11 April 2023
During an inspection looking at part of the service
Delph House is a residential care home providing accommodation and personal care to up to 22 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 15 people using the service. Delph House is an adapted property on 2 floors with communal spaces for relaxing and taking meals.
People’s experience of using this service and what we found
Although we noted clear improvements in many areas, this inspection identified some concerns which were similar to those from the last inspection regarding staffing, safeguarding and oversight. The provider has responded by making some immediate changes to the management of the service which has given us some assurance. However, this is the third consecutive inspection this service has been rated Requires Improvement overall.
Safeguarding concerns had not always been robustly managed and information appropriately shared. The provider took action to address this issue immediately, and retrospectively notified CQC of several safeguarding incidents we had not been aware of. Staff had an understanding of safeguarding procedures and most knew how to identify and raise concerns.
Prior to our inspection there had been concerns raised by healthcare professionals about staff’s ability to identify a person’s deteriorating health and take prompt action. This placed people at potential risk of harm. We have judged this is both an English language proficiency issue and a matter of some staff needing further development of their skills and confidence. The provider has assured us they will continue to develop staff language and skills to ensure they can manage people’s health concerns confidently and keep them safe.
Medicines were mostly well managed. A more proactive approach was needed in some cases to ensure people’s potential risks relating to their deteriorating health was always considered, especially those living with dementia.
People were not always supported to have maximum choice and control of their lives as staff did not always support them in the least restrictive way possible. Staff did not demonstrate a good understanding of the Mental Capacity Act (2005) which ensures people consent to their care and treatment. Some staff’s understandable concern for people’s safety was prioritised over their right to make decisions, even if these decisions were seen as unwise. There was a risk people’s rights would not be fully protected and further training and development of staff was required. The provider agreed to take this forward.
People using the service and relatives gave us broadly positive feedback about the care and support provided. People praised the kindness of the staff and there was an acknowledgement that, although further work was required, the service was improving in many areas. Further engagement with staff, people who used the service and relatives was needed to drive the service forward. The provider has been open and honest with us about the challenges the service has faced and we noted improvements in many areas. However, we have noted similar issues at the last 3 inspections which is a cause for concern.
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 09 March 2022). 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 although improvements had been made the provider remained in breach of regulations relating to safe care and treatment and good governance. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.
Why we inspected
We carried out an unannounced focused inspection of this service on 15 December 2021. 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 safe care and treatment and good governance.
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 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 remains 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Delph House on our website at www.cqc.org.uk.
Enforcement
We have identified continued breaches of regulation relating to safe care and treatment and good governance at this inspection. We have also identified a breach of regulation relating to a failure to notify CQC of safeguarding incidents..
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, which will help inform when we next inspect.