Delph House

Updated 5 October 2023

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.

Inspection team

The inspection was carried out by 2 inspectors on 11 April 2023 and by 1 inspector on 14 April 2023. An Expert by Experience carried out telephone calls to relatives of people who used the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Following the receipt of some additional information we undertook a third inspection visit on 31 May 2023. This visit was carried out by 2 inspectors.

Service and service type

Delph House 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. Delph House 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our first inspection visit there was a registered manager in post. However, they had left the service and deregistered by the time the inspection process concluded.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included information shared by the local authority quality and safeguarding teams. We used the information the provider sent us in the provider information return (PIR). 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 2 people who used the service and 7 relatives. We also spoke with 2 care staff, 4 senior care staff, the cook, the deputy manager, the registered manager and the provider. In addition to this we received feedback from 3 health and social care professionals.

We reviewed 7 care plans in detail and sections from other plans alongside medicine administration records for 3 people. We observed medicines being administered and reviewed the storage, stock control and disposal arrangements for medicines including controlled medicines. We also reviewed other records relating to the safety and quality of the service.

Updated 5 October 2023

About 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.