CQC report explained · a nursing home
What the CQC found at The Devonshire
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2020
River View Care Centre rated Requires Improvement; inspectors found improvements in safety, effectiveness and leadership, but caring and responsiveness were not fully assessed.
Inspectors visited on 28 and 29 September 2020. They focused on Safe, Effective and Well-led because of the COVID-19 pandemic. They reviewed care, medicine and staffing records, spoke briefly with two people, five staff, relatives and professionals, and checked infection control.
The home was rated Good for Safe, Effective and Well-led. Inspectors found better risk assessments, safe medicines, suitable staffing, improved nutrition monitoring, staff training and stronger management checks. They also found the home was clean and had detailed infection control arrangements.
Caring and Responsive were not fully inspected, so they were recorded as Insufficient evidence to rate. The overall rating remained Requires Improvement. This was an improvement from the previous inspection, when there had been several breaches and the home was rated Inadequate in some areas.
Risk management
The home had updated risk assessments and clear actions to reduce risks such as choking, skin damage and missed call bells.
“People had their risks appropriately measured and mitigated to enable them to remain safe.” from the report
Infection control
Inspectors found detailed pandemic arrangements, appropriate protective equipment and a very clean environment.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Food and fluids
People's hydration and nutrition were monitored, with specialist advice sought when concerns arose. Food could be adapted for dietary, religious and cultural needs.
“Drinks and snacks were offered throughout the day and left within reach of people.” from the report
Staff training and support
Mandatory training was fully up to date, and managers checked staff understood what they had learned.
“The provider's mandatory training for all staff was at 100% compliance.” from the report
Improved environment
Five of the six units had been refurbished to better support the people living there, including people with dementia.
“The service had made significant improvement with five of the six units having been completely refurbished to meet the needs of people living there.” from the report
Open management
Staff, relatives and professionals described the home as open and inclusive. The manager used audits, meetings and feedback to oversee improvements.
“The service focused on the need to receive feedback to ensure practice improved and was reflective of how people wanted to be supported.” from the report
Incomplete infection-control record
needs fixingA care plan did not initially show where protective equipment should be put on and removed after arrangements had changed. It was corrected during the inspection.
“However, the care plan had not been updated to illustrate this.” from the report
Audit actions not always signed off
needs fixingOne type of audit showed issues that had not always been marked as completed. The manager corrected this immediately.
“For one audit type we found where issues were noted these were not always signed off to show they had been actioned.” from the report
Limited assessment of caring and responsiveness
minorThese two areas were not fully inspected, so the report does not provide a complete current rating for them.
“Due to the Covid-19 pandemic this inspection focused on three domains only.” from the report
- 01How do you make sure risk assessments and care plans remain up to date when people's needs or infection-control arrangements change?
- 02How do you check that actions identified in audits are completed and signed off?
- 03How will you show us how caring and responsive care is assessed now that these areas were not fully reviewed?
- 04How do you monitor people's food and fluid intake, and what happens when someone is not meeting their target?
- 05How are people's individual preferences, communication needs and first languages recorded and followed?
This was a COVID-19-focused inspection of Safe, Effective and Well-led; Caring and Responsive were not fully reviewed and their previous ratings were not changed. This explanation was written from the published report of 11 November 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.
What inspectors found, September 2019
Rated Requires Improvement and placed in special measures; inspectors found serious weaknesses in leadership, safety, dignity, nutrition and personalised care.
This was an unannounced inspection on 30 and 31 May 2019. Inspectors spoke with people living in the home, relatives, staff and health professionals. They observed care, checked care and medicine records, and reviewed accidents, complaints, staffing and quality audits.
There had been improvements since the previous inspection, but important problems remained. Staff did not always follow care plans for choking risks, repositioning, food and fluids. Records were sometimes inaccurate or incomplete. Inspectors also saw people whose privacy and dignity were not always respected, and activities were not consistently tailored to individual interests.
The home was rated Requires Improvement overall. Safe, Effective, Caring and Responsive were all rated Requires Improvement. Well-led was rated Inadequate because checks and audits did not reliably identify or fix problems.
The home had previously been rated Inadequate and placed in special measures. Although the overall rating improved, it remained in special measures because an inadequate rating had been given in a key question at two consecutive comprehensive inspections. CQC said it would usually inspect again within six months to check for significant improvement.
Medicines
People generally received their medicines safely. Staff administering medicines had been trained and assessed as competent, and guidance was available for medicines given when needed or in a disguised form.
“People were assisted to take their prescribed medicines by staff who were assessed as competent to do so.” from the report
Healthcare support
People could access GPs and specialist professionals when needed. Records showed referrals and prompt contact with healthcare professionals.
“We observed health care professionals being contacted in a prompt manner when someone required specialist input.” from the report
Staff availability
Inspectors saw enough staff to meet people's needs during the inspection. Staffing levels were supported by a dependency assessment and staff rotas.
“We saw that there were enough staff to meet people's needs during the inspection.” from the report
Openness and approachability
The management team was accessible and transparent. People, relatives and staff had opportunities to give feedback through meetings and other ways.
“During the inspection, we found the management team to be accessible, honest and transparent.” from the report
Risks were not always managed
seriousStaff did not always follow care plans for choking or repositioning. One person did not have a call bell until inspectors raised the issue.
“People were at risk of choking and measures to reduce the risk were not always being followed.” from the report
Food and fluids
seriousRecords did not consistently show that people at risk of malnutrition, dehydration or skin damage received the required snacks and fluids.
“Staff failed to consistently monitor food and fluid intake or take appropriate action in line with people's care plan.” from the report
Dignity and privacy
seriousSome staff did not ask permission before providing care. Inspectors also saw an open bedroom door during personal care and private medical information displayed where passers-by could see it.
“People were not always asked for permission or informed of the care that would be delivered before staff delivered care.” from the report
Weak quality checks
seriousAudits did not reliably identify repeated problems, such as slow call-bell responses. Actions were sometimes vague and did not say who was responsible or when they should be completed.
“This audit failed to identify trends and themes and actions taken were not effective in reducing response times to call bells.” from the report
Recruitment checks
seriousSome recruitment records did not show that reasons for leaving previous jobs or satisfactory evidence of conduct had been checked.
“There remained some areas where the required information was lacking.” from the report
- 01How do you now make sure staff follow care plans for thickened fluids, pureed food and regular repositioning?
- 02How are food and fluid charts checked each day for people at risk of malnutrition, dehydration or skin damage?
- 03What has changed to protect people's privacy, dignity and consent during personal care?
- 04How do you make sure activities are based on each person's interests, and how do you record that they took place?
- 05What actions have been completed in response to the special measures and the conditions on the registration?
This inspection looked at all five CQC key questions, the care provided and the premises, and followed earlier inspections where the home had been rated Inadequate and placed in special measures. This explanation was written from the published report of 5 September 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.
Every inspection of The Devonshire
4 rated inspections over 2 years: the service has improved, from Inadequate to Requires improvement.
- November 2020Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: GoodCaring: Insufficient evidence to rateResponsive: Insufficient evidence to rateWell-led: Good
- September 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2019Inadequatestayed InadequateSafe: InadequateWell-led: Inadequate
- November 2018InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- July 2017
Registered with the Care Quality Commission on 30 July 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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