Archived: Darsdale Home

Darsdale Home is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 24 people using the service.

Darsdale Home has accommodation across two floors, in one adapted building.

People’s experience of using this service and what we found

Some changes had been made to the quality assurance systems since the last inspection. However, audit processes remained ineffective at assessing, monitoring and improving key areas of the service.

The action plan developed by the provider following the last inspection was not effective in identifying, prioritising, monitoring and reviewing improvements. There was no detailed and structured plan of how the provider intended to achieve a 'good' rating and improve care standards in the service.

A priority action identified in a fire risk assessment for the external staircase to be inspected by a qualified professional had not been addressed in a timely manner. Until this had taken place, people and staff were potentially at heightened risk of physical harm in the event of an emergency evacuation.

Systems to assess, monitor and manage risks to people's health, safety and welfare were not always up to date and effective. Care planning and risk assessment documentation was not always in place and regularly reviewed. Not everyone had grab sheets or up to date personal evacuation plans to ensure they were supported safely in the event of an emergency hospital admission or fire evacuation.

People were potentially unlawfully deprived of their liberty whilst living in the service. Oversight of applications for people to be deprived of their liberty, where this was necessary, was ineffective. Not everyone who lacked or had fluctuating capacity to make specific decisions had mental capacity assessments in their care records, or documentation showing best interest meetings had been held. Staff knew how to support people to make day to day decisions about their care.

Some improvements were found in medicines processes. Management of controlled drugs was safe. Improvements were required to protocols for 'as required' medicines and medicines care plans to ensure these were personalised and person-centred.

An ongoing programme of redecoration was gradually taking place but the décor in areas of the service was tired and required refreshing. People did not get maximum benefit from the large gardens around the service.

Recent changes had been made to the tool used to calculate safe staffing numbers as well as staffing levels and shift patterns. These changes required time to embed and their impact upon people's care and safety to be assessed and reviewed.

Checks were undertaken to ensure staff were suitable to work with vulnerable people. Some gaps were found in recruitment files, which were also identified at the last inspection.

Medical care and support was sought, when required, if people experienced falls, incidents or accidents. Monthly analysis of accidents, incidents and falls and sharing lessons learned was introduced following the last inspection but needed strengthening and embedding into practice.

Staff wore personal protective equipment (PPE) to reduce the risk of cross contamination or infection spread. Visitor sign in processes were in place and visiting arrangements aligned with current guidance.

A new safeguarding policy had recently been introduced and information about safeguarding processes was on display in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 May 2022) and there were three breaches of regulation. We issued two Warning Notices following the inspection due to concerns about poor governance arrangements under Regulation 17 and insufficient staffing levels under Regulation 18. We also issued a Requirement Notice under Regulation 12 due to concerns about people’s safe care and treatment.

At this inspection we found the provider remained in breach of regulations. Improvements to staffing meant they were no longer in breach of Regulation 18 but there were continued breaches in relation to governance and management oversight, and people’s safe care and treatment.

The service has been rated requires improvement in six consecutive inspections and has now deteriorated to inadequate. The service has been in Special Measures since 1 September 2021 due to repeated ratings of requires improvement and the key question of ‘well-led’ deteriorating to inadequate at the last inspection. During this inspection not enough improvements have been made. Therefore, this service remains in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked if the Requirement Notice we served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to provider oversight and people receiving safe care and treatment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service and what we found

The provider could not assure themselves staffing levels were safe. The tool used to calculate staffing numbers remained ineffective. Although staffing numbers had improved since the last inspection there were ongoing concerns about staffing levels and deployment to ensure people always received safe and person-centred care. The provider had not identified the workload of the deputy manager was too high. Staffing levels have been raised as a concern in four previous inspections since 2017.

The provider could not assure themselves of the quality and safety of key aspects of people’s care. Some areas of people's care were not quality assured by the provider so they could not identify and drive continuous improvements. The provider did not have an improvement plan in place to demonstrate their priority actions, timescales and progress to achieve a 'good' rating in all areas

Some medicines processes remained unsafe and action was taken promptly during the inspection to start addressing these. Some care records were not in place for people who had recently moved to live in the service which was rectified during the inspection.

People were not as involved in decisions about their care as they could be due to lack of staff time, and training in some areas. This included a lack of training in specialist communication techniques to support people express their views and wishes. Staff did not have sufficient time to support people to spend time how they preferred to, for example, going outside regularly, chatting with staff and developing new interests.

