Durban House

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.

Durban House provides personal and nursing care for up to 42 people who may be living with dementia. At the time of our inspection 34 people were using the service.

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

The provider failed to ensure sufficient staff were appropriately deployed to meet people’s needs at all times.

We could not be assured risks associated with people’s needs were always assessed appropriately or managed.

We were not confident that unexplained injuries were investigated to ensure people were safeguarded.

Infection control procedures were not always followed in relation to cleanliness and clinical care.

The management of medicines requires improvement.

Governance systems were not effective in promoting a person-centred culture and failed to ensure people received high quality care.

Audits conducted by management failed to identify specific areas of concern we found during our inspection.

Care records required improvement to ensure continuity of care.

Some policies required review to ensure all relevant information was in these and they were being adhered to.

Staff did not always treat people with dignity and respect.

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

Rating at last inspection

The last rating for this service was good (published on 1 January 2019)

Why we inspected

The inspection was prompted in part due to concerns received about skin care, dignity not being provided, a lack of leadership and safeguarding concerns.

We undertook this focused inspection to check people were safely cared for. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is requires improvement. This is based on the findings at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

Durban House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation, nursing and personal care and support to a maximum of 42 older people, including those who may have a physical disability or be living with dementia. There were 40 people living in the home at the time of our inspection.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences. People were supported to express their views and be involved in making decisions about their care and support.

There were systems and processes in place to protect people from harm, including how medicines were managed. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received regular and on-going health checks. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

The registered manager was promoting an open, empowering and inclusive culture within the service. Quality assurance systems were in place, however there were sometimes gaps in the way these processes were taking place, particularly in relation to record keeping. We have recommended the provider and registered manager formalise the process for auditing and monitoring gaps in recording, while their new systems are being embedded in practice.

Further information is in the detailed findings below

The previous inspection took place in February 2014 when we found the service was meeting all assessed standards. Since our last inspection the service had increased the number of people accommodated from 33 to 42 as the provider had extended the building. Durban House is registered to provide care support and nursing care. There was a registered manager in post .A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Most people living at Durban House were living with dementia.

At this inspection we found the service was supporting people safely, effectively and in a caring way. Staff knew people well and were kind and caring. Visitors were welcomed. Staff respected people's preferred routines and activities provided were geared towards people's needs and interests.

People were protected from abuse and avoidable harm. Risk to people's health and welfare were managed appropriately. Environmental risks were regularly considered and managed well.

There were generally sufficient numbers of suitably trained and safely recruited staff to meet peoples' needs. There were some occasions, particularly in the mornings when staff were stretched which meant they could not respond to people's wishes as quickly as they would want, but this did not have an impact upon people's safety.

Staff received appropriate training and support.

The service liaised well with health care professionals when they needed support and guidance about people's health care needs.

People liked the food and were supported to have a diet which suited their needs and preferences. Staff ensured they sought consent before supporting people with their care and adhered to the Mental Capacity Act 2005.

People were given information about what the service could provide and staff were able to provide appropriate support because people's needs were clearly assessed and updated when a change had taken place.

People were encouraged to provide feedback about the quality of the service and complaints were responded to quickly. A particular strength of this service was how they included people in it's development. One dignity champion was a resident. Quality assurance processes helped to ensure the service maintained good standards which met people's needs and expectations.

The people we spoke with were satisfied with the care and support they received. They told us staff were caring and responsive to their needs. People's relatives told us they found people were looked after in clean, comfortable surroundings and that staff respected their dignity and individuality. We observed interactions between people and staff that were positive, encouraging and reassuring.

One family member wrote on a comment card, 'Durban House is the best for my mother. The fantastic care and friendliness shown to my mother and other people make our visits just a joy. If we ever had a concern it was always dealt with promptly.' Another comment read, 'People are all treated with dignity and respect at all times. Nothing is too much trouble for the staff.' People said they were listened to and were involved in decisions about their care and the service they received.

We found people were supported to access other healthcare services to ensure their needs were met. People living with dementia experienced effective, responsive care which met their needs and was delivered by caring staff. Processes were in place to monitor and assess the quality of the service.

People we spoke to told us that they were happy with the care and support they received. They told us they were able to express their views and could make choices about the care they received. We were told by one relative that the home was family focussed. They said "you could not get a happier team." Another told us that they felt the staff were "dedicated."

We saw that each person who lived at the home had a plan of care which detailed their needs and wishes. The plans included their physical, social and healthcare needs. We found that the home worked with a variety of healthcare professionals in order to meet people's needs. These included the speech and language therapist and mental health team.

Staff we spoke to told us they received the training they needed to do their job. We found that whilst training was provided some gaps were identified.

The home had processes in place to monitor the service provided to people who lived at the home. Records showed that regular audits relating to the management of people's medication, care plans and people's weights had been undertaken. We saw that the home also had a system in place to record accidents and incidents.