The Care Quality Commission
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Archived: Derby House Nursing Home

Overall: Requires improvement read more about inspection ratings

12 Broad Walk, Buxton, Derbyshire, SK17 6JS (01298) 23414

Provided and run by:
Derby House Nursing Home Limited

All Inspections

2 and 18 November 2015

During a routine inspection

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.

16, 23 September 2014

During a routine inspection

When we visited Derby House the service was providing care and support to 25 people. Our inspection was undertaken over two days. We spoke with two people who lived at the home and with the relatives of two others. The focus of the inspection was to answer the five key questions below:

Is the service safe?

Effective processes were not in place to ensure that appropriate information was available for staff relating to the immediate care needs of people who had been admitted in an emergency.

The provider had not taken reasonable steps to record and report instances of suspected abuse.

People were not protected from the risk of infection because appropriate guidance had not been followed and cleaning had not been undertaken effectively. This meant that people were not cared for in a clean, hygienic environment.

Medicines were not managed safely and effectively.

The staff we spoke with told us that they had recently undertaken safeguarding training. They also were able to describe how they would report any suspected incidents of abuse. However following our visit we referred two people to the local safeguarding team. This meant that although staff had received appropriate training they had not acted upon what they had learned.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This meant that the service could identify the risks to people.

Is the service effective?

Staff did not had access to up to date information to help them meet people's needs because updated plans of care were not available within people's records.

Body maps had been completed when it was noted that people had problems with the integrity of their skin. This meant that staff were able to track whether people's skin conditions had improved or not.

Is the service caring?

We observed staff speaking with people in a respectful manner and people appeared relaxed and comfortable in their surroundings. When speaking with staff it was clear that they cared for the people they supported.

One person told us, 'The staff seem to know what they are doing, they are nice to me'.

Two of the people who lived at the home, and both relatives we spoke with raised concerns about the lack of activities at the home. One person told us, 'I have been here around a year. There are no activities, I would like to join in with things but no one has asked me what I like doing'.

Is the service responsive?

The people we spoke with knew how to make a complaint if they were unhappy. We reviewed the records of complaints and found that they had been investigated and responded to in a timely manner.

Is the service well-led?

Effective systems were not in place to manage the effectiveness of the cleaning of the home and the equipment. This meant that areas of the home and some items of equipment had not been effectively cleaned.

Staff had been rushing tasks and making mistakes. Effective systems were not in place to review the skill mix of the staff on duty.

Medications errors had taken place and there were no effective systems to monitor the management of medications.

8, 11 October 2013

During a routine inspection

People receiving care at Derby House told us they were very happy there. One person said, "It's really lovely. The staff are really caring and professional and everyone treats you with respect." Another person said, "This is a super home. Nowhere could be better as far as I am concerned."

We found that people's needs were assessed and their care planned and delivered appropriately at Derby House. We observed people receiving personalised care that ensured their welfare and safety.

We saw that people's consent was obtained for their care, and that proper procedures were used if they could not make their own decisions, for example due to dementia.

We saw that the number of nursing and care staff was adequate and additional staff were always provided where this was needed.

We found the environment was very homely, clean and comfortable and that all equipment used to provide people's care was serviced, clean and safe to use.

We saw that procedures were in place to ensure complaints and comments about the service were responded to appropriately by the provider.

24 May 2012

During a routine inspection

There were 26 people living at Derby House at the time of our inspection visit. We met most people and spoke with eight people to gain their views of the service. We also spoke with two relatives.

All of the people we spoke with made positive comments about living in the home. They told us "Staff treat me well and with respect. I am happy about that" and "It is very nice here. They look after us very well. They certainly look after us". A relative told us "It is great here. I like it very much. I can't think of anything better. We have been able to bring items to make the room comfortable and like home. We can choose what goes in the room. It has a lovely view. I can take my relative out".

We observed positive interactions between people in the home and staff. Staff showed care and concern for people and treated people with respect. We found there was a relaxed and friendly atmosphere in the home.