Delph House

Delph House is a residential care home providing accommodation and personal care to up to 22 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 15 people using the service. Delph House is an adapted property on 2 floors with communal spaces for relaxing and taking meals.

People’s experience of using this service and what we found

Although we noted clear improvements in many areas, this inspection identified some concerns which were similar to those from the last inspection regarding staffing, safeguarding and oversight. The provider has responded by making some immediate changes to the management of the service which has given us some assurance. However, this is the third consecutive inspection this service has been rated Requires Improvement overall.

Safeguarding concerns had not always been robustly managed and information appropriately shared. The provider took action to address this issue immediately, and retrospectively notified CQC of several safeguarding incidents we had not been aware of. Staff had an understanding of safeguarding procedures and most knew how to identify and raise concerns.

Prior to our inspection there had been concerns raised by healthcare professionals about staff’s ability to identify a person’s deteriorating health and take prompt action. This placed people at potential risk of harm. We have judged this is both an English language proficiency issue and a matter of some staff needing further development of their skills and confidence. The provider has assured us they will continue to develop staff language and skills to ensure they can manage people’s health concerns confidently and keep them safe.

Medicines were mostly well managed. A more proactive approach was needed in some cases to ensure people’s potential risks relating to their deteriorating health was always considered, especially those living with dementia.

People were not always supported to have maximum choice and control of their lives as staff did not always support them in the least restrictive way possible. Staff did not demonstrate a good understanding of the Mental Capacity Act (2005) which ensures people consent to their care and treatment. Some staff’s understandable concern for people’s safety was prioritised over their right to make decisions, even if these decisions were seen as unwise. There was a risk people’s rights would not be fully protected and further training and development of staff was required. The provider agreed to take this forward.

People using the service and relatives gave us broadly positive feedback about the care and support provided. People praised the kindness of the staff and there was an acknowledgement that, although further work was required, the service was improving in many areas. Further engagement with staff, people who used the service and relatives was needed to drive the service forward. The provider has been open and honest with us about the challenges the service has faced and we noted improvements in many areas. However, we have noted similar issues at the last 3 inspections which is a cause for concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found although improvements had been made the provider remained in breach of regulations relating to safe care and treatment and good governance. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 15 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Delph House on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches of regulation relating to safe care and treatment and good governance at this inspection. We have also identified a breach of regulation relating to a failure to notify CQC of safeguarding incidents..

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Delph House is a residential care home providing personal care and accommodation to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

People's experience of using this service and what we found

People’s care plans were not robust to ensure that people would be kept safe, and receive consistent support.

People’s care record keeping had not been completed in full in all areas, to demonstrate the level of support the person had received. This did not ensure their individual needs had been met. The provider had not identified this prior to the inspection.

People were not consistently kept safe. The provider lacked an awareness in relation to which safeguarding's had been raised by external bodies and what actions had been completed, this caused a risk that appropriate steps had not been taken.

People continued not to receive a good standards of care. Oversite and governance by the provider remained insufficient to ensure all areas of concern following our last inspection had been actioned.

People’s care environment had improved, ensuring the service was homely and damaged equipment had been removed.

The environment appeared visibly clean and the provider was taking appropriate steps to ensure they were meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 June 2021). The service remains rated requires improvement as an outcome of this inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. However, the provider remained in breach of regulation 12 for failing to assess the risks to people and regulation 17 due to a lack of oversite and governance of the service effecting the quality of record keeping, including care plans and ensuring people were engaged and involved in their support.

Why we inspected

We carried out an unannounced, focussed inspection of this service on 1 June 2021. Breaches of regulatory legal requirements continued to be found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Delph House on our website at www.cqc.org.uk.

Follow up

We have identified a repeated breach of regulation 12 for failing to assess the risks to people and a repeated breach of regulation 17 in relation to the oversite of the care records used within the service and further deterioration for not ensuring people were engaged and involved in their support.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Please see the action we have told the provider to take at the end of this report.

