Darlington Court

Darlington Court is a residential care home providing personal and nursing care to up to 61 people in purpose-built accommodation. The service provides support to older people, many of whom have dementia, and younger people with disabilities. At the time of our inspection there were 41 people using the service.

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

Improvements in systems for infection prevention and control had been sustained and there was no longer a breach of regulations.

There was inconsistent practice regarding record keeping and people’s care was not always fully documented. This meant the provider could not always be assured that people had received the care they needed. Shortfalls in record keeping had been identified through the provider’s quality monitoring systems but actions had not yet been taken to fully address the issues. We did not identify a negative impact on people’s quality of life, but this is an area of practice that needs to improve.

People were receiving a personalised service from staff who knew them well. People told us they felt safe living at Darlington House. Staff demonstrated an understanding of their responsibilities for safeguarding people and risks to people were assessed and managed appropriately.

There were enough suitable staff to provide people with the care they needed. People and their relatives spoke highly of the staff and the care they received. One person told us “They are caring and I get on with them all.” A relative told us, “The staff seem caring. They take an interest in what my relation likes. If she’s unhappy they try to understand why.”

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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.

The registered manager was well thought of by people, their relatives and the staff. One relative told us, “I would say it is well managed.” A staff member said, “It feels like a family here, the manager is very supportive.”

There was a positive culture and staff were focussed on supporting and improving people’s quality of life. People were achieving good outcomes, including improvements in their health and well -being. People, relatives and staff told us they would recommend the home. A staff member told us, “I am happy working here and I would definitely feel happy for a family member to come here. We try and provide everything we can for people to make it a good place to live.”

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 17 February 2021) and there was a breach of regulations. 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. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (published on 10 March 2020) to calculate the overall rating. The overall rating for the service has changed from requires Improvement to good. This is based on the findings at this inspection.

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

Follow up

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

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

We found that staff did not always follow policies and procedures that were put in place to protect people and staff during an outbreak of COVID-19. We identified issues in the way people were admitted to the service, staff following specific safety procedures and the recording of some cleaning tasks designed to reduce the risk of infection.

There were enough staff working to provide the support people needed. However, the COVID-19 pandemic had created an increased level of sickness amongst staff and required the high usage of agency staff and the need for permanent staff to carry out tasks that were not usually part of their role.

Staff were wearing appropriate PPE in-line with government guidelines. Staff had completed infection prevention and control (IPC) training. People received their medicines safely, when they needed them. COVID-19 testing was in place and the management of the service worked closely with other stakeholders, such as the Local Authority and Public Health.

People received care from kind staff who were committed to keeping them safe and meeting their needs. Quality assurance systems were in place and ensured good quality care in many aspects of the service. Staff felt supported by management, and senior managers had implemented systems and training to drive improvement of the shortfalls identified.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

Rating at last inspection

The last rating for this service was Good (published 10 March 2020).

Why we inspected

We first undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about an outbreak of COVID-19. A decision was made for us to inspect and examine those risks. Subsequently after the first day of inspection, the provider received test results that confirmed a further significant number of people living at the service had contracted COVID-19. After these test results, a decision was made for us to inspect and examine those further risks. We returned for a second day and undertook a focused inspection in light of concerns we had received. We reviewed 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.

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 Darlington Court on our website at www.cqc.org.uk.

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.

We found the following examples of good practice.

Visiting was by arrangement and people were required to complete a health checklist and were told about the infection precautions required for visiting the home on arrival. There was clear signage in corridors and communal areas to remind people about social distancing.

A virtual tour of the home was made available to people and family members ahead of admission.

Seating in communal areas supported social activities whilst managing distances safely

Darlington Court is a nursing home providing residential and nursing care to 48 people with a range of health needs, including people living with dementia, at the time of the inspection. The home can support up to 61 people. Accommodation is provided over two floors, accessible by a lift and stairs. There is a dedicated unit on the ground floor for people living with dementia. All rooms have en-suite facilities.

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

People told us they felt safe living at the home. They were protected from the risk of abuse and harm by staff who had been trained appropriately and knew what action to take if they had any concerns. Risks to people had been identified and assessed, with guidance for staff on how to support people, which was followed. Staffing levels were sufficient and had been assessed based on people’s needs; new staff were recruited safely. Medicines were well managed. The home was clean and smelled fresh.

Before people came to live at the home, their needs were assessed, to ensure the home could provide the level of care and support they required. People’s care and support needs were continually reviewed and assessed. People received care from suitably trained staff and were encouraged in making decisions relating to their care. 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.

