This unannounced inspection took place on 3 January 2019. Darlington Court 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.

Darlington Court is situated in Rustington in West Sussex and is one of a group of homes owned by a national provider. Darlington Court is registered to accommodate 61 people. At the time of the inspection there were 46 people accommodated in one adapted building, over two floors. Each person had their own room and ensuite bathroom. The home provided accommodation for older people, those living with dementia and people who required support with their nursing needs. People's needs included physical disabilities, diabetes and epilepsy.

At the first comprehensive inspection on 24 and 25 February 2015, the home was rated as Requires Improvement and breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 were found. At the next scheduled inspection on 24 May and 2 June 2016, the home had improved and was rated as Good'. At this inspection on 3 January 2019 the rating of the home changed to Requires Improvement. This is the second time the home has been rated as Requires Improvement. This was because there was mixed feedback from staff about the leadership and management of the home. Some staff told us that the registered manager was approachable and supportive. Other staff told us that they did not feel able to approach the registered manager if they encountered problems of concerns. This was fed back to the registered manager and regional director who told us they would discuss this with staff to further identify the issues and to help find a solution.

Quality assurance processes were not always effective. The provider's audits had identified some of the shortfalls that had been found as part of this inspection. Action had been taken to make changes, however this needed further improvement. This related to records not being sufficiently maintained as well as mental capacity assessments not being completed for specific decisions relating to people’s care. Other shortfalls that were found as part of this inspection, however, had not been identified by the provider. These included ensuring that all people had access to appropriate pressure relieving equipment when required. In addition, the involvement of people and relatives in discussions about people’s care was not documented to demonstrate this had taken place.

Assessments had been undertaken to determine people’s needs to enable them to maintain their health. One person, had been assessed as being at a high-risk of developing pressure wounds. Although they had received appropriate support from community nurses when they had sustained a pressure area wound, they did not have access to appropriate pressure-relieving equipment to maintain their health. Staff were unable to provide an explanation of what setting the person’s pressure relieving mattress should be set to. Guidance had not been provided to staff to inform their practice. This meant that staff could not assure themselves that the person was using a suitable piece of equipment to prevent further pressure damage. When this was fed back to the registered manager, immediate action was taken and the mattress was replaced.

The home had a registered manager. A registered manager is a ‘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 home is run. Since the previous inspection on 24 May and 2 June 2016, the registered manager of the home had changed. The management team consisted of the registered manager who had been in post for one year, a clinical lead and two unit managers. A regional director regularly visited the home to conduct quality assurance a

The inspection took place on 24 May and 2 June 2016 and was unannounced.

Darlington Court provides nursing and residential care for people with a range of health needs, including physical frailty and dementia. It is registered for up to 61 people and at the time of our inspection, 31 people were living at the home. Darlington Court is a purpose built nursing home surrounded by landscaped gardens and patio areas. The home is divided into five units: Milton and Shelley on the ground floor provide residential care to older people and people living with dementia. On the second floor, three units: Byron, Elliott and Keats, provide nursing care. The majority of rooms are of single occupancy, with five double rooms. Each unit has communal areas comprising a sitting room and dining room with kitchenette.

A registered manager was 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.

The last inspection took place on 24 and 25 February 2015. As a result of this inspection, we found the provider in breach of a number of regulations and asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and required standards were now being met.

Sufficient numbers of suitable staff were employed to keep people safe and meet their needs. People risks had been identified and assessed and were reviewed monthly. Environmental risk assessments were also completed. Medicines were managed safely. Checks were made on new staff before they commenced employment. People said they felt safe living at Darlington Court.

Staff had been trained in a range of areas and received individual supervision as well as attending staff meetings. New staff underwent a period of induction and followed the Care Certificate, a universally recognised qualification. Staff had a good understanding of their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and put this into practice. People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. They had access to a range of healthcare professionals and services. The ground floor at Darlington Court had recently undergone a period of refurbishment and all rooms had en-suite facilities.

