The Dales Nursing Home

Updated 10 January 2020

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 Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and one Expert by Experience on the first day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector completed the inspection on the second day.

Service and service type

The Dales Nursing home 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

This inspection was unannounced on the first day and announced on the second day.

What we did before the inspection

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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service and six relatives or friends about their experience of the care provided. We spoke with the provider, registered manager, operations manager, administrator and 13 staff members. This included registered nurses, a nursing assistant, care staff, a chef, housekeeper and activities co-ordinator.

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.

We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We received feedback from seven health and social care professionals and two members of staff we had not previously spoken with.

Updated 10 January 2020

About the service

The Dales Nursing Home is a care home providing personal and nursing care to people aged 65 and over. At the time of inspection there were 31 people living at the Dales.

The Dales accommodates 31 people in an adapted building. It is a Victorian terraced property on three floors sited close to the city centre of Exeter. The service had a lift access to all floors. Some of the areas of the service are difficult to access due to the layout of the building. There are communal areas on the ground floor.

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

People felt safe living at the Dales. Two people said, “They are so good and kind” and If I am upset they will comfort me.” Staff had undertaken training on abuse and knew the correct actions to take if necessary.

People, relatives and professionals were happy with the care provided. Relatives spoke highly of the service and how they were made welcome at any time. One said, “I spend a lot of time here and staff will do anything for you.”

People had an assessment of their needs carried out and a care plan in place. People were included in decisions about their care, particularly around their wishes at the end of their life. The registered manager was passionate about end of life care and professionals spoke highly of both the care, skill and leadership shown to people nearing the end of their lives. One professional said, “(Registered manager) appears to inspire her team of carers to be equally compassionate and caring.”

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; the policies and systems in the service supported this practice.

The service had not always recruited prospective staff in a safe way. This meant the service could not be sure staff were safe to work with people who may be vulnerable. A new recruitment procedure and checking system has now been put in place.

Staff had completed the required training to perform their roles effectively and felt supported and valued in their role. They received supervision regularly in relation to their care practice.

Staff treated people in a respectful, kind and dignified way. Positive relationships had developed and staff knew people’s individual needs well. Staff were respectful of people’s dignity.

People were supported to eat and drink enough to meet their needs. They received their medicines at the right time and in the correct way.

People had individual assessments of risk in place but other risks had not always been identified which might pose a risk to people living at the Dales. However, these were all resolved during the inspection.

People found the registered manager supportive and approachable. Staff were positive about the culture of the service.

The new provider visited the service regularly and took an active approach in leading the service. They were committed to improving the service and had made extensive refurbishments to the building. They valued staff and their commitment to the service.

Some audits of the service took place, but these did not cover all the areas required. Some essential records to keep the building and people safe were not completed. However, systems have now been put in place for all areas of the service.

The service worked with other agencies to promote people’s health, safety and well-being.

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 10 April 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements.

The provider has taken action to mitigate the risks following the inspection which makes the impact on people low.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Dales Nursing Home on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.