People were supported to eat and drink in a healthy way and had a choice of menu; specialist diets were catered for. A relative commented, “Mum enjoys her food and often only eats soup and sandwiches which is her choice. The food is cooked to perfection and they always make her choice of sausage sandwiches for breakfast”.

Staff were warm, kind and caring with people. People’s diverse needs were identified and catered for, so that care was delivered in a personalised way that met people’s preferences. People were treated with dignity and respect. People confirmed there were enough staff on duty.

Care plans were detailed and reviewed with people and their relatives. People and their relatives confirmed they had care plans and they were fully consulted about their needs. Activities were planned in line with people’s preferences and what they were interested in. People’s communication needs had been identified, so that staff communicated with them in a way that suited them. Complaints were managed in line with the provider’s policy. If it was their wish, and their needs could be met, people could live out their lives at the home.

People were happy living at the home and their relatives spoke positively about the home, and of the registered manager and staff. Feedback was obtained through residents and relatives’ meetings. People and their relatives could also post comments into a box near reception. A robust system of audits monitored and measured the care provided and the service overall. The service worked in partnership with others to benefit people’s care.

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 13 February 2019).

At this inspection we found improvements had been made. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Darlington Court is situated in Rustington in West Sussex and is one of a group of homes owned by a national provider. Darlington Court is registered to accommodate 61 people. At the time of the inspection there were 46 people accommodated in one adapted building, over two floors. Each person had their own room and ensuite bathroom. The home provided accommodation for older people, those living with dementia and people who required support with their nursing needs. People's needs included physical disabilities, diabetes and epilepsy.

At the first comprehensive inspection on 24 and 25 February 2015, the home was rated as Requires Improvement and breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 were found. At the next scheduled inspection on 24 May and 2 June 2016, the home had improved and was rated as Good'. At this inspection on 3 January 2019 the rating of the home changed to Requires Improvement. This is the second time the home has been rated as Requires Improvement. This was because there was mixed feedback from staff about the leadership and management of the home. Some staff told us that the registered manager was approachable and supportive. Other staff told us that they did not feel able to approach the registered manager if they encountered problems of concerns. This was fed back to the registered manager and regional director who told us they would discuss this with staff to further identify the issues and to help find a solution.

Quality assurance processes were not always effective. The provider's audits had identified some of the shortfalls that had been found as part of this inspection. Action had been taken to make changes, however this needed further improvement. This related to records not being sufficiently maintained as well as mental capacity assessments not being completed for specific decisions relating to people’s care. Other shortfalls that were found as part of this inspection, however, had not been identified by the provider. These included ensuring that all people had access to appropriate pressure relieving equipment when required. In addition, the involvement of people and relatives in discussions about people’s care was not documented to demonstrate this had taken place.

Assessments had been undertaken to determine people’s needs to enable them to maintain their health. One person, had been assessed as being at a high-risk of developing pressure wounds. Although they had received appropriate support from community nurses when they had sustained a pressure area wound, they did not have access to appropriate pressure-relieving equipment to maintain their health. Staff were unable to provide an explanation of what setting the person’s pressure relieving mattress should be set to. Guidance had not been provided to staff to inform their practice. This meant that staff could not assure themselves that the person was using a suitable piece of equipment to prevent further pressure damage. When this was fed back to the registered manager, immediate action was taken and the mattress was replaced.

The home had a registered manager. A registered manager is a ‘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 home is run. Since the previous inspection on 24 May and 2 June 2016, the registered manager of the home had changed. The management team consisted of the registered manager who had been in post for one year, a clinical lead and two unit managers. A regional director regularly visited the home to conduct quality assurance audits and provide support to the management team and staff.

The provider’s aims of creating a home-from-home environment were shared amongst the staff team and implemented in practice. People told us that they felt comfortable and at ease. People, their relatives and staff were involved in decisions related to the running of the home. They told us that their views and suggestions were listened to and respected and that they felt able to raise concerns about their care.

The provider and registered manager saw the importance of partnership working. They worked with the local authority and external healthcare professionals to ensure people received coordinated care. There was shared learning between the provider’s other homes and regular meetings helped ensure that good practice was shared.

People told us that they felt safe. They were protected from abuse and discrimination. Sufficient numbers of skilled staff ensured people’s physical and emotional needs were met.

Risks to people’s safety were identified and mitigated. Infection control was maintained.

People’s needs were assessed and reviewed. People received personalised care and were actively involved in discussions in relation to it.

People had access to medicines when they needed them. Medicines were managed safely. People received support from external healthcare professionals when required. People were complimentary about the effect that the care they had received had had on their health.

People could plan for their end of life care to help ensure their comfort was maintained and their wishes were respected.

