David House

Updated 5 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

David House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced. Inspection activity started on 15 February 2022 and ended on 17 February 2022.

What we did before inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We also spoke with four members of staff and the registered manager. We reviewed a range of records. This included four people’s care records and four medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and business continuity plans.

Updated 5 April 2022

About the service

David House is a residential care home providing accommodation and personal care to eight people most of whom have mental health needs. Care and support is provided in one adapted building. There were eight people living in the service at the time of our inspection.

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

The service was short of staff. This was the result of staff leaving the service in November 2021 after it became a legal requirement for all care staff to be vaccinated against COVID-19 unless exempt. The shortage of management and staff resulted in a number of shortfalls. These included, recruiting staff without the correct references in place and staff not being provided with regular supervision. The provider’s quality audits failed to identify and rectify these shortfalls. The registered manager did not have a deputy, assistant, senior or team leader at the time of the inspection. This placed all the responsibilities for leadership and for driving improvements on them and contributed to shortfalls we found.

People’s medicines were administered safely and reviewed regularly by health professionals. The risk of people experiencing foreseeable harm was reduced because people had risk assessments in place. Staff were trained to protect people from abuse and the cleanliness of the environment protected people from infection.

People’s needs were assessed, and they participated in their assessments. Staff received an induction and on-going training to meet people’s needs effectively. People ate well and were supported to access healthcare services in a timely manner.

People told us staff were caring and supported them to maintain important relationships. Staff promoted people’s dignity and independence. People participated in the decisions made about their care and support.

The care and support people received was personalised. People engaged in activities and there were plans in place to increase the range of activities people were supported with. People’s communication needs were assessed and met, and people understood how to make a complaint if they were dissatisfied.

People and staff expressed confidence in the registered manager. There was an open culture at the service and the views of all were gathered. The registered manager and staff worked in partnership with other organisations to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 3 February 2021). 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, environmental safety and food quality. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We found no evidence during this inspection that people were at risk of harm from these concerns. However we have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

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 monitor the service 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 safe care and treatment, premises, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.