Archived: Darsdale Home

Updated 14 October 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector, an inspection manager and a medicines inspector. An Expert by Experience made phone calls to relatives for feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Darsdale Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Darsdale Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection a manager had recently started in post. They had submitted an application to become registered.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority safeguarding and quality monitoring teams. The provider had not been asked to submit a PIR since the last inspection. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service and 11 relatives for feedback on their experience of care. We spoke with a director who was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with ten members of staff including the manager, deputy manager, senior care staff, activities coordinator, housekeeping and kitchen staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with a visiting professional.

We looked at aspects of 11 people's care records and three staff files. We also reviewed 21 medicine administration records (MAR) and eight medicine care plans. We looked at a range of other records including quality assurance checks and information about training and staff supervision.

After the inspection

We reviewed further information about DoLS applications from both the service and local authority. We reviewed the fire risk assessment and updated documents submitted by the provider.

Updated 14 October 2022

About the service

Darsdale Home is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 24 people using the service.

Darsdale Home has accommodation across two floors, in one adapted building.

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

Some changes had been made to the quality assurance systems since the last inspection. However, audit processes remained ineffective at assessing, monitoring and improving key areas of the service.

The action plan developed by the provider following the last inspection was not effective in identifying, prioritising, monitoring and reviewing improvements. There was no detailed and structured plan of how the provider intended to achieve a 'good' rating and improve care standards in the service.

A priority action identified in a fire risk assessment for the external staircase to be inspected by a qualified professional had not been addressed in a timely manner. Until this had taken place, people and staff were potentially at heightened risk of physical harm in the event of an emergency evacuation.

Systems to assess, monitor and manage risks to people's health, safety and welfare were not always up to date and effective. Care planning and risk assessment documentation was not always in place and regularly reviewed. Not everyone had grab sheets or up to date personal evacuation plans to ensure they were supported safely in the event of an emergency hospital admission or fire evacuation.

People were potentially unlawfully deprived of their liberty whilst living in the service. Oversight of applications for people to be deprived of their liberty, where this was necessary, was ineffective. Not everyone who lacked or had fluctuating capacity to make specific decisions had mental capacity assessments in their care records, or documentation showing best interest meetings had been held. Staff knew how to support people to make day to day decisions about their care.

Some improvements were found in medicines processes. Management of controlled drugs was safe. Improvements were required to protocols for 'as required' medicines and medicines care plans to ensure these were personalised and person-centred.

An ongoing programme of redecoration was gradually taking place but the décor in areas of the service was tired and required refreshing. People did not get maximum benefit from the large gardens around the service.

Recent changes had been made to the tool used to calculate safe staffing numbers as well as staffing levels and shift patterns. These changes required time to embed and their impact upon people's care and safety to be assessed and reviewed.

Checks were undertaken to ensure staff were suitable to work with vulnerable people. Some gaps were found in recruitment files, which were also identified at the last inspection.

Medical care and support was sought, when required, if people experienced falls, incidents or accidents. Monthly analysis of accidents, incidents and falls and sharing lessons learned was introduced following the last inspection but needed strengthening and embedding into practice.

Staff wore personal protective equipment (PPE) to reduce the risk of cross contamination or infection spread. Visitor sign in processes were in place and visiting arrangements aligned with current guidance.

A new safeguarding policy had recently been introduced and information about safeguarding processes was on display in the service.

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 4 May 2022) and there were three breaches of regulation. We issued two Warning Notices following the inspection due to concerns about poor governance arrangements under Regulation 17 and insufficient staffing levels under Regulation 18. We also issued a Requirement Notice under Regulation 12 due to concerns about people’s safe care and treatment.

At this inspection we found the provider remained in breach of regulations. Improvements to staffing meant they were no longer in breach of Regulation 18 but there were continued breaches in relation to governance and management oversight, and people’s safe care and treatment.

The service has been rated requires improvement in six consecutive inspections and has now deteriorated to inadequate. The service has been in Special Measures since 1 September 2021 due to repeated ratings of requires improvement and the key question of ‘well-led’ deteriorating to inadequate at the last inspection. During this inspection not enough improvements have been made. Therefore, this service remains in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked if the Requirement Notice we served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

Enforcement and Recommendations

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 have identified breaches in relation to provider oversight and people receiving safe care and treatment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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.