Archived: Darnton House Nursing Home

Updated 12 February 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 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.

This inspection took place on 16 and 17 November 2015 and was unannounced. The inspection team consisted of four adult social care inspectors on the 16 November 2015 and two adult social care inspectors on 17 November 2015. During the inspection, we spoke with nine people living at the service, five relatives, ten staff, the manager and two of the Company’s Directors. We also spoke with five external professionals, including doctors, before, during and after the inspection. The views of all the people we consulted with are reflected in this report.

On this occasion we did not ask the provider to complete a provider information return (PIR) before our visit. A PIR is a document that asks the provider to give us some key information about the service, what the service does well and any improvements they are planning to make. Prior to our inspection we looked at all the data and information we held about this service and noted that a number of concerns had been highlighted. We had also received concerning information from the Local Authority Commissioners and Clinical Commissioning Group that also used the services of this particular provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed care and support in communal areas and looked at the kitchen, laundry and the majority of the bedrooms. We reviewed a range of records about people’s care and how the home was managed. We looked at some aspects of care for thirteen people in total this included looking at care records, risk assessments, food and fluid records, turn charts, daily records, professional visits records, diary records, menus, medication administration records and care plans.

We looked at a variety of staff records including training, induction and supervision for all staff and recruitment records for ten staff employed at the home. We looked at other records including quality assurance audits that were available at the inspection.

Updated 12 February 2016

This inspection was carried out over two days on the 16 and 17 November 2015. Our visit on 16 November 2015 was unannaounced.

This was the service’s first inspection following registering with the Care Quality Commission (CQC) in March 2015.

Darnton House Nursing Home provides accommodation for up to 96 adults who require nursing care. It is a privately owned service. The service is located in its own grounds close to a local hospital.

The ground floor accommodates 32 people who are living with dementia. The 1st Floor accommodates 32 people with physical care needs. The top floor accommodates up to 32 people who are medically fit and transitioning back into the community for care and support as needed. This is a joint project between the service and Tameside Hospital Foundation Trust.

At the time of our inspection, 18 people lived in the service and a further 18 were living there temporarily before moving back into the community.

Prior to the inspection the Care Quality Commission (CQC ) received a number of serious concerns relating to medicines management, appropriate care and support of service users and staff suitability.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations 9, 11, 12, 13, 14, 15, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no registered manager of the home 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.

The service was not well led. The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and failed to provide appropriate care to maintain their safety.

People who lived in the service did not consistently receive their medicines in a safe manner that met their individual needs. Arrangements to ensure that people received the correct medicines were not in place. The storage, administration and timing of medicines were unsafe and did not meet individual needs. We saw that there were not clear instructions available for staff to give medicines. Where instructions were available, these had not been correctly followed. This placed people at risk of harm.

The service was not consistently respecting and involving people who use services in the care, they received. For example, the care plans reviewed during the inspection did not involve the person or their relative when they were written and the person’s views, choices and personal preferences were not reflected.

People had no input into the planning of menus or activities which meant that people’s preferences, choices and personal opinions had not be sought or considered as part their right to participate in making decisions about their daily lifestyles and freedom of choice.

The service was not meeting its obligation under the Mental Capacity Act (2005) for people who may lack capacity to make decisions. For example, people’s mental capacity was not assessed and decisions were made that did not support people’s rights. Such decisions that people may find difficult to make for themselves could be small decisions – such as what clothes to wear – or major decisions as where to live. In some cases, people can lack capacity to consent to particular treatment or care that is recognised by others as being in their best interests, or which will protect them from harm. The Mental Capacity Act (2005) has been introduced as extra safeguards, in law, to protect people’s rights and make sure that the care or treatment they receive is in their best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required, not all the necessary DoLS applications had been made. The manager was unable to determine what applications had been made or if they had been progressed. The deprivation of liberty safeguards provide legal protection for those vulnerable people who are, or may become, deprived of their liberty whilst living in a care home. Lack of appropriate DoLS applications and authorisations being made could mean that restrictions had been placed on a person’s liberty that are not in their own best interests to protect them from harm.

We saw that people’s health care needs were not accurately assessed and that risks such as poor nutrition were not always recognised. People’s care was not planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met.

Records regarding care delivery were not checked to ensure accuracy or that they were up to date leaving people at risk of not having their current individual needs monitored or met.

The provider’s staff recruitment practices were not in keeping with their own policy. We saw that staff had not all received appropriate checks before they started working in the service. References were not validated to make sure they were genuine before staff started working in the service. Lack of appropriate and safe pre-employment checks being conducted before someone started working in the service placed both people using the service and other staff at risk of unsuitable people being employed.

We saw that the management of nutrition was not sufficient to make sure that people’s nutritional needs were identified in a timely manner and that they were provided with diets that met their needs.

The reporting and addressing of safeguarding incidents was not sufficient for the service to be aware of what concerns were in place nor, what action they needed to take. Safeguarding concerns were not recognised or addressed.

The environment was well decorated and furnished to a high standard, however it had not been adapted to meet people’s needs and in some instances was not suitable for the people living there. For example, decoration in parts of the home was not appropriate for people living with dementia and lighting in certain parts of the home was poor, especially for people with restricted sight.

Feedback from people living in the service and their families was complimentary regarding staff and the care that they received.

The overall rating for this service was ‘Inadequate’ and the service is therefore in 'Special Measures'.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.