Staff were kind and caring. People were supported sensitively and their privacy and dignity were maintained. Positive relationships had developed between people as well as with staff. Compassionate interactions were observed and staff took time to interact with people. Staff were mindful of supporting people in a way that met their needs. When people displayed signs of apparent anxiety, staff took time to listen to them and offered distraction techniques. People were calm and settled after their interactions with staff. Comments from people included, “I think they’re marvellous” and “They are very good with me”. A relative told us, “They have time for everybody. I’ve never heard staff here be unkind about anybody and you can have a laugh with them”.

People had access to sufficient quantities of food and drink to maintain their nutrition and hydration. People told us that they enjoyed the food and that they were provided with choice.

People had access to an environment that met their needs. Communal areas, as well as private spaces, enabled people to spend time on their own or with others.

People were not socially isolated. Planned group activities, as well as one-to-one interaction between people and staff, enabled people’s social needs to be met. People were observed to be engaged. They were laughing, smiling and enjoying the interaction and stimulation that was provided.

People were encouraged to be independent. Some people could independently move around the home and chose how to spend their time. Records advised staff that some people enjoyed undertaking household chores and encouraged staff to involve people where possible.

People were involved in their care and in the running of the home. Concerns that had been raised had been listened to and dealt with. People and their relatives told us that they were happy with the care people received. They spoke fondly of the staff and of the registered manager and told us that they felt that the home was a nice place for people to live.

Darlington Court provides nursing and residential care for people with a range of health needs, including physical frailty and dementia. It is registered for up to 61 people and at the time of our inspection, 31 people were living at the home. Darlington Court is a purpose built nursing home surrounded by landscaped gardens and patio areas. The home is divided into five units: Milton and Shelley on the ground floor provide residential care to older people and people living with dementia. On the second floor, three units: Byron, Elliott and Keats, provide nursing care. The majority of rooms are of single occupancy, with five double rooms. Each unit has communal areas comprising a sitting room and dining room with kitchenette.

A registered manager was in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection took place on 24 and 25 February 2015. As a result of this inspection, we found the provider in breach of a number of regulations and asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and required standards were now being met.

Sufficient numbers of suitable staff were employed to keep people safe and meet their needs. People risks had been identified and assessed and were reviewed monthly. Environmental risk assessments were also completed. Medicines were managed safely. Checks were made on new staff before they commenced employment. People said they felt safe living at Darlington Court.

Staff had been trained in a range of areas and received individual supervision as well as attending staff meetings. New staff underwent a period of induction and followed the Care Certificate, a universally recognised qualification. Staff had a good understanding of their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and put this into practice. People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. They had access to a range of healthcare professionals and services. The ground floor at Darlington Court had recently undergone a period of refurbishment and all rooms had en-suite facilities.

People were looked after by kind and caring staff who knew them well. Staff were encouraged to sit and chat with a different person they did not know well in a daily event entitled, ‘Tea at 3’. People were supported to express their views and to be involved in decisions about their care. They were treated with dignity and respect. Some care plans contained guidance about people’s end of life wishes.

Handover meetings were organised between each change of staff shift which enabled information to be shared about people’s care needs in an effective way. Before people were admitted to the home, a pre-assessment was completed which formed the basis of their individualised care plan. A range of planned activities was available to people. Complaints were managed in line with the provider’s policy.

The home had undergone a period of change relating to the care provision and a change of registered manager since the last inspection. Systems were in place to measure the quality of care delivered and drive continuous improvement. Staff felt well supported by management and people and their relatives attended monthly meetings to feed back their views about the service. The registered manager was involved in various initiatives and worked in partnership with other agencies.

The inspection team was made up of two inspectors and an expert by experience. During the inspection we considered how people were cared for in each part of the service. We looked at the care provided to people who have dementia or mental health needs, to elderly people who required nursing care, and also to those who required rehabilitation.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff who supported them and from looking at records. Records we examined included care records, staff rotas, staff training records and records related to the provider's quality assurance processes.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no one who currently lived at the service was subject to a DoLS authorisation. The manager demonstrated an understanding of DoLS and there were policies and procedures in place that the manager and staff could refer to if needed.

People who use the service have been protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The systems in place to make sure that the manager and staff learned from adverse events such as accidents and incidents were not sufficiently robust. Whilst statistical information regarding the number of incidents had been recorded, there was no analysis of this information to identify patterns in order to reduce the recurrence of such incidents.

Is the service effective?

People who have capacity to make decisions for themselves have been asked to give their consent to the care and treatment provided. However, where people have been assessed as not having capacity, best interest meetings had not been held with families and other professionals involved in the person's care to ensure the individual's human rights have been maintained.

