Delph House

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.