The Care Quality Commission
  • Care Home
  • Care home

Archived: The Dulwich Care Centre

Overall: Requires improvement read more about inspection ratings

93 Knollys Road, Streatham, London, SW16 2JP (020) 8677 6902

Provided and run by:
T.D. Bailey Investments Limited

All Inspections

27 and 28 May 2015

During a routine inspection

The Dulwich Care Centre is a care home with nursing. The service provides personal care and nursing care to older people with physical disabilities and those living with dementia. The service can accommodate up to 92 adults across four floors. We undertook an unannounced inspection to the service on 27 and 28 May 2015. At the time of our inspection 50 people were using the service, and one of the floors was closed. The service was operating across three floors, two providing residential care to people with dementia, and one providing people with general nursing care.

At our previous comprehensive inspection on 13 and 14 November 2014 the service was in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. We undertook an inspection on 11 February 2015 to follow up on five of the breaches, including follow up of a warning notice issued in relation to care records. We found at that inspection that the five breaches had been addressed and the service was meeting the regulations inspected. These related to managing complaints, monitoring the quality of the service, safe staffing levels, maintaining accurate care records, and adhering to their registration requirements.

At this comprehensive inspection we followed up on the three outstanding breaches relating to: involving and respecting people that use the service, care and welfare of people and supporting workers. At this inspection on 27 and 28 May 2015 we found that action had been taken to address the previous breaches.

Since our previous comprehensive inspection on 13 and 14 November 2014. Management of the service had changed. The previous registered manager had left the service and a new manager was in the process of being recruited. An interim manager was in post at the time of our inspection. 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.

At this inspection we found that people were provided with safe and appropriate care. People’s needs were assessed and care plans were developed which informed staff how to support the person to manage those needs. Plans were also in place to address any risks to the person, and to maintain their safety and welfare whilst at the service.

Staff treated people with dignity and respect. Staff were aware of people’s individual needs, for example any communication, dietary or health needs and provided them with the appropriate support. People were safely supported by staff with their medicines.

People were involved in decisions about their care. The staff were aware of their responsibilities under the Mental Capacity Act 2005 and decisions were made in people’s ‘best interests’ if they were assessed as not having the capacity to make decisions about their care. Relatives were involved as appropriate in people’s care decisions. The management team were aware of the processes around the Deprivation of Liberty Safeguards, but further training was required to the rest of the staff team to ensure people were not unduly restricted from leaving the service.

A new activities programme had been established and group activities were regularly held. The team had started to build links in the local community and people were being supported to attend community events and activities. Some people would benefit from further one to one activities, and the service was hoping to implement this once the activities team was fully established.

People, and relatives, were asked for their feedback about the service and changes were made in response to the feedback received. The management team regularly reviewed the quality of the service and made improvements where required. Managers ensured any changes were discussed with the staff team.

Leadership and management of the service had been strengthened. Staff were being empowered and encouraged to take on additional duties. Staff were supported through supervision sessions and regular staff meetings. A full training programme had been established and staff had been supported to attend courses to develop their knowledge and skills.

There was some apprehension within the team and from relatives about what would happen when the changes occur to the management team and the permanent manager starts. Relatives felt that whilst the service had improved, some continuity and consistency was required. The staff felt that the required changes had been made and the team now focussed on embedding those changes.

We have rated this service as 'requires improvement'. We had previously rated the service as 'inadequate'. We could not rate the service as 'good' because to do so requires consistent and continual good practice over time which has not yet been achieved.

11 February 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 13 and 14 November 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to; staffing levels, the systems for monitoring the quality of service provision, complaints, care records and notifications.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements inspected. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Dulwich Care Centre on our website at www.cqc.org.uk.

At our previous inspection we found there were not sufficient staffing levels to meet people’s needs, they did not have adequate systems for recording and analysing incidents, complaints were not being listened to or responded to, care records contained inaccuracies and did not provide detailed information about people’s care and support needs, and the provider did not make the statutory notifications required by their registration with us.

Since our comprehensive inspection the registered manager had resigned. An interim management team was in place, and the service was in process of recruiting a new manager. The interim manager of the service was on leave at the time of our inspection. The regional manager and operations manager were providing daily managerial support to the service whilst the interim manager was away. At the time of this inspection 66 people were using the service.

Staffing levels had been reviewed and increased. There were sufficient staff to meet people’s needs and maintain their safety. Staff responded to call bells promptly and spent time engaging people in conversation and activities. Staff told us there were enough staff to enable them to complete their duties in a timely manner.

Care records had been reviewed and updated. Assessments had been reviewed to identify any risks to people and plans included detailed information about how the risks were to be managed. Care plans were specific to people’s needs. They provided staff with detailed information about people’s needs and how they were to be supported. Information was provided about people’s preferences, interests and daily routines. Information was also provided about people’s communication needs, so that staff could support them to express their views and wishes.

Relatives’ meetings had been re-established. A summary of concerns received and the action the service had taken to address them had been communicated with people’s relatives. Staff and people’s relatives felt able to raise concerns and felt their concerns were being listened to. We saw that complaints had either been dealt with or were in the process of being investigated.