People were looked after by kind and caring staff who knew them well. Staff were encouraged to sit and chat with a different person they did not know well in a daily event entitled, ‘Tea at 3’. People were supported to express their views and to be involved in decisions about their care. They were treated with dignity and respect. Some care plans contained guidance about people’s end of life wishes.

Handover meetings were organised between each change of staff shift which enabled information to be shared about people’s care needs in an effective way. Before people were admitted to the home, a pre-assessment was completed which formed the basis of their individualised care plan. A range of planned activities was available to people. Complaints were managed in line with the provider’s policy.

The home had undergone a period of change relating to the care provision and a change of registered manager since the last inspection. Systems were in place to measure the quality of care delivered and drive continuous improvement. Staff felt well supported by management and people and their relatives attended monthly meetings to feed back their views about the service. The registered manager was involved in various initiatives and worked in partnership with

Darlington Court is a privately owned care home that provides care for up to 61 people. The care home provides care for up to 26 older people who have dementia or mental healthcare needs and for up to 15 frail elderly people with nursing needs. Up to 20 places have been allocated as community beds. They are for people who are receiving rehabilitation after surgery or other hospital treatment, before returning home, or who are receiving treatment in order to avoid admission to hospital.

The inspection team was made up of two inspectors and an expert by experience. During the inspection we considered how people were cared for in each part of the service. We looked at the care provided to people who have dementia or mental health needs, to elderly people who required nursing care, and also to those who required rehabilitation.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff who supported them and from looking at records. Records we examined included care records, staff rotas, staff training records and records related to the provider’s quality assurance processes.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no one who currently lived at the service was subject to a DoLS authorisation. The manager demonstrated an understanding of DoLS and there were policies and procedures in place that the manager and staff could refer to if needed.

People who use the service have been protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The systems in place to make sure that the manager and staff learned from adverse events such as accidents and incidents were not sufficiently robust. Whilst statistical information regarding the number of incidents had been recorded, there was no analysis of this information to identify patterns in order to reduce the recurrence of such incidents.

Is the service effective?

People who have capacity to make decisions for themselves have been asked to give their consent to the care and treatment provided. However, where people have been assessed as not having capacity, best interest meetings had not been held with families and other professionals involved in the person’s care to ensure the individual’s human rights have been maintained.

We found that people's nutritional needs were met. However, we observed that the lunchtime experience in the dining area used by people who lived with dementia was not a positive one. People routinely had to wait over 40 minutes from the time the meal was served before they were helped to eat their meal. This meant any hot food that had been served was cold by the time the person could eat it. Care staff who assisted people to eat their meal did not ensure the pace was dictated by the person and encouragement was not given where needed.

Whilst people’s needs had been assessed, care planning systems were not effective. Care records did not include sufficient information for nursing and care staff to ensure people’s needs had been consistently and effectively met. Some care records had not been reviewed at sufficiently regular intervals to ensure they reflected the current needs of individuals.

The quality monitoring systems at the service were not sufficiently robust. The system demonstrated that routine audits took place and action plans had been drawn up where necessary to address any shortfalls. However, there was no evidence to demonstrate that their implementation had been monitored to ensure they were effective in making the improvements required.

Is the service caring?

People who received nursing care and rehabilitative care told us that they were very happy with the care they received. One person told us, “The staff are wonderful. They are very good and helpful. Another person said, “Everything’s hunky-dory. I can’t complain.”

Our observations of the care provided to people who lived with dementia indicated they did not receive the same quality of care. We observed people having to wait for up to 50 minutes before they received the care they required. When they received care and support to eat their meal the care staff did not engage with people to ensure they ate and drank enough and to ensure the mealtime was a pleasant experience. They were not offered choices with regard to what they wished to drink.

Is the service responsive?

Although the views and opinions of people and their relatives about the service were sought, there was no evidence to confirm they had been taken into account when changes had been made.

