Archived: Delph House Limited

We inspected unannounced on 6 May 2015 and announced on 11 May 2015.

This was the first inspection of Delph House Limited under the provider’s new registration. The Director and registered manager were the same as under the previous registration ‘Delph House Care Home’. The last inspection of ‘Delph House Care Home’ under the previous registration was in April 2014 and we did not identify any shortfalls.

Delph House Limited is a nursing care home for 39 older people some of whom may be living with dementia in Broadstone, Poole. There were two shared bedrooms in use at the home. At the time of the inspection 36 people were living at the home and 23 of these people were receiving nursing care.

The registered manager has been in post at Delph House Limited and the previous registration since the service’s registration in October 2010 under The Health and Social Care Act 2008. 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 identified serious shortfalls and breaches of the regulations. You can see the action we have asked the provider to take at the end of this report.

Where providers are not meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. You can see what action we have taken at the end of the report.

People’s medicines were not safely managed, stored, recorded or administered. This was because some people did not have their medicines as prescribed and staff did not have clear instructions when they needed to give people ‘as needed’ medicines. Some medicines were not correctly stored or recorded. People’s pain was not effectively managed and creams were not applied as prescribed. This placed some people at risk of harm and not receiving the treatment they needed.

Any risks to people’s safety were not consistently assessed and managed to minimise risks. Their needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. People did not always receive the nursing care and treatment they needed and this placed them at risk of harm or neglect. Their health care needs were not always met because the healthcare support they needed was not delivered. People who were had vulnerable skin and or had lost weight and people who needed nursing treatment for bowel management were particularly at risk.

Prompt action was not taken when people lost weight and they did not all receive the fluids and food they needed to increase or maintain their weight.

Risks to people in the building were not always managed to keep people safe and some peoples’ specialist chairs were not clean.

There were not enough nursing staff to meet people’s care and treatment needs. Staff did not have all of the right skills and knowledge to be able to provide care and treatment to keep them safe.

People told us they felt safe and staff understood how to report any allegations of abuse. However, there was not an effective safeguarding investigation system in place to fully afford people protection. Staff did not fully understand the implications of the Mental Capacity act 2005.

The registered manager did not understand their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). The DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. Applications had not been submitted for most of the people who this applied to and they were being unlawfully deprived of their liberty.

People knew how to complain but complaints were not always recorded.

The systems and culture of the home did not ensure the service was well-led. This was because people, relatives and staff were not routinely involved or consulted about the development of the home. The management of the home was reactive rather than proactive. When we identified shortfalls and risks to people they were addressed. However, the quality monitoring systems in place had not identified the shortfalls we found for people or driven improvement in the quality of care or service provided.

People and relatives spoke highly of the caring qualities of the staff and managers. We saw that staff treated people kindly and with respect.

Activities were provided and people had opportunities to be occupied.

The overall rating for this service is ‘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.