Darlington Court is a privately owned care home that provides care for up to 61 people. The care home provides care for up to 26 older people who have dementia or mental healthcare needs and for up to 15 frail elderly people with nursing needs. Up to 20 places have been allocated as community beds. They are for people who are receiving rehabilitation after surgery or other hospital treatment, before returning home, or who are receiving treatment in order to avoid admission to hospital.
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.