People had a range of care plans and risk assessments in place which reflected their care needs and preferences. Processes to ensure these were reviewed regularly were in place but required strengthening.

Accidents, incidents and falls were recorded and followed up appropriately. Safeguarding processes were followed when required.

Staff used personal protective equipment (PPE) effectively to keep people safe and undertook regular testing for COVID-19.

People received care from staff who were kind and compassionate. People's privacy and dignity were respected.

Staff continued to work in partnership with health professionals involved in monitoring and providing care and treatment for people using the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 September 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 2 September 2021. The service remains in special measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 June 2021. Three breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in the areas of safe care and treatment, staffing and governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to people receiving safe care and treatment, staffing levels and governance arrangements.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Darsdale Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires Improvement’. The service was placed in ‘special measures’ following the last inspection due to the repeated rating of requires improvement combined with breaches of regulation. Following this inspection, the service will remain in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of requires improvement or a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as requires improvement overall or inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service and what we found

Staff deployment did not always meet people’s individual care and support needs. Staff did not always have sufficient time to maintain expected standards with regards to personalised care.

Medicines management processes did not fully follow best practice guidance. Improvements were needed to ensure people were not at risk of harm.

Infection control measures had been increased since COVID-19 and staff had worked hard to ensure people remained safe during COVID-19. PPE (personal protective equipment) was readily available, and staff used this appropriately. However, some issues were identified during the inspection with regards to the laundry, which the registered manager assured us would be rectified.

People who lived at the service told us they felt safe and happy most of the time. However they did have some concerns about how long it took for staff to answer call bells and they were unsure if they had food choices as they did not have menu’s at mealtimes.

People told us staff treated them well and they knew who the registered manager was. Staff had a good understanding of safeguarding, and how and who to report concerns to. People received care from trained staff. Safe staff recruitment checks were completed before staff commenced their employment.

The provider’s systems and processes used to monitor quality and safety were not fully effective. The provider’s internal governance, systems and processes had not fully identified the shortfalls we found. Care plans and risk assessments were found to be not up to date. Staff were in the process of transferring people’s care records from paper to a new electronic care planning system.

Relatives gave positive feedback about the service, telling us that communication had recently improved, however they would of liked to of known more during the start of COVID-19.

Staff felt supported by the provider, registered manager and each other, however they were conscious the service had a number of vacant posts which might further impact them.

There was evidence of partnership working with professionals to support people's healthcare needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well-led. The service was able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture. Staff respected people's privacy and dignity, seeing them as individuals regardless of their health condition or day to day needs. The new care planning software was person centred, detailing what mattered to people, including external professional guidance with on their preferences. However, inspectors felt opportunities to engage in meaningful activities, interest and hobbies including social inclusion was limited. There was a lack of stimulation in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 7 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been sustained and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same, Requires Improvement. This is based on the findings at this inspection. This service has been rated requires improvement for the last four consecutive inspections.

The registered manager took immediate action to mitigate some of the risks identified during this inspection; this included reviewing the cleaning schedules of the service and reviewing dependency levels.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Darsdale Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches in relation to the management of medicines, staff deployment, and governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. As this service has been rated requires improvement for the last four consecutive inspections, we are placing the service in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of requires improvement or inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Darsdale is a care home, it provides personal care to older people, people with mental health conditions, physical disability, dementia and learning disabilities or autistic spectrum disorder. At the time of the inspection there were 27 people using the service. The service can support up to 30 people.

Darsdale provides accommodation across 2 floors, with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. There is an enclosed courtyard and communal gardens.

People’s experience of using this service and what we found

The provider had taken steps to improve the service and ensured people received safer care. The provider had implemented robust systems to ensure they maintained effective oversight of the quality and safety of the service.

Environmental risks had been addressed. Infection control measures had been reviewed and cleaning hours increased. Floor coverings with strong odour had been replaced. Management of safety in the kitchen had improved and risks around falls from height were mitigated.

Fire door repairs had been completed and were checked regularly. Personal emergency evacuation plans had been updated to ensure effective evacuation of the building in the event of a fire.

Robust processes were in place to ensure the safe recruitment of staff and staff numbers had been reviewed and increased to ensure people’s needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 04 January 2020) when there was a breach of regulation.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 December 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they now met legal requirements. This report only covers our findings in relation to the governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Darsdale is a care home service, it provides personal care to older people, people with mental health conditions, physical disability, dementia and learning disabilities or autistic spectrum disorder. At the time of the inspection there were 27 people using the service. The service can support up to 30 people.

