Archived: Delphine Court

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.

Delphine Court is a purpose built house, providing residential care with support to people living with a learning disability and autism spectrum disorder. It was registered to support up to eight people. Four people were using the service at the time of our inspection. Staff supporting people did not wear a uniform or any identifying clothing that suggested they were care staff when coming and going with people, and people were supported to have access to local community facilities and services.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People and their relatives for the most part had a very positive experience of this service.

We saw differing experiences of transitions to the service since our last inspection. One had worked very well with a slow and planned move for someone. Another was on an emergency basis and the planning, staff training and awareness of their complex needs meant this did not succeed for the person. The registered manager told us that lessons had been learnt from this.

Issues relating to the environment to maintain good infection control practices and a homely environment still needed to be addressed. The acquiring of additional lidded bins to promote effective hand hygiene was addressed immediately by the registered manager.

We made a recommendation that the provider addresses the communal areas of the home to make it more homely.

Since our last inspection, care plans, staff supervision and staff morale had improved significantly. Staff were trained. People were also accessing the community more and staff were more confident in how they supported people when they became distressed.

There were systems in place to protect people from the risk of abuse. Staff were knowledgeable about the action they would take if abuse were suspected. Medicines were managed safely.

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; the policies and systems in the service supported this practice.

People were supported to access a range of healthcare professionals to ensure they remained healthy.

Care plans were improved but further work to develop communication plans and positive behaviour support plans was needed. People were supported to maintain relationships with their families.

The registered manager was leaving the service and a new manager was in post. They had worked together to support an effective transition. Improvements made needed to be sustained and embedded. The new manager was keen to improve communication systems for staff and families and address the environment to make it more homely.

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 19 March 2019). We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to safe care and treatment and good governance.

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 improvements had been made and the provider was no longer in breach of the regulations. However, further improvements were required in the safe and effective domains.

Why we inspected

This was a planned inspection based on our inspection programme.

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 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.

People’s experience of using this service:

On the first day of our visit we found fire doors propped open and hazardous items not stored securely. This was addressed by the service as soon as we pointed it out. As and when required medicines needed to be monitored more effectively with clear protocols put in place. Staff recruitment records needed to be available on site and references needed to be more robust.

People received their medicines when needed. Staff safeguarded people from abuse. Risks to people were assessed and action taken to address them. The provider ensured there were enough suitable staff working to support people safely.

Staff received training but supervision and appraisal records were not robust or met the providers frequency policy. People received support with food and nutrition, and staff helped them gain access o a wide range of healthcare professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

We observed some staff were over-enthusiastic and did not readily pick up social cues from people about the level of engagement they wanted. Relatives were generally positive about the support their family members received from staff, who they described as caring and kind.

People received person-centred support based on their assessed needs and preferences. Support plans needed to have clear goals embedded. Clear complaints procedures were in place to address issues at the service.

The quality assurance process at the service was not robust as audits were not regular and did not address issues we found on our visit. Feedback from staff and relatives we spoke with said communications systems could be improved. Staff stated they felt supported by the registered manager. Systems were in place to ensure the voices of people, relatives and staff were heard. The service worked with other organisations and agencies to promote people’s health and wellbeing.

Rating at last inspection: At the last inspection the service was rated Good (Report published 16 October 2018).

Why we inspected: We received information of concern from the local authority safeguarding team and other professionals visiting the service. This inspection was brought forward due to the information we received.

Follow up: We will request an action plan from the provider to understand what immediate action they will take to improve the quality and safety of care provided to people. We will also meet with the provider to discuss this action plan.

The service was newly registered in December 2016 and so it had not been previously inspected or rated.

Delphine Court provides care and support for up to eight people who have a learning disability. On the day of our visit there was one person using the service and another person was due to transition [move in] to the service later that day.

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.

The person using the service was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service support this practice.

Processes and procedures were in place to ensure people were protected from abuse and harm. Staff spoke confidently about the actions they would take if they thought a person was at risk of harm.

Medicines were stored and managed appropriately. The service ensured staff were trained and their competency assessed prior to administering medicines.

Staff were recruited safely and were given appropriate training before they commenced employment. We discussed with the registered manager that staff files needed to accurately reflect all the pre-employment checks that had been carried out for new staff members as checks had sometimes been confirmed at a regional manager and human resources level, rather than with the service and registered manager. The registered manager stated they would review and amend this process straight away.

Staff had received specific training in managing the needs of people who used the service such as epilepsy and specific speech and language therapy approaches. There were sufficient staff on duty to meet the needs of the person and the staff team were supportive of the registered manager and of each other.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

The person’s care plans were person centred and had been well assessed. The home had developed plans such as communication systems, supported by speech and language therapists to help the person be involved in how they wanted their care and support to be delivered. The person was given choices and encouraged to take part in all aspects of day to day life at the home, including shopping, laundry and cooking. One person was transitioning into the home and we saw this had been planned and assessed so it was as smooth as possible.

The service encouraged the person to maintain their independence. Staff supported the person in a caring way. They were supported to be involved in the local community as much as possible and to use public transport and access regular facilities such as the local G.P, shops and leisure facilities.

A regular programme of staff meetings took place where issues were shared and raised. The service had a complaints procedure and staff told us how they could recognise if the person they were supporting was unhappy. The service met with the person regularly and recorded their views about activities and whether they were happy. A family member also told us the service kept them involved in their relative’s life. Professionals told us they were kept updated. This showed the service listened to the views of people.

There was a regular programme of auditing in place to check the safety and quality of the service being delivered at Delphine Court.