Processes had been re-established to monitor the quality of the service including care record audits, and incident and accident reporting processes. All incidents were reviewed by the management team to ensure appropriate action was taken to support the person and reduce the risk of reoccurrence.

We viewed all incidents since our last inspection and saw that notifications were made to us as required when there were incidents that had led to serious injury to a person or if there were safeguarding concerns.

At our previous comprehensive inspection on 13 and 14 November 2014 we also found a breach of legal requirements relating to the care and welfare of people that use services, respecting people that use services, the activities on offer and the support provided to staff through training, supervision and appraisal to ensure they had the skills and knowledge to meet people’s needs. We will carry out another unannounced inspection to check on all outstanding legal breaches.

13 and 14 November 2014

During a routine inspection

The Dulwich Care Centre provides accommodation for nursing and personal care for up to 92 people. At the time of our inspection 75 people were using the service. The service is split across four floors. The lower ground floor provides residential care, the ground floor provides general nursing care, the first floor provides nursing care for people with dementia, and the second floor provides residential care for people with dementia.

At our previous scheduled inspection on 6 June 2013 we found the service was not meeting the regulations we inspected relating to care and welfare of people using the service, meeting people’s nutritional needs, supporting workers and care records. We undertook four follow up inspections to review the quality of care provided to people who used the service. At our last inspection on 6 March 2014 we found the service to be meeting the regulations inspected.

The service had a registered manager in post as required by their registration. 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 registered manager in post at the time of our inspection had been registered with the Care Quality Commission since they started at the service in April 2013.

Accurate records were not kept about people’s care and support needs. People did not always receive the support they required in line with their individual needs and to maintain their welfare and safety. Information was missing about risks to people’s safety and how these were to be managed. Some staff had limited knowledge about people’s needs and felt they did not have the skills and knowledge required to support people with all aspects of their care, including meeting their mental health needs and provision of activities.

Staff did not always receive the training and support they required to ensure they had the skills to meet people’s needs. There were insufficient staff to provide a responsive service.

People were not always treated with respect, and their privacy and dignity was not always maintained. There was a lack of activities provided at the service, and little interaction or engagement with people who used the service.

Concerns and complaints raised by relatives of people using the service were not always listened to or responded to in a timely manner. The service did not use information from complaints or incidents to improve the quality of the service.

People and their relatives were involved in decisions about their care, and ‘best interests’ meetings were held in line with the Mental Capacity Act 2005 for people who were unable to make decisions about their care. People were able to see healthcare professionals, including the GP, as required.

Medicines were securely stored and appropriately administered. Checks were undertaken by the provider and the registered manager on the quality of service provision.

We found breaches of the regulations relating to the care and welfare of people using the service, maintaining the privacy and dignity of people using the service and treating people with respect. There were also breaches of the regulations in relation to staffing levels, support and training provided to staff, the systems for monitoring the quality of service provision, complaints, care records and notifications. You can see what action we told the provider to take at the back of the full version of the report.  

6 March 2014

During an inspection looking at part of the service

We did not speak with people using the service during this inspection, as we visited the service to follow up on one aspect of medicines management regarding the recording of medicines given to or used for people. At our previous inspection in December 2013 we found gaps on some medicines records, including the records used when staff applied prescribed creams. This meant we could not tell whether some medicines had been given or used as prescribed.

At this inspection, we found that the provider had put in place a system of auditing medicines records at the end of each shift, and new documentation to record the use of prescribed creams. We found that these new arrangements had improved the recording of medicines given to or used for people, and the service was now compliant with this regulation.

9 December 2013

During an inspection looking at part of the service

At our previous inspection on 21 October 2013 we found that safe and effective arrangements were not in place to manage medicines for people at the service as we found omissions in the recording, handling and safe administration of medicines. At this inspection on 09 December 2013 we found that some improvements had been made and medicines were being safely handled and administered. However, we found that there were still some omissions in the recording of medicines.

At our previous inspections on 17 December 2012, 06 June 2013 and 21 October 2013 we found that care records were not always accurate and fit for purpose. We found there were some inconsistencies and inaccuracies in the way information was being recorded relating to a person’s care. At this inspection on 09 December 2013 we found that appropriate action had been taken to address our previous concerns and we found the care records to be accurate and fit for purpose. We saw evidence that appropriate assessments and care plans were in place. These were regularly reviewed to ensure they met the person's current needs and highlighted any changes in a person's health or support needs. Care records were securely stored and all electronic care records kept were password protected.

21 October 2013

During an inspection looking at part of the service

People who used the service told us, “I like it here.” They also told us the staff were “lovely” and they were available when they needed any support or help from them. Relatives of a person using the service told us the staff had a good attitude and they interacted well with people using the service.

At our previous inspection on 06 June 2013 we found that improvements were required to: improve the care and welfare provided to people who used the service, ensure that people had their nutritional needs met, ensure that staff were adequately supported and ensure that accurate care records were kept. The provider informed us that the required improvements would be made by 30 September 2013. At this inspection on 21 October 2013 we found that improvements had been made. People received care and treatment in line with their individual needs, they were supported to eat and staff were adequately supported. However, we found that improvements were still required regarding the care records kept about people using the service.

