Archived: Derby House Nursing Home

Updated 23 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 2 and 18 November 2015. The first day of the inspection was unannounced.

The inspection team was made up of two inspectors and a specialist adviser. The specialist adviser was a qualified nurse.

Before the inspection visit we looked at information we held about the service, for example enquiries and notifications received. A notification is information from the provider about the service they provide. We also spoke with Healthwatch who told us they held no information on this provider. We also spoke with the Local Authority.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we spoke with the providers, the registered manager, one nurse and four care staff. We also spoke with eleven people who used the service or their relatives. We looked at care plans for three people and pathway tracked these. This is a way of following the systems and processes around caring for individuals that ensures their care is undertaken in a proficient and safe way. We also looked at three staff records and various quality audits that had been undertaken in the home.

Following the inspection we spoke with one professional who was a regular visitor to the service.

Updated 23 March 2016

We undertook this inspection on 2 and 18 November 2015. The first visit was unannounced.

Derby House Nursing provides care and support for people, many of whom are living with dementia. The home is registered to accommodate 31 people; at the time of our inspection 21 people were living there.

Accommodation was provided over three floors and there was a lift installed. The Victorian building overlooks a park and has a mixture of large and small rooms. Some rooms had ensuite toilets. There were communal toilets and bathrooms.

At the time of our inspection there was a registered manager in place. A registered manager 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 of the Health and Social Care Act 2008 and associated Regulations about how the service was run.

At our previous inspection on 16 and 23 September 2014 we found that the provider did not have effective processes in place to ensure the care and welfare of people who were admitted to the home in an emergency. The provider had not taken reasonable steps to record and report instances of suspected abuse. Also, there were not effective processes in place to monitor the standard of cleaning of the premises and equipment nor were people protected from the risks associated with the unsafe management of medicines. In addition, appropriate arrangements were not in place to assess the skill mix of staff required to provide appropriate care for people.

These were respective breaches of Regulations 9, 11, 12, 13 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection the provider told us what action they were going to take to rectify the breaches and at this inspection we found that improvements had been made with regard to Regulations 9, 11 and 13.

At this inspection we found people were not cared for in a way that met their needs and reflected their preferences. Also the requirements of the Mental Capacity Act 2005 had not been followed. These were breaches of Regulation 9 and Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations

People told us they felt safe and were protected from the risk of abuse or avoidable harm. However, we found that the auditing of medicines was inadequate and there was not a safe handover from one nursing shift to the next. There were not safe practices around cleanliness and cross contamination as there was insufficient equipment available for staff to decontaminate their hands.

There were sufficient staff on duty to meet people’s personal care needs. Staff were knowledgeable about the people who used the service and were aware of their roles and responsibilities. They had the skills, knowledge and experience required to support the people who were resident in the home. Appropriate checks had been carried out to ensure that staff who were recruited were appropriate to be caring for people. There were caring and positive relationships between staff and the people who lived in the care home. However, people were not always treated with dignity and we saw personal care being delivered without screening.

Consent to care and treatment was not sought in line with legislation and guidance and not all staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported to have enough to eat and drink and the meals were nutritious and well planned. Food was cooked from fresh ingredients. People were also supported to have good health and the provider was in frequent contact with health care professionals as appropriate.

People did not always receive care that was personal to their needs and they were not always supported to pursue their own interests and activities. There was very little community activity undertaken in the home and people spent most of the time alone in their rooms.

Quality audits were undertaken on a regular basis by the provider. These included checking whether the home was clean, that equipment was safe and that people were happy with the quality of care they received. These were not effective at identifying shortfalls in care at the home.

Residents meetings were undertaken where residents were invited to express their views about the care and support they received.