People’s care needs had not been reassessed and their care records were out of date. Information in care records were not sufficiently detailed to guide staff on people’s current care and treatment.

People who lived with dementia experienced care and treatment that was task centred rather than in response to their individual needs and preferences.

Is the service well-led?

The provider has created two posts, known as unit managers. A trained nurse has been appointed to each of them. They have been responsible for oversight of the day to day running of the physical frail unit (PFU) and the mentally frail unit (MFU). The deputy manager has responsibility for oversight of the rehabilitation unit. The general manager, who has also been registered with the Commission, has been responsible for the entire provision of service.

Care workers we spoke with were able to describe their roles and responsibilities and what they were expected to do.

They also confirmed they felt well supported by their manager. However, they were unable to confirm that formal supervision sessions and staff meetings were held routinely to ensure effective communication between the managers and all the staff employed at the service.

We spoke with three of the 17 people who had received rehabilitation and treatment between discharge from hospital and their return home. Each person confirmed they were satisfied with the care and treatment they had received. One person told us, "Overall, the service has been pretty good." Another person said, "I came to Darlington Court for exercise and therapy after my accident. I am getting this fairly well.” A third person told us, “My mobility has not been very good. So, I came here to get sorted out. I’ve had treatment from ‘OTs’ (occupational therapists) and ‘physios’ (physiotherapists). It’s been a struggle, but I can do more on my own now.”

We spoke with two care assistants who explained what they were expected to do to ensure people’s needs had been met safely. This included supporting people with their care and treatment needs.

We spoke with a team of physiotherapists and occupational therapists who were based at Darlington Court. They told us about the systems that had been put in place to manage and to provide treatment to people.

We also spoke with the manager, the clinical lead and a registered nurse. They explained to us how care and treatment records have been managed to ensure people have been protected against the risk of receiving unsafe or inappropriate car or treatment. We found that records we looked at demonstrated that people's needs had been assessed and appropriate care and treatment plans had been drawn up.

The manager also advised us how staffing levels have been determined to ensure there are sufficient numbers and skills mix to meet the needs of people accommodated. Duty rotas we looked at confirmed the numbers and skills mix of staff that had been provided.

We spoke with four of the 18 people who had received rehabilitation and treatment services between discharge from hospital and their return home. Each person confirmed they were satisfied with the care and treatment they had received. One person told us, “This is a comfortable place. The staff are very nice and everyone is friendly.” Another person said, “The care I have received is very good. The nurses are very friendly. They listen to you and you are not forced to do anything. I couldn’t eat when I came in. The staff did not force me, they were so patient. Now I can eat normally again.”

We also spoke with two relatives whose family members had been admitted for long term care. They also confirmed their satisfaction with the care and treatment provided. One relative informed us, “The home and people within it are very caring. The manager is prepared to sort out any problems we have. The staff care and are so kind.” A second relative commented, “Darlington Court is a happy, caring place with jolly good staff – that includes everyone.”

People we spoke with said that the manager visited them in hospital to assess their needs. We found that care records we looked demonstrated that people’s needs had been assessed and appropriate care plans had been drawn up. This included nursing care and also physiotherapy treatment. This meant that people's care and treatment needs had been managed safely by the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

On this occasion we concentrated our inspection on experiences of people who have received rehabilitation and treatment between discharge from hospital and their return home. We spoke with five people who have received this service. We also spoke with two relatives.

People we spoke with confirmed that the manager visited them in hospital to assess their needs. However, the care and treatment provided fell below the expectations of people. For example, one person told us, “I was told there would be a lot of physiotherapy, both morning and afternoon. This is what sold it for me. When it started, they would come in to me for 15 minutes each morning, nothing more.”

They also told us the care staff were kind and hard working. The general opinion was that there was not enough staff on duty to meet the needs of people accommodated. We were given several examples when people had to wait half an hour, and sometimes an hour, before they received assistance.

We found that there were significant gaps in care records and there was no evidence that care plans had been designed to meet individual needs. This meant that people's care needs were not being managed safely by the service.

