28 November 2017
During a routine inspection
Derby House 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 care home can accommodate up to seven older people who may be living with dementia. Derby House is a large detached Victorian property. Accommodation is provided over two floors and comprises of seven single en-suite bedrooms. On the first floor, there is a large open plan kitchen, dining and living room. Derby House does not have a passenger lift; residents who cannot use the stairs access the first floor by a stair lift. The care home is in a residential area of Stretford and has good access to public transport and motorway links. At the time of this inspection there were seven people living at the home.
Regarding the registration of this service, there is no condition that the provider must employ a registered manager. As such the provider managed the day to day responsibility of running of the care home and was supported by a deputy manager.
The previous inspection took place in April 2017 and was prompted in part by the notification of an incident following which a person died. This incident was subject to an investigation and as a result our inspection did not examine the circumstances of the incident but was intended to ensure the people living at the service were safe. When we completed our inspection in April 2017, we found concerns relating to medication management, consent to care, recruitment practices, staff training and governance systems. The service was rated ‘Inadequate’ overall and placed in ‘special measures’.
At this inspection we found that insufficient improvements had been made following our previous inspection. We identified continuing breaches in the Health and Social Care Act regulations relating to recruitment, medication management, infection control and prevention, staffing training, consent to care and governance systems. We made a recommendation that the provider review best practice guidance on dementia friendly environments.
At our last inspection, we found recruitment processes did not adequately ensure suitable candidates were employed to work at the service. At this inspection we found little had changed and recruitment processes needed to be strengthened.
The provider had made some improvements in infection control and prevention practices as identified by an infection control audit. We noted not all action identified as a priority had been taken. This meant people were at risk as appropriate action to prevent the spread of infection had not been taken.
Regarding the safe administration of medicines, we identified concerns with how medication was recorded. This was a continued breach of the regulation as people were insufficiently protected from risk of harm.
Measures to ensure people’s safety such as door guards and regular fire drills were not effectively used or carried out. We noted personal emergency evacuation plans were in place and kept in an accessible location.
Staff were aware of safeguarding principles and knew what action to take should they suspect abuse was taking place. They had received relevant training in this area. This meant there were effective systems to help protect people from risk of harm.
People’s liberty was restricted as the provider had not reapplied for this to be authorised under a Deprivation of Liberty Safeguards (DoLS). The provider had not ensured that staff had received relevant training to understand the requirements of the Mental Capacity Act in general, and DoLS.
The provider’s induction process for new staff and mandatory training was not sufficiently robust. We identified were several gaps in training which meant staff had not completed training in key areas such as safeguarding, dementia awareness and fire training. Failure to provide relevant training and professional support meant that staff were not sufficiently supported to function effectively in their roles.
People’s care and support needs were initially assessed before they were accommodated at the service. This was to ensure the service would be able to provide suitable care. Care needs were assessed holistically and covered identified support needs such as for medication, foot care and mobility. Care plans contained relevant details to help staff support people according to their individual needs.
People told us the food was of acceptable quality. This helped to maintain people’s good health and wellbeing. Meals took into consideration people’s preferences. The service operated a four weekly menu but these menus contained very little detail about the meals on offer.
Care records demonstrated that people living at the service had access to medical attention and healthcare professionals such as GPs and podiatrists when required. This meant that people’s healthcare needs were being met in line with their individual needs.
People told us staff treated them well. We saw that there was good rapport and friendly interactions between people and staff. People got on well with the staff and staff demonstrated that they knew people well. This meant people were cared for by staff who knew their preferences and understood their support needs. However based on the lack of improvement made, we found the service had not sufficiently demonstrated the hall marks of a caring organisation.
People’s dignity and privacy were treated respectfully. We saw examples of how people were encouraged to develop and maintain their independence. In so doing, the service helped to ensure people maintained a good quality of life and wellbeing.
At the last inspection in April 2017, there was insufficient meaningful activity taking place throughout the day which was suited to the people living at Derby House. At this inspection we noted some initial improvements had been made. There was no dedicated activities coordinator at the home. One of the staff had taken on added responsibility in this area. Activities included indoor games and visits from community groups. This should help the service ensure that people were engaged in suitable activity that was meaningful and stimulating.
Care plans reflected people’s physical, mental, emotional and social needs and included a personal history, religious practices and communication needs. People and their relatives were involved and contributed to the care planning process.
People knew how to make a complaint and we saw the service recorded and investigated complaints appropriately. There was a complaints policy and procedure in place.
At the last inspection we discussed end of life care with the manager. They told us these discussions were held with people, their relatives and GPs.
Insufficient improvements had been to quality assurance and improvements systems. For example, we identified gaps in audit processes and we found no record of ‘lessons learnt’ from accidents and incidents that had taken place within the service. This was a continued breach of the relevant regulation and meant the provider did not have adequate oversight of the quality of care provided.
The service conspicuously displayed its most recent performance rating within the home. We noted the provider was open and honest to people and their relatives about the service’s recent performance and held a meeting to discuss the outcome of the previous inspection (April 2017) and how they would improve the service provision.
We observed the culture of the service to be relaxed and welcoming. People knew who the manager was and engaged well with them. The manager was ‘hands-on’, friendly and approachable. Staff told us both the manager and deputy manager were helpful and supportive.
The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. Services in special measures 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.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.