Daleside Nursing Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed 5 quality statements in the caring key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Our rating for the key question has changed to requires improvement. The staff were not always caring. We identified 1 breach of the legal regulations. People were not always treated with dignity and respect in their day-to-day care and support. Some people were not receiving regular opportunities to bathe in line with their personal preferences and needs. People were not always treated as individuals. Care plans were not always reflective of people’s personal preferences. Where preferences were identified, this was not always respected. Where people shared bedrooms, their personal space was not always protected by dignity screens. Their personal property was not clearly defined or the areas around their bed personalised. There was a lack of leisure activities available for people to participate in. Some family members felt this had led to a decline in peoples wellbeing as they had a lack of social stimulation. Staff did not always respond to people’s immediate needs quickly and efficiently. Family members raised concerns about the promptness of staff responses when a person needed additional care. We observed staff who knew people well and treated people with kindness however, important information about people’s personal histories was not recorded. For one person, this information had been provided as part of their transition to the service however, this information had not been incorporated into their care plan. This meant routines which were important to them were not known by staff.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback whether staff treated people with kindness, dignity and respect. Family members we spoke with did not all feel their relatives were being treated with dignity and respect. One family member told us, “[Name’s] dignity can sometimes be compromised because her nightdress isn’t pulled down when [staff] change her.” The same person told us staff often place food out of their relatives reach which had resulted in it spilling over the person. They added “It isn’t very dignified.” We shared this feedback with the management team. Other people did tell us staff treated people with kindness. One family member described staff as 'family'.

Staff demonstrated an understanding of how they protect people’s privacy and dignity. This included closing doors/curtains when providing personal care, asking for consent and offering choice.

We received feedback from the local authority detailing how they were working through concerns raised by family members about people’s care in the service. This included a family member who was concerned about their relative sleeping on a urine saturated mattress. The local authority told us the provider operated a resident of the day system however, did not use this effectively to find out people’s preferences in care. We received an update from a social worker who visited the service and spoke with a person who had raised a complaint. They reported the person to be comfortable and settled and living in a homely environment.

We observed positive interactions between members of staff and people within the communal areas of the service. For example, telling jokes, talking about the news with people, ensuring people were clean and well-presented and checking in with people who were sat quietly. Staff spoke about people in a kind and caring manner. We found however, this was not always the case for people who were residing on the upper floors. One person had temporarily moved into a bedroom as they were having some decoration. Staff had not moved any other person’s clothing, toiletries or personal items and we observed them to be sat alone in an empty bedroom. Two people were sharing a bedroom. We observed there was a commode next to one bed. There was no privacy screen to protect either persons privacy or dignity when the commode was in use. We raised both issues straightaway with the regional manager who took immediate action to action to address our concerns.

We received mixed feedback whether people felt they were treated as individuals. We receive positive feedback about ensuring peoples dietary preferences were met. One person said, “When I first came here, I gave the chef a list of all the food I don’t like, and they don’t give me boiled potatoes.” However, a family member told us they didn’t believe staff knew their relative well. They told us, “I did have to give them back Dad’s care plan with a lot of red pen on it because it was just dreadful mistakes all over it. For example, Dad has two sons.” A person told us they don’t have a choice about their preferred routines. They told us, “I don’t get asked what time I want to go to bed or get up. [Staff] just do it.”

Staff told us any religious or cultural needs would be within a person’s care plan. When asked about engaging with people using preferred communication methods, some staff were less certain. For example, they were not all aware how to support one person who communicated using an I-PAD. Senior staff members were able to provide examples of when they have referred people to other services for support around developing effective communication methods.

We observed a mixture of staff on duty supporting people. When staff were new or an agency worker, we observed experienced staff explaining to them about any individual needs or preferences. However, some observations did not demonstrate staff were treating people as individuals. For example, the bedroom of the two people sharing did not have clear definitions of personal space. One of the people had recently moved into the room and some of their personal belongings were draped over chairs and their personal belongings had not been fully unpacked and put away. Some photographs were on a unit however, it was unclear who they belonged to. This was addressed straightaway by the regional manager when raised.

Care plans lacked detail about people’s preferences about care. Each person had a ‘Life story’ section. This was blank in every care plan we reviewed. Preferences in terms of the gender of staff was inconsistently recorded, or respected. For example, in the personal care section of one person’s plan it stated the person prefers support from female staff. Other areas of the plan stated the person had no preference. We spoke with one male staff member who confirmed they routinely supported the person with personal care and was not aware of this preference. One person had some information in a file which had been provided by a previous care provider. This stated the person liked to have their hair washed and liked to touch it and be complimented. This was not reflected in the persons care plan. There were no records to indicate this person was having their hair washed on a regular basis. Language used about people in care plans was not always appropriate. One person was described as ‘resistive’ and ‘disruptive’ and ‘destructive’ within different areas of their care plan. There was no detail to explain what this meant, or how to support the person appropriately. We raised this with the management team, and it was explained to us the care plan system used drop down boxes containing standard wording. The regional manager told us this person’s care plan would be fully reviewed and rewritten.

