Archived: The Dulwich Care Centre

Updated 13 August 2015

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 is 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.

We undertook an unannounced inspection of this service on 27 and 28 May 2015. The inspection team consisted of two inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we viewed the information we held about the service including any statutory notifications received. We also spoke with a representative from the local authority that funded the majority of placements at the service. This person led on monitoring compliance with the service improvement plan which was put in place following our previous comprehensive inspection on 13 and 14 November 2014.

During our inspection we spoke with six people using the service and six people’s relatives. We spoke with 18 staff, including the interim manager, the clinical nurse manager, the activities coordinator, the maintenance officer and members of the care team. We viewed nine people’s care records. We undertook general observations and formal observations using the short observation framework for inspections (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. The expert by experience participated in the lunchtime meal to assess the quality of food provided. We reviewed medicines management processes. We viewed records relating to the management of the service including incident records, complaints and audits to assess the quality of the service. We viewed records relating to staff including training, supervision and appraisal records.

Updated 13 August 2015

The Dulwich Care Centre is a care home with nursing. The service provides personal care and nursing care to older people with physical disabilities and those living with dementia. The service can accommodate up to 92 adults across four floors. We undertook an unannounced inspection to the service on 27 and 28 May 2015. At the time of our inspection 50 people were using the service, and one of the floors was closed. The service was operating across three floors, two providing residential care to people with dementia, and one providing people with general nursing care.

At our previous comprehensive inspection on 13 and 14 November 2014 the service was in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. We undertook an inspection on 11 February 2015 to follow up on five of the breaches, including follow up of a warning notice issued in relation to care records. We found at that inspection that the five breaches had been addressed and the service was meeting the regulations inspected. These related to managing complaints, monitoring the quality of the service, safe staffing levels, maintaining accurate care records, and adhering to their registration requirements.

At this comprehensive inspection we followed up on the three outstanding breaches relating to: involving and respecting people that use the service, care and welfare of people and supporting workers. At this inspection on 27 and 28 May 2015 we found that action had been taken to address the previous breaches.

Since our previous comprehensive inspection on 13 and 14 November 2014. Management of the service had changed. The previous registered manager had left the service and a new manager was in the process of being recruited. An interim manager was in post at the time of our inspection. 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.

At this inspection we found that people were provided with safe and appropriate care. People’s needs were assessed and care plans were developed which informed staff how to support the person to manage those needs. Plans were also in place to address any risks to the person, and to maintain their safety and welfare whilst at the service.

Staff treated people with dignity and respect. Staff were aware of people’s individual needs, for example any communication, dietary or health needs and provided them with the appropriate support. People were safely supported by staff with their medicines.

People were involved in decisions about their care. The staff were aware of their responsibilities under the Mental Capacity Act 2005 and decisions were made in people’s ‘best interests’ if they were assessed as not having the capacity to make decisions about their care. Relatives were involved as appropriate in people’s care decisions. The management team were aware of the processes around the Deprivation of Liberty Safeguards, but further training was required to the rest of the staff team to ensure people were not unduly restricted from leaving the service.

A new activities programme had been established and group activities were regularly held. The team had started to build links in the local community and people were being supported to attend community events and activities. Some people would benefit from further one to one activities, and the service was hoping to implement this once the activities team was fully established.

People, and relatives, were asked for their feedback about the service and changes were made in response to the feedback received. The management team regularly reviewed the quality of the service and made improvements where required. Managers ensured any changes were discussed with the staff team.

Leadership and management of the service had been strengthened. Staff were being empowered and encouraged to take on additional duties. Staff were supported through supervision sessions and regular staff meetings. A full training programme had been established and staff had been supported to attend courses to develop their knowledge and skills.

There was some apprehension within the team and from relatives about what would happen when the changes occur to the management team and the permanent manager starts. Relatives felt that whilst the service had improved, some continuity and consistency was required. The staff felt that the required changes had been made and the team now focussed on embedding those changes.

We have rated this service as 'requires improvement'. We had previously rated the service as 'inadequate'. We could not rate the service as 'good' because to do so requires consistent and continual good practice over time which has not yet been achieved.