Archived: Delves Court Care Home

The provider sent us an action plan detailing what action they had taken in respect of the areas where they were not meeting the regulations. During this inspection we found the provider had made improvements to the service and the regulations had been met.

Since our last comprehensive inspection we have been notified that the provider has been placed in administration. An experienced care home operator has been appointed by the administrator to assist in the running of the home.

Delves Court Care Home is a nursing home providing accommodation, nursing and personal care for up to 64 older people who may have dementia. The home is spread over three floors however the third floor is being refurbished and is not currently being used. There were 33 people living at the home when we visited. The home has a registered manager who was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People told us they felt safe. Staff were aware of how to protect people from the risk of harm or abuse. Risks to people had been assessed and equipment was available for staff to use. People received their medicines as prescribed. People felt there were adequate numbers of staff to meet their needs. Staff received the training and support to carry out their role and meet people’s varying needs.

Staff obtained consent from people before they provided care. Where people did not have the capacity to make decisions about their care a process was in place to ensure people’s rights were protected. People had a choice of meals and were supported to meet any specific dietary needs. People had access to other healthcare professionals to ensure their healthcare needs were met. People told us they felt involved in their care and treatment.

People said staff were kind, caring and treated them with dignity and respect. People were involved in a number of different individual or group activities during the day. Staff supported people’s independence. People and relatives felt listened to and were able to provide feedback about the service. People and relatives said if they had any complaints these would be addressed by the registered manager or appointed provider.

People felt the management team were approachable and visible within the home. Staff understood their roles and responsibilities. The appointed provider had management systems in place to assess and monitor the quality of service provided.

At our last inspection in November 2015 we found the provider was not meeting the legal requirements to ensure people who used the service were protected against the risks associated with the unsafe use and management of medicines. We served a warning notice on the provider for a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A Warning Notice is a formal way we have for telling providers they are not meeting people’s needs or the requirements of the law, and that improvement is required. We met with the provider and asked the provider to send us an action plan detailing the improvements they would make.

We asked the provider to ensure action was taken to address the concerns we found by 29 February 2016. At this inspection we checked to see if the provider had made the improvements required.

Delves Court Care Home provides accommodation, nursing and personal care for up to 64 older people who may have dementia. The home has three floors with the first and second floor providing nursing care. The home currently has a registered manager in place. 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.

Although improvements had been made regarding the specific issues raised within the warning notice we found further improvements were needed to manage medicines safely.

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with the nine people who used the service, two visiting relatives and three members of staff. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Six out of nine people who used the service told us that staff were not always available when they called the buzzer to request support for their care needs. There were not enough staff to meet the care needs of people who used the service.

We found that policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) were in place. This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had needed to be made.

We saw that risk management plans were up-to-date and staff said they received updates when people’s needs changed. This was intended to ensure that people were not put at unnecessary risk. Staff were able to tell us about risk management plans for people who used the service. We spoke with one member of staff who had not read the care plan for one of the people they supported. They had relied on information from other staff and information received at shift handovers. Policies and procedures were in place to make sure staff had information they needed so that unsafe practice was identified and people were protected.

Is the service effective?

We found that people had an individual care plan which set out their care needs. Assessments included people’s health and social care needs. We saw this information was clearly documented in people’s care plans. This was intended to ensure that people’s individual care needs were met.

People had access to a range of health care professionals. We saw information on health appointments people had attended in the community. People we spoke with told us that the GP was called out when they needed them and district nurses came to the home when they required them to. Three people we spoke with said they could benefit from seeing a dentist and one person requested an optician. The registered manager told us there were no records of people requesting these services prior to our inspection.

Is the service caring?

We asked people who used the service for their opinions about the staff that supported them. We received mixed feedback from people we spoke with. One person told us: “I can’t fault them. If I need anything they’ve worked with me”. Another person told us: “There are some good staff and some are slack”. Three people out of nine that we spoke with said that they liked most of the staff, but there were several members of staff they did not like. On the day of our inspection we observed that interactions between staff and people who lived at the home were positive and staff appeared to have warm relationships with people they cared for.