Family members told us they were able to visit regularly and people who lived at the service told us they were able to maintain important relationships. One person told us, “Yes, my friend’s daughter came in. She did my nails.” Family members told us there was a lack of activities for people to participate in. Comments included, “I’m not sure whether her mental state has gone done because she’s bored in here. She has nothing to do she just sits here” and, “We take my relative out, the staff do not. They had a singer on a few weeks ago but other than that they don’t do anything with residents. They are just left.” One person chose to stay in their bedroom as they didn’t enjoy the company of another person in the home. They told us, “It does get lonely sometimes.”

Staff told us there was a lack of activities currently due to staff absence. They told us they did their best to keep people entertained but this was not always possible due to the workload. One staff member said, “I feel like we have no time to spend with people, we are always rushing on to the next job.” The regional manager acknowledged there was a lack of meaningful activity and told us they were addressing the absence issues and were recruiting to positions. Staff told us people have visitors regularly and there were no restrictions in place.

We observed people having family and friends visiting freely throughout our assessment. We observed people being offered appropriate choices around mealtimes. During mealtimes, we observed people being encouraged to be as independent as they were able. However, we observed periods where people were left alone in bedrooms with no activity to engage in. We observed there was a lack of meaningful activity in the communal areas. During the assessment, we observed a small number of people doing artwork, but did not observe any other activities other than people watching TV or listening to music. There was an activity board in the dining room to advertise ‘what’s on’ however, this was blank throughout the assessment.

Some care plans included information when people were able to do things for themselves, however this was not always consistent. Records maintained by staff did not always evidence how people’s independence was promoted. Peoples interests and hobbies were not recorded, and standard wording was used in some care plans which did not reflect the person. For example, one person’s care plans said to ‘encourage the person to socialise and build relationships.’ The care plan stated staff should ‘prepare the sensory space in the home.’ The person was cared for in bed and there were no examples of how staff should encourage this, and we confirmed there was no sensory room within the service. The care plan for one person who received 1-1 support did not direct staff to activities they may like to engage in whilst receiving this level of support. Records maintained by staff only recorded personal care tasks and did not capture social or leisure activities people participated in.

Some family members we spoke with told us they did not feel people’s immediate needs were always promptly responded to. One told us, “It is so frustrating because we are raising the same issues all the time. We have to get clean bedding because sometimes [staff] don’t change his wet sheets. [Staff] say he refuses but I don’t think he has had a shower since he has been here.” People gave us mixed feedback. One person told us they could call for staff assistance whenever they needed however, another person told us they had paid some money and were waiting for the registered manager to arrange a chiropodist. We shared all this feedback with the management team who confirmed a chiropodist was yet to be sought and told us they would address the concerns raised.

Staff told us they found it difficult to spend time with people unless they were providing an aspect of care. One staff member commented, “I feel sorry for the residents at times, as sometimes they walk around crying, looking depressed. They have nothing to do and are not stimulated.” Staff were able to describe appropriate action they would take to respond to people’s immediate needs. For example, if they saw a person upset, they told us they would talk to people, offer reassurance and ensure the person had company (if they wanted).

We observed staff on the ground floor communal areas responding quickly to people’s immediate needs and saw were people treated with kindness. However, this was not always the experience of people who were cared for in bed or resided on the top two floors. On two occasions we alerted staff to people who were needing assistance. One person needed assistance with personal care. The other person said they were in pain. Both people had pressed the buzzer and staff had not responded in a timely manner.

Some staff told us they found it difficult to take their allocated breaks due to being busy. They told us about the room in which to take their breaks was unsuitable. We viewed this area and fedback to the management team the area needed to be refurbished. The regional manager told us they would review the systems in place with the nurses and senior care team to ensure all staff were taking their breaks.

Although some staff spoke of difficulties in taking breaks, we did see clear systems were in place. Senior care staff and nurses were responsible for ensuring staff took their allocated breaks. We observed staff being directed to take breaks during our assessment. The provider had appropriate policies and procedures in place to support workplace wellbeing including flexible working arrangements. During our conversations with staff, we were told of a recent staff awards evening in which staff were recognised for their contribution to people’s care. We checked the provider social media pages and website and could see examples of this event. Staff told us this was enjoyable and feeling recognised was appreciated.