Darsdale provides accommodation across 2 floors, with a lift to the second floor. People with higher dependency needs are accommodated on the ground floor. There is an enclosed courtyard and communal gardens.

People’s experience of using this service and what we found

People told us they were happy with their care and the home had a good atmosphere. Staff did not consistently agree with some staff feeling unsupported and not respected by the provider. The provider had not maintained enough oversight of the service to ensure people were receiving high quality person centred care that met their needs and kept them safe. We found safety concerns with the environment including fire and falls risks that the providers internal systems and processes had not identified prior to the inspection.

People's choices, lifestyle, religion and culture as well as their personal and health care needs were planned into care delivery. Further development was required of care and support for people with sight and hearing impairments or Dementia to ensure their communication and social needs were being met. We have made a recommendation around ensuring individualised activities that meet people’s needs are made available.

Some areas of the home required more attention to detail around cleaning. Staff used gloves and aprons when providing personal care and washed their hands to prevent the spread of infection.

People and staff told us there were not enough staff. People reported delays in the answering of their call bells and staff being rushed. Staff told us they did not always have time to chat with people and they were multitasking following cuts in hours in other departments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, further work was required to ensure people’s mental capacity assessment records reflected decisions they could and could not make for themselves and best interest meeting decisions needed to be recorded.

Safe recruitment checks were in place to ensure only suitable staff were employed. People told us they felt safe. Individualised risk assessments were in place and reviewed regularly to mitigate risk. Staff had received training and could recognise signs of abuse and knew when and how to report it. Medicines were managed, stored and disposed of safely.

People were supported to access health care services when needed, the care staff and management team worked in partnership with other professionals. Staff had been trained and had the skills needed to do their job. Pre-admission assessments took place to ensure the service could meet people's needs prior to care starting. A complaints procedure was in place and people told us they felt listened to if they made a complaint.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 7 September 2018) and there was a breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the providers oversight of the safety of the environment and quality of the service.

Since the last inspection we recognised that the provider had failed to display their CQC rating on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Please see the action we have told the provider to take at the end of this full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Darsdale Home accommodates up to 30 older people in a converted building which has two floors. Most of the bedrooms and all communal areas were based on the ground floor. At the time of our inspection there were 27 people staying there.

At our last inspection in August 2017 the service was rated as overall ‘Requires Improvement’. Although we found there have been some improvements at this inspection we found there were areas that still needed to improve, so overall the service remains rated as ‘Requires Improvement.’

The service did not have a registered manager, however, a manager was in place who was in the process of completing their application to become the registered manager. 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.

People received care from staff who were kind, compassionate and respectful. However, the care was task focussed and there was limited interaction with people outside of completing care tasks.

People’s needs were assessed prior to coming to the home and detailed care plans were in place, however, these did not always reflect the current care needs of people. Risks to people had been identified and measures put in place to mitigate any risk but staff were not always aware of the risks and did not follow the guidance given.

The systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service had not been consistently kept.

Staffing levels had improved but needed to be maintained and account taken of people’s needs outside of basic care and mobility. There was a high usage of staff from a staffing agency which had impacted on the consistency and standard of care delivered.

Staff were supported through regular supervisions and undertook training which helped them to understand the needs of some of the people they were supporting, training needed be widened to cover the needs of a diverse group of people.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

The manager was approachable and people felt confident that any issues or concerns raised would be addressed and appropriate action taken.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to continuously look at ways to improve the experience for people.

There was a registered manager in post. 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.

There were not enough staff to meet all of people’s needs. Although people’s physical needs were met the staff were under too much pressure to provide for people’s well-being with less positive engagement and activities than people needed. The provider and registered manager were aware of the shortfalls in relation to the deployment of staff however, appropriate timely action to mitigate the impact of the staffing levels on people in the home had not been taken.

This was a breach of regulation and you can see what action we told the provider to take at the back of the full version of this report.

People were protected from the risk of harm because staff were confident in the steps that they should take to safeguard people. Risks to people had been assessed and plans of care were in place to manage the known risks to people. People could be assured that they would receive their prescribed medicines safely.

People were supported by staff that had access to regular supervision and training that was relevant to their role. People were supported to access healthcare services and to maintain adequate nutrition and hydration.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs.

People’s care needs were met in line with their individual care plans and assessed needs.

People knew how to make a complaint or raise a concern about their care and support. Where the registered manager or provider had been alerted to complaints there were clear procedures in place for their management and complaints were responded to quickly.

The provider and registered manager were accessible to people and staff. They were committed to improving the care and support that people received.