Delph House is a residential care home providing personal care and accommodation to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

People’s experience of using this service and what we found

People’s care environment was found to be visibly unclean with some safety concerns also identified. This did not ensure people were kept safe and protected from harm.

Record keeping had not been completed in full in all areas. The provider had not identified this prior to the inspection.

People told us they felt safe and well supported at the service. Staff were observed to be attentive to individuals needs and supported them in a timely manner.

Staff felt clear in their job role and felt the management were approachable and supportive.

People received their medicines on time, and felt able to raise any concerns with staff when required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 13 August 2019)

Why we inspected

We received concerns in relation to the safe care and treatment of people supported. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to documentation and storage of medicines, infection, prevention and control, management of risks to people, safeguarding people from abuse and effective governance.

Please see the action we have told the provider to take at the end of this report.

People’s experience of using this service:

People experienced mostly good outcomes of care. The service had recently appointed a new manager who was working alongside the existing registered manager who was on leave at the time of our inspection. Once registered the existing manager was going back to the service they originally came from which is owned by the same provider. The service provided safe care to people because it had adequate systems and processes in place to ensure risks were identified and well managed. There were enough staff who were familiar with people’s needs.

People lived in a clean environment and there were plans in place to continue to refurbish and redecorate the home and improve signage which would help people navigate their way around.

People received support to stay healthy and access other services as needed. Staff were sufficiently trained to meet people’s needs and the manager had identified a range of additional staff training to help enhance staffs existing skills. They had also established regular staff supervision and observation of practice.

People were given medicines as needed and staff received the necessary training and assessed as competent before it was prescribed.

Most people were happy with the service provided and there were a range of social activities to support people’s individual needs. Several people said activities were restricted in terms of staff’s availability and there was less to do in the afternoon and evening. Staff were allocated to oversee and provide activities each day but usually in the morning.

Staff were kind and caring and upheld people’s dignity. We were confident that the service was moving forward and there was a clear plan of action and enough management oversight. Some improvements had only recently been implemented and were not yet firmly embedded.

Rating at last inspection: The service was rated Good at the last inspection on 01/11/2016.

Why we inspected: This was a planned inspection to assess if the service was still providing a good service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Delph House can provide accommodation and personal care for 22 older people. It can also accommodate people who have sensory needs, who have a physical disability or who live with dementia. There were 17 people living in the service at the time of our inspection most of whom were older people who lived with dementia.

The service was operated by a company which acted as the registered provider. The company was formed by two directors. One of them was the managing director who was personally involved in overseeing the running of the service. They regularly called to the service to see how things were going. There was also a registered manager who is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In this report when we speak about both the directors of the company and the registered manager we refer to them as being, ‘the registered persons’.

At our inspection on 2 and 3 November 2015 there were three breaches of legal requirements. We found that some people had not been consistently supported to eat and drink enough to stay well. In addition, we found that some people had not received all of the care and reassurance they needed when they became distressed. We also found that quality checks had not been robustly completed and this had led to shortfalls in the service not being quickly resolved. After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 15 December 2015. At the present inspection we found that the necessary improvements had been made to ensure that the three legal requirements had been met. However, we noted that some quality checks still needed to be strengthened further. This was necessary to better enable the registered persons to quickly resolve some remaining problems with how the service was run.

At this inspection we also found that staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. Medicines were safely managed but some additional steps needed to be taken to reduce the risk of accidents. There were enough staff on duty to provide people with the care they needed but a background check had not been completed before a new member of staff had been appointed.

Staff had been provided with support and guidance and they knew how to care for people in the right way. Most people enjoyed their meals but some of them wanted to have more choice. Staff had ensured that people had received all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Although staff respected people's privacy and promoted their dignity this was not fully reflected in the arrangements used when people saw the hairdresser. Confidential information was kept private.

People received all of the practical assistance they needed and had been encouraged to pursue their hobbies and interests. There was a system for quickly and fairly resolving complaints.

People had been invited to suggest improvements to their home and their views had been acted upon. The service was run in an open and inclusive way, good team work was promoted and staff were supported to speak out if they had any concerns. People had benefited from staff acting upon good practice guidance.