We visited a part of the premises know as the Physically Frail Unit, which is a part of the care home that has been set up to provide care to people who have predominantly nursing and physical care needs. We were informed that 35 people were accommodated here.

We spoke with three people and with two of their relatives who were visiting them. They told us about their experiences when they were admitted to Darlington Court. They confirmed that someone visited them in order to discuss their needs and how they would be met.

They told us about the care and treatment they have received since they have been living at the service. They confirmed that, overall they were satisfied with the care they have received. We were informed that staffing levels provided have not always been sufficient to meet their needs.

We asked people about how prescribed medication has been administered to them. We were told that they received medication when they have needed it.

We also asked people if they knew how to make a complaint if they had any concerns about the service provided. They confirmed they had been made aware of the process and that they were confident their concerns would be taken seriously.

We visited the Wordsworth Unit, which is a part of the care home that has been set up to provide care to people who have dementia. People accommodated there were not able to tell us about their experiences.

To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. This tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spent 30 minutes watching care provided to four people in the dining room towards the end of breakfast. We found that overall people had positive experiences. The majority of staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own.

The inspection took place on 24 and 25 February 2015 and was unannounced.

Darlington Court is a privately owned care home that provides nursing care for up to 61 people. At the time of our inspection, there were 46 people living at the service. This includes people who have general nursing or residential needs and people who live with dementia or have mental health needs. In addition the service provides short stay rehabilitation. This is for people following surgery or other hospital treatment before returning home, or for people who are receiving treatment in order to avoid admission to hospital. Darlington Court is a purpose-built home on the outskirts of Rustington; all bedrooms have en-suite facilities. The home is arranged in two suites, each with its own lounges, dining room and kitchenette. There is an activities room and hairdressing salon.

The service has a registered manager. 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.

People did not always have call bells within reach, so that they could not summon staff speedily when they needed help. Staffing levels were not sufficient to keep people safe. Where people had developed pressure ulcers, their wound care was not managed safely as staff lacked the necessary knowledge and skills. People’s medicines were not always administered safely as there were gaps in the recording. Medicines were stored safely, but there was an overstock of some medicines which were old stock.

Staff knew how to recognise signs of potential abuse and what action to take to keep people safe. The provider followed safe recruitment practices. People were protected against the risk of infection. Laundry was managed in line with safe practice and clinical waste was disposed of appropriately.

The majority of people were supported by staff to have their nutritional needs met. However, some people did not receive the support they needed. There was a variety of choice on the menu and the dining areas were made welcoming for people with attractively laid tables and drinks on offer. People had access to healthcare professionals and a GP visited the service daily. Milton Unit was in the process of being refurbished to meet the needs of people living with dementia. However, some aspects were not made easily understandable or accessible for people, such as notices or signage. Staff were trained to at least Diploma Level 2 in Health and Social Care and received regular face to face supervisions with their managers. They understood the requirements of the Mental Capacity Act (MCA) 2005 and involved people in the decision making process.

People were looked after by kind, caring and compassionate staff and they were involved in planning their care. They were treated with dignity and respect and their relatives and friends could visit at any time. As they reached the end of their lives, people were cared for and supported to have a comfortable and pain-free death.

Some people felt that care was not personalised to meet their needs. Activities were organised, but many people chose not to be involved with these or were unable to participate fully because they needed one to one support. There was limited access to the community, unless people’s relatives and friends took them out. There was an inconsistency in the way information was recorded in people’s care plans, with a risk that people’s care needs were not assessed accurately. Staff knew people well at a personal level and understood the way they preferred their care to be delivered.

Systems for measuring the quality of the service were not sufficient to drive continuous improvement nor to feed into the strategic direction of the service. Care records were at risk of being completed inconsistently and complaints had not always been handled in line with the provider’s policy.

People were involved in developing the service, as were their relatives. Regular meetings were held and satisfaction surveys sent out.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.