Archived: Delphine Court

Updated 13 November 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors. One pharmacy inspector also reviewed medicine records remotely.

Service and service type

Delphine Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a registered manager. The previous registered manager left the service in March 2020, and a new manager was in the process of applying to be registered with CQC, however they had since left the service.

Notice of inspection

We carried out this inspection unannounced.

What we did before the inspection

We attended multiple safeguarding meetings held by the local safeguarding team following whistleblowing concerns that were raised about the service.

We reviewed information we had received about the service since the last inspection. We spoke with local safeguarding authority team members and service commissioners. We spoke with specialist colleagues in community learning disability services. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people, the area manager, deputy manager, two team leaders, and seven care staff members both on inspection and after the inspection during telephone interviews. We also spoke with the relatives of three people who use the service via telephone interview.

We reviewed two care plans, four medicine administration records (MARS), staff rotas, two staff recruitment records and a variety of records relating to the quality of the service.

During staff telephone interviews, the inspectors received information raising concerns about the delivery of the regulated activity. These concerns were about specific individuals and we have shared them with the local safeguarding authority for action and investigation where appropriate.

After the inspection

We requested further information from the area manager.

We shared the concerns we found with the local safeguarding team, Environmental Health department and Infection and Prevention Control nursing team from the local Clinical Commissioning Group (CCG) and various commissioning authorities of those people where we identified as being the highest risk.

Updated 13 November 2020

Delphine Court is a residential care home providing accommodation with personal care to adults with a learning disability and autistic spectrum disorder. At the time of this inspection, four people lived at the service.

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

Support plans were not person centred. Risks which affected people's health, safety and wellbeing such as nutrition were not addressed or mitigated. Accidents and incidents had not been reviewed and analysed therefore, action had not been taken to reduce risks or identify trends in people's behaviours.

Records did not show staff had been trained or assessed to support people with their medicine administration. Staff were not trained to support people with their specific assessed needs such as trauma and attachment disorder.

The service did not have sufficient infection prevention and control measures in place. Government guidance in relation to COVID 19 was not followed. Communication systems were inadequate. Handover records were poor and inconsistent and relatives we spoke with all reported a lack of communication with the management of the service.

Medicines were not managed safely. Staffing was not provided at the levels for which they were commissioned. Staff reported they had not always felt safe with staffing levels and staff rotas and signing in records we viewed were not completed and confusing. The service was using agency staff and was actively recruiting.

We found unsafe practices in the kitchen such as a defective fridge and inappropriate storage of food. We saw one person's bathroom contained significant levels of black mould.

The service has not addressed issues from previous inspections. Issues from 2018 were still apparent relating to providing a homely environment and documentation such as maintaining a comprehensive training matrix for staff.

Quality checks were not consistent, audits were not effective at highlighting and addressing issues apparent within the service. There was a clear lack of provider oversight as they had not ensured effective and competent management was in place. There was not a registered manager and at the time of our inspection the service was overseen by an area manager with support from other managers from the provider's north east services. Some staff members we spoke with raised concerns about the management of the service.

We did observe people appeared comfortable and happy with staff interaction with them. Relatives we spoke with told us care staff members were kind and supported people in a positive way.

People had access to the community either visiting shops or going for a drive but there was little in the way of meaningful activities reflecting the development of life skills or using people's interests or choices taking place.

The service didn’t always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; by not providing a homely living environment, a lack of choice and control over meaningful activities and appropriate staffing levels to enable them to live a full life.

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

Rating at last inspection

The last rating for this service was requires improvement (report published 1 May 2020.)

Why we inspected

Serious whistleblowing concerns were received by the local authority safeguarding team in relation to management of the service and the quality of care and support that was being provided. There had been a number of safeguarding concerns raised by other professionals. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

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 changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence the provider needs to make substantial improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Delphine Court 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 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 breaches in relation to the safety of people and the risk of harm. We also identified breaches in relation to the management and monitoring of the service, consent, support for nutrition and hydration and staffing at this inspection.

Please see the action we have told the provider to take at the end of this 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 continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 six 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.