environment
minorSome care records contained little information about people's preferences and life history. Signposting, colour contrast and garden access had not been sufficiently improved for people with impairments.
“However, we found that information for some people about their preferences, likes and dislikes and life history was minimal.” from the report
- 01What has changed to make sure bedrails, windows and other equipment risks are assessed and acted on?
- 02How do you now record capacity assessments and best-interest decisions, including for bedrails and personal care?
- 03How do you make sure people are not woken or given personal care early unless this is their choice or lawful best-interest care?
- 04How are topical creams labelled, dated and supported by clear instructions?
- 05How do you check that improvement actions, staff supervision and daily care records are completed and kept up to date?
This was an unannounced comprehensive inspection covering all five questions; the previous inspection in July 2016 had rated the home Good overall. This explanation was written from the published report of 21 December 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.
Every inspection of Downside House
3 rated inspections over 3 years: the service has held its Good rating throughout.
- December 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2015
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 7 December 2010.
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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