Durban House

Updated 17 November 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 undertaken by 2 inspectors.

Service and service type

Durban House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. Durban House is a care home with 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 inspection there was a registered manager in post. There was also an acting manager. The provider informed us that it was their intention to register the acting manager once they had been further inducted into their role.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. We sought feedback from the local authority and professionals who work with the service.

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 6 people living in the home and 2 relatives. We also spoke with the nominated individual, registered manager, acting manager, 3 registered nurses, 4 care staff, the maintenance person, the chef manager and the head of housekeeping.

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.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We also received written feedback from a further 3 staff, 14 relatives and 2 health and social care professionals.

Updated 17 November 2022

About the service

Durban House is a care home providing personal and nursing care to up to 42 people. At the time of our inspection there were 30 people using the service, some of whom were living with dementia. Durban house is an older style building that has been repurposed into a nursing home. The accommodation is arranged over 3 floors with some rooms having ensuite facilities and direct access to the garden. The home has 2 comfortable communal lounges and a dining area. There is also a ‘bistro’ where visitors can meet with their family members for a coffee.

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

Whilst some improvements were evident, insufficient action had been taken to address all of the breaches of the fundamental standards that we identified at our last inspection. Governance arrangements needed to be more robust. We continued to identify concerns regarding how risks to people were assessed and mitigated. This inspection also identified 2 new breaches regarding the safety of recruitment and how people were being safeguarded from abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, some of the systems in the service needed to be developed to fully support this practice.

Improvements had been made to ensure that people received person centred care and, overall, there were sufficient numbers of staff deployed.

Improvements were needed to ensure that people always received their medicines as planned. Protocols for the use of ‘when required’ or PRN medicines lacked detail and personalisation. People received their medicines in a patient and person-centred manner.

The provider had appropriate infection prevention and control policies and practices in place and the housekeeping team ensured good standards of cleanliness and hygiene were maintained.

Relatives felt listened to and told us their views were acted upon. This now needed to be more clearly evidenced in relation to people using the service.

When incidents had occurred, the leadership team had apologised and given people honest and transparent information about what had happened.

Staff worked with a range of health and social care professionals including, GPs, social workers, the community mental health team, speech and language therapists and tissue viability nurses to meet people’s needs.

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 1 December 2021) and there were 4 breaches of the Regulations.

At this inspection we found the provider remained in breach of regulations and the service remains rated as requires improvement.

This service has now been rated requires improvement for their last 2 consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 June 2021. Breaches of legal requirements were found. The provider completed an action plan after that inspection to show what they would do and by when to improve.

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.

This inspection has found evidence that the provider still needs to make improvements. Please see the safe and well-led key question sections of this full report.

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 has remained the same. 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 Durban House on our website at www.cqc.org.uk.

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, governance, safeguarding and recruitment at this inspection.

We have made a recommendation about training in relation to the Mental Capacity Act 2005.

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