Durlston House

Updated 2 March 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.

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

One inspector and an assistant inspector carried out the inspection.

Service and service type

Durlston House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. 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 inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since it was registered. We sought feedback from partner agencies such as the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with 1 person to tell us their experience. We spoke with 3 relatives of people who live at Durlston House.

We spoke with 8 members of staff including the manager, area manager, deputy manager and 5 support workers.

We reviewed a range of records. This included 3 people’s care records and 5 medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We received feedback from two professionals who have contact with the service.

Updated 2 March 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Durlston House is a residential care home providing personal care to 5 people at the time of the inspection. The service can support up to 5 people.

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

Right Support

The provider did not have enough suitably trained staff to provide the support people needed. Staff were not suitably trained to administer rescue medicine, prescribed for one person in the event of a prolonged seizure. The service did not have sufficient staff to provide support in line with the hours commissioned by the local authority. This restricted some of the activities that people could participate in.

Systems in place to manage risks to people were not always effective and records were not always up to date. Some records contained conflicting information about the support people needed to stay safe. Staff completed incident reports where necessary, however, these had not been reviewed by the management team in a timely way. This increased the risk that action would not be taken to learn lessons following incidents.

The provider had good infection prevention and control systems. Staff took appropriate action to prevent the transmission of infections. The home was clean and hygienic.

People were supported to plan and prepare their meals. Staff provided support and guidance on maintaining a balanced diet.

The service had been designed to meet people’s needs. Self contained accommodation had been built in the home to meet the needs of 1 person. Other people had been supported to personalise their bedroom to make them comfortable spaces.

Right Care

People were treated with kindness and appeared comfortable and relaxed in the presence of staff. We used the ‘Talking Mats’ communication system with 1 person, who told us they liked the staff. Relatives told us they thought people were well treated and were confident their relative was protected from abuse.

Staff demonstrated a good understanding of people’s needs. We observed staff interacting with people in a friendly and respectful way.

People were supported to access the health services they needed. Regular assessments were completed to ensure people had attended regular health appointments, such as dentists, annual health checks and specific health clinics.

Right culture

Staff did not always work within the principles of the Mental Capacity Act (MCA). We identified 2 examples where staff had restricted people. At other times we observed staff working within the principles of the MCA and records of support also demonstrated this.

Staff did not consistently use people’s enhanced communication systems.

The provider did not have effective systems to assess, monitor and improve the quality of the service being provided. The systems that were in place had identified improvements were needed, but actions to make these improvements had not been completed in a timely way.

People were supported to maintain key relationships and take part in a range of activities, although some activities were limited due to staffing levels. Staff supported people and their representatives to made decisions about their care. These views were recorded in their support plans.

Staff worked in ways that respected people’s privacy and dignity.

The service had newly appointed manager and area manager. They reported they were aware of the shortfalls and were in the process of addressing them. The manager said their focus was on recruitment, to ensure they had sufficient staff to provide safe and positive support for people. Relatives told us communication with the management team had improved significantly since the appointment of the present manager. They said the manager had worked with them to resolve any concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 1 December 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches of regulations in relation to safe care and treatment, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.