Most of the people we spoke with said their preferences, interests and diverse needs were being met. Three out of nine people told us that their preferences were not always met. One person told us they did not think there was enough choice of foods to meet their preferences. One person told us they had stated a preference to take a shower which could not be responded to because of low staffing levels on that day. Another person told us that they had wanted to get up earlier than normal, but was unable to do so due to staffing issues.

Most people we spoke with told us that they felt their privacy and dignity were always respected by care staff. One person said that two or three members of staff were ‘sharp’ in their tone when speaking with them. We observed some areas of good practice where people’s dignity had been respected. We observed other examples of practice, where improvements were needed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in respect of improving dignity and respect for people.

Is the service responsive?

We were told that resident and relative meetings had not been scheduled for over eight months. The registered manager told us this was something they were considering reinstating. We were told that previous meetings arranged had been poorly attended by people who used the service and their relatives. We discussed with the manager a number of complaints that had been reported to CQC. The registered manager expressed a view that some people preferred to report issues to CQC and other external bodies rather than directly with them. They told us there was an open door policy at the home and they welcomed feedback from people who lived at the home and their relatives.

We were told and saw that people took part in regular reviews about their care and support needs. This was documented in the care records we looked at. Where people’s needs changed staff demonstrated a sound knowledge of the change of needs and how to support people appropriately. We saw that risk assessments had been changed in response to people’s changing needs.

Is the service well-led?

We found that the service did not have an effective quality assurance system in place. We found that previously used feedback processes such as surveys and residents and relative meetings had not been undertaken since the last inspection.

We were told that a survey to obtain the views and opinions of people using the service had not been conducted by the provider for over a year. The registered manager told us that due to staffing constraints they had not had the opportunity to complete this. We were not able to gather robust evidence of how the service used feedback from people to improve standards at the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in respect of ensuring the people who use the service are enabled to provide feedback on their experiences of care and treatment.

The registered manager told us they received good support from their management team. They told us they had concerns about staff absenteeism levels at the home since March 2014. We saw that they had taken a number of measures to address this matter. Staff told us they felt supported by the manager and had effective working relationships with their team.

People who lived in the home and their relatives told us that they were asked about the care they or their relative needed.

People told us that there was always a choice of food available and most people told us that they usually liked the food served. There was a need to explore choice available for people who required a cultural diet. There were systems in place to protect people from the risk of poor nutrition or dehydration.

We saw that people received the care and assistance they needed to ensure that they were protected against the risk of poor nutrition or dehydration.

We found the home was homely, well maintained and clean. People who lived or visited the home all told us they found the home to be clean. One person told us: "It's very clean". A relative told us: "It's always very clean and there is no smell".

The home had improved procedures in place to minimise the risk of unsuitable people working at the home. People told us: "The staff are very good". Another person said: "The staff are very good and try their best but they never stop".

During our visit we spoke with 12 people who lived at, or were visiting Delves Court, four staff members and the manager to enable us to establish that people were getting appropriate care that met their needs and supported their rights.

People had a plan of care that detailed the care and support they needed. People we spoke with all told us that they were happy living in the home and with the care they received. One person said, "I am very happy here my bedroom is like my little flat, I have all the things I need here". Another person said, "I couldn't want for more". A visitor we spoke with said, "We have no concerns, they are all marvellous here", and "I have been in a lot of homes and this is the best".

Appropriate arrangements were in place to store and manage people's medicines.

Checks on staff were undertaken before they commenced work, however further information was required to provide assurance that vulnerable people would be protected from unsuitable people working in the home.

The home had appropriate systems in place to enable people to raise concerns and be confident that their concerns would be investigated and addressed.

Systems were in place to monitor the quality of the service provided and check that people had the care they needed.