The Dales Nursing Home

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.

The service had 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.

There was a very high level of confidence in the leadership and management of the service expressed by people, relatives, staff and health and social care professionals. One health professional told us, “I think The Dales nursing home is outstanding. All my patients who have been looked after there have been cared for to the highest level. [Manager’s name] is an outstanding manager and gels the whole team. They care enormously for their patients and their staff. The Dales is a well-run home and I encourage any of my patients to be there for its high level of professional care”.

People told us staff were kind and caring and respected their privacy and dignity. One person said, “I love it here. Even when a new one (staff) comes in they are all very good.” The service placed a strong emphasis on a ‘person centred approach’, and ensured people, and their advocates where appropriate, were fully consulted and involved in all decisions about their lives and support. This meant people’s legal rights were protected. The registered manager played an active role in promoting this ethos of person centred care in their links with other providers and external health professionals. For example through delivering a presentation at a provider engagement meeting, and when student doctors and hospice care workers came to work at The Dales to learn about the service provided. These links also benefitted the people living at The Dales because they also created an opportunity for the staff working there to learn and keep up to date with best practice.

Many people at The Dales were receiving palliative care, and the service worked closely with the hospice and palliative care teams to provide the support they needed. A health professional told us, “In terms of end-of-life care, I feel The Dales far excels any of the other care homes in Exeter. They have a large number of short-stay palliative care patients who are well looked after with dignity and respect”. The home was registered with ‘The Gold Standards Framework’, which is a practical, evidence based approach to providing the best care for people as they approach the end of their lives.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. The service was extremely proactive in supporting people to maintain their fluid and food intake, especially people identified as being at risk of malnutrition.

People were kept safe and free from harm. Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s support plan showing how they should be supported to manage these risks. Systems were in place to ensure people received their prescribed medicines safely.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Where concerns had been bought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people.

There was a committed staff team at the home which was well supported by the registered manager and provider. A comprehensive induction and staff training programme meant staff were knowledgeable about their roles and responsibilities, and people’s individual needs. This enabled them to do their jobs effectively, and on-going professional development was encouraged for all staff members. They told us, “I am all up to date. Whenever we want training (registered manager’s name) asks and they come here. It’s quite good training.”

There had been some problems with staffing in recent weeks due to high levels of staff sickness. Shifts were covered by agency staff if they were unable to provide cover from the permanent staff team. One person who remained in their room every day said staff came to see them “Quite often”. If they needed assistance they used their call bell and told us “They are here within a minute or two. They are very good – even the cleaner. They can’t do enough for you.”

The provider had comprehensive and effective quality assurance systems in place to monitor safety and the quality of care. This included regular, documented observations of care delivery and staff interaction carried out by the provider. The service actively sought feedback from people using the service, their families and staff. Staff supported people to complete a bi-annual survey, and the results were published in the homes newsletter, with action that had been taken to address any concerns raised.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

A new activities organiser was in post, and the registered manager told us this was an opportunity to review the activities programme to ensure it continued to meet people’s needs, as many were now unable to actively participate. The service had developed strong community links, for example with local schools, university and churches. The registered manager said, “The ladies and gents that live here have to feel they are part of this community. We have to involve people and have people coming from the outside in”.

People’s relatives said they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.