Archived: Durham Care Homes

Updated 27 April 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by concerns raised by the local authority following a series of monitoring visits to the service.

Inspection team: The inspection team consisted of two inspectors on 6 and 7 February 2019 and one inspector on 8 February 2019.

Service and service type: Durham Care Homes is a ‘care home’. People in care homes receive accommodation and nursing or personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was a manager in the service but they had not yet registered with CQC. It is important for a manager to be registered with CQC so they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: The inspection was unannounced on the first day. The provider and manager were informed we were to return on 7 and 8 February 2019.

What we did: Before the inspection we spoke with local authority safeguarding, contracts and commissioning teams. We attended a meeting with agencies to listen to and discuss concerns. We reviewed notifications of incidents received since the last inspection in November 2018.

During the inspection, we spoke with four people who used the service and two of their relatives. We spoke with the provider, the manager, two senior care workers, two care workers, the cook, a catering assistant and a visiting health professional. It was difficult to speak with a second cook as their first language was not English.

We looked at care records for nine people who used the service and medication records for 13 people. We looked at a range of other records used for the management of the service. These included three staff recruitment files, audits, the staff rota and training records.

Updated 27 April 2019

About the service: Durham Care Homes is a residential care home for up to 20 people. At the time of the inspection, it was providing personal care to 14 people aged 65 and over.

People’s experience of using this service: The quality of care had deteriorated since the last inspection. People’s safety had been placed at risk due to safeguarding policies and procedures not being followed. The provider and manager had not assessed and managed risk, which placed people at risk of harm. Some people had not received their medicines as prescribed. Staff recruitment continued to be poor. There was insufficient staff to meet people’s needs. There were concerns with staff practices regarding infection prevention and control.

Some people’s nutritional and hydration needs had not been fully assessed and met; the meals provided were repetitive and gave limited choice to people. The meals and snacks for people on soft diets were inadequate. Staff contacted health professionals when required, although during the inspection, staff had to be prompted on two occasions to seek medical assessment for people.

Staff did not have the right skills, experience and knowledge to care for people safely. There was partial understanding from the manager regarding mental capacity legislation, the need for people’s deprivation of liberty (DoLS) to be authorised and the need for people to consent to their care. However, some people’s DoLS had expired and applications had not been resubmitted. Three people met the criteria for DoLS but applications had not been made to the local authority for authorisation.

We observed episodes of care and staff interaction with people and each other that was poor and required improvement. There were also some interactions between staff and people who used the service that was kind and considerate. There were times when people’s privacy and dignity were compromised. There was very little social stimulation provided to people, especially those people who remained in their bedrooms.

People had assessments and plans regarding their care and support needs. However, the care plans lacked important information, were not always kept up to date when changes occurred and had limited direction for staff in how to deliver care in a person-centred way.

The service was not well-led and there continued to be a lack of effective governance and oversight by the provider and manager. The day to day shifts lacked organisation and the culture in the service required significant improvement; there was institutional and unsafe practices, which went unnoticed and unchecked by management. Records were not always accurate and up to date.

More information is in the full report.

Rating at last inspection: Requires improvement; published 19 February 2019.

Why we inspected: We received information from the local authority regarding an escalation of concerns about the service; they had been completing monitoring visits. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement: The service met the characteristics of Inadequate in four key questions of safe, effective, responsive and well-led and Requires Improvement in caring. We are taking enforcement action and will report on this when it is completed.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.