People who used the service had specific care plans regarding their identified needs and these had been reviewed on a regular basis. Assessments were undertaken to assess the risk posed to people who used the service for example their risk of falling, poor nutrition, and developing pressure sores. Management plans had been put in place when required. Staff liaised with other health professionals if there were any concerns regarding a person’s health that could not be managed by the service.

There were processes in place to ensure that people received sufficient amounts of food and drink. We saw that adequate support was provided to people that required assistance from staff to eat. A choice of meals was offered at each mealtime, and the service was able to cater for individual dietary requirements.

There were structures in place to support staff. There was a new system in place to undertake regular supervision sessions and staff had received an annual appraisal to review their performance and identify areas for development. There was a dedicated training manager in post and we saw that many staff were undertaking training courses, in addition to the mandatory training, to improve their skills and knowledge.

There were still inconsistencies and limited information within people’s care records. For example we found that for people that were at high risk of developing pressure sores it was not consistently recorded that they were being appropriately repositioned to reduce this risk. We saw that there were inconsistencies in the recording of ‘do not attempt resuscitation’ status between the electronic and paper records.

In addition to the follow up on actions taken by the provider relating to the areas of service identified above, we also reviewed the provider’s management of medicines. We found that there was missing information on some of the medication administration records which meant we could not be assured that there was appropriate recording of medication administered.

6 June 2013

During a routine inspection

At the time of our inspection 47 people were residing at The Dulwich Care Centre.

During our inspection we looked at the care records of 12 people. We spoke with ten people using the service, the manager and nine staff on duty.

People using the service had their own care records and we saw that some contained information about how they would like to be supported and had a number of care plans relating to their support needs. However, we found for some people that care and treatment was not provided in a way that reflected their individual needs and did not ensure their welfare and safety.

We observed that the food and drinks were provided to people using the service and the service was able to cater for special dietary requirements. However, we found that some people who required assistance to eat were not appropriately supported to do so.

All staff had recently undertaken their mandatory training covering manual handling, health and safety, and infection control. However, from speaking with staff and looking at staff records we found that not all staff had received regular supervision sessions, and there had been no appraisals within the last year.

We found that some people's individual care records did not contain accurate information and there was some information missing regarding the support needs of people using the service.

9 August 2013

During an inspection in response to concerns

This inspection focussed on the staffing establishment at The Dulwich Care Centre. We found that there were enough staff to meet the needs of people using the service. One person using the service told us, 'The staff are wonderful ' they always have time for a chat.'

The staffing establishment was reviewed every four weeks and the staffing levels could be increased if the needs of the people using the service increased or if someone required one-to-one support.

17 December 2012

During an inspection looking at part of the service

The service had taken action to address some of the shortcomings identified in our earlier inspections, but we found that further improvements were needed.

Improvements had been made to the storage, administration and recording of medication. New medicines trolleys had been purchased and checks were in place to monitor the safety of medicine administration.

We also found that steps had been taken to ensure there were sufficient numbers of staff on duty to care for the people using the service. The provider had improved the way in which the quality of the services was monitored.

We found care plans in place to address health care needs and there were appropriate referrals to health services. However, we found evidence that the changing needs of one of the people using the service had not been adequately reviewed. People could not be sure their records contained appropriate information about their care and treatment.

We observed staff sitting with people and supporting them to eat at a pace that was appropriate for them. However, the majority of interaction between staff and people using the service that we observed was task-based, and we found evidence that individual needs were not always met.

16 August 2012

During a routine inspection

We spoke with eight people living at the home, and four visitors. They told us they had confidence in the staff and that people were well looked after. One person told us that they and their relative were asked about their preferences when they came to live at the home. A visitor said there was a relaxed atmosphere at the home. Visitors told us they hoped there would be regular meetings for relatives because it was a good opportunity to ask questions about their relatives' care and what was happening at the home.

29 September 2011

During a routine inspection

The people we spoke with were generally positive about the staff working in the home. A relative told us that the staff were very friendly and 'I don't have a bad word to say about them'. Another visitor we spoke to said their relative felt 'really at home', and that when they had been choosing a home the staff had been very helpful and open.

The people we spoke with told us that they were happy and felt well cared for. A visitor told us that she and her relative living in the home were very impressed with the care received. A relative told us that they hadn't seen anything they didn't like whilst visiting the home over the last few months. A visitor told us that she was very happy with her relative's care and that she thought people were safe here. One visitor said their relative had been given the chance to take part in activities, but didn't want to do them.

A visitor told us that the food looked good, and her relative living in the home liked it. A visitor said that they had told the staff their relative's food preferences and the home had taken account of this when they served food.

Although the relatives and people we spoke with were positive about the service, our observations showed some concerns about the task-based approach of some of the staff, and a lack of respect for people's privacy and dignity, particularly on the second floor unit for people with dementia.