We found that people's nutritional needs were met. However, we observed that the lunchtime experience in the dining area used by people who lived with dementia was not a positive one. People routinely had to wait over 40 minutes from the time the meal was served before they were helped to eat their meal. This meant any hot food that had been served was cold by the time the person could eat it. Care staff who assisted people to eat their meal did not ensure the pace was dictated by the person and encouragement was not given where needed.

Whilst people's needs had been assessed, care planning systems were not effective. Care records did not include sufficient information for nursing and care staff to ensure people's needs had been consistently and effectively met. Some care records had not been reviewed at sufficiently regular intervals to ensure they reflected the current needs of individuals.

The quality monitoring systems at the service were not sufficiently robust. The system demonstrated that routine audits took place and action plans had been drawn up where necessary to address any shortfalls. However, there was no evidence to demonstrate that their implementation had been monitored to ensure they were effective in making the improvements required.

Is the service caring?

People who received nursing care and rehabilitative care told us that they were very happy with the care they received. One person told us, 'The staff are wonderful. They are very good and helpful. Another person said, 'Everything's hunky-dory. I can't complain.'

Our observations of the care provided to people who lived with dementia indicated they did not receive the same quality of care. We observed people having to wait for up to 50 minutes before they received the care they required. When they received care and support to eat their meal the care staff did not engage with people to ensure they ate and drank enough and to ensure the mealtime was a pleasant experience. They were not offered choices with regard to what they wished to drink.

Is the service responsive?

Although the views and opinions of people and their relatives about the service were sought, there was no evidence to confirm they had been taken into account when changes had been made.

People's care needs had not been reassessed and their care records were out of date. Information in care records were not sufficiently detailed to guide staff on people's current care and treatment.

People who lived with dementia experienced care and treatment that was task centred rather than in response to their individual needs and preferences.

Is the service well-led?

The provider has created two posts, known as unit managers. A trained nurse has been appointed to each of them. They have been responsible for oversight of the day to day running of the physical frail unit (PFU) and the mentally frail unit (MFU). The deputy manager has responsibility for oversight of the rehabilitation unit. The general manager, who has also been registered with the Commission, has been responsible for the entire provision of service.

Care workers we spoke with were able to describe their roles and responsibilities and what they were expected to do.

They also confirmed they felt well supported by their manager. However, they were unable to confirm that formal supervision sessions and staff meetings were held routinely to ensure effective communication between the managers and all the staff employed at the service.

We spoke with two care assistants who explained what they were expected to do to ensure people's needs had been met safely. This included supporting people with their care and treatment needs.

We spoke with a team of physiotherapists and occupational therapists who were based at Darlington Court. They told us about the systems that had been put in place to manage and to provide treatment to people.

We also spoke with the manager, the clinical lead and a registered nurse. They explained to us how care and treatment records have been managed to ensure people have been protected against the risk of receiving unsafe or inappropriate car or treatment. We found that records we looked at demonstrated that people's needs had been assessed and appropriate care and treatment plans had been drawn up.

The manager also advised us how staffing levels have been determined to ensure there are sufficient numbers and skills mix to meet the needs of people accommodated. Duty rotas we looked at confirmed the numbers and skills mix of staff that had been provided.

We also spoke with two relatives whose family members had been admitted for long term care. They also confirmed their satisfaction with the care and treatment provided. One relative informed us, “The home and people within it are very caring. The manager is prepared to sort out any problems we have. The staff care and are so kind.” A second relative commented, “Darlington Court is a happy, caring place with jolly good staff – that includes everyone.”

People we spoke with said that the manager visited them in hospital to assess their needs. We found that care records we looked demonstrated that people’s needs had been assessed and appropriate care plans had been drawn up. This included nursing care and also physiotherapy treatment. This meant that people's care and treatment needs had been managed safely by the service.

On this occasion we concentrated our inspection on experiences of people who have received rehabilitation and treatment between discharge from hospital and their return home. We spoke with five people who have received this service. We also spoke with two relatives.

People we spoke with confirmed that the manager visited them in hospital to assess their needs. However, the care and treatment provided fell below the expectations of people. For example, one person told us, “I was told there would be a lot of physiotherapy, both morning and afternoon. This is what sold it for me. When it started, they would come in to me for 15 minutes each morning, nothing more.”

They also told us the care staff were kind and hard working. The general opinion was that there was not enough staff on duty to meet the needs of people accommodated. We were given several examples when people had to wait half an hour, and sometimes an hour, before they received assistance.

We found that there were significant gaps in care records and there was no evidence that care plans had been designed to meet individual needs. This meant that people's care needs were not being managed safely by the service.