The inspection took place on 21, 22 and 23 July 2015 and was unannounced.
The last inspection of the service was in July 2013 when it was found compliant in protecting people from abuse and safe management of medicines.
The service predominantly cared for older people who lived with dementia, had physical disabilities and mental health needs. It could accommodate up to 22 people and at the time of the inspection 16 people in total were living there.
The registered manager had left in June 2015. A new manager was in position and had started four weeks prior to our inspection. 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.
Some information of concern was received by us prior to the inspection. We had asked the provider to investigate the issues raised, which they did. They reported that none of the concerns reported were correct. The issues raised were also explored during this inspection.
We found people’s needs and risks were not always met because of poor staffing numbers, a lack of staff knowledge and in places inadequate care planning. The manager was aware staff required more resources and support to ensure people’s needs were met. The manager was also aware that personalised care needed to be promoted and implemented. Appropriate checks were carried out before staff started work in order to protect people against those who may be unsuitable to care for them. People had access to activities but these were limited and not always provided in a way that met people’s needs or preferences. The arrangements in place to ensure people were properly protected under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were being reviewed.
People’s privacy and dignity was maintained most of the time, but compromised when, for example, eye drops, were administered in front of other people at the dining room table. People’s medicines were managed safely, although some situations discussed with the staff, demonstrated they needed further training to ensure they understood and followed best practice guidelines at all times.
People’s care plans were not always maintained accurately and were read infrequently by some staff. This put people at risk of inappropriate and unsafe care because, care plans were not always kept relevant and some staff did not update themselves with the contents. People had access to health and social care professionals and to specialists when required. People were supported to have a balanced diet and to receive enough drinks. People who mattered to those who lived at Dalkeith were able to visit when they chose and were made welcome.
People lived in an environment which was being cleaned but where improvements to the cleaning arrangements were needed. Arrangements were in place to avoid the spread of infection. Other regulators’ recommendations were followed and requirements were met, for example, the Fire Officer's recommendations. Improvements to the kitchen were planned for the latter part of 2015. Accidents and incidents were monitored and appropriate actions were taken to avoid reoccurrences.
Representatives of the provider were actively involved in the running of the service, A quality monitoring system was in place but had not effectively measured the service's performance and levels of compliance against their regulatory responsibilities. The manager was aware of the challenges the service faced in moving forward and in becoming compliant with the required regulations. People were responding well to the manager’s open approach and they and their relatives felt listened to. People felt confident that they could find a member of staff to speak to if they had a concern or wanted to raise a complaint. They told us the manager was very approachable.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in the following areas: the management of some risks which have an impact on people's health, the planning of people's care, training and support for staff and systems for quality monitoring and governance purposes. You can see what action we told the provider to take at the back of the full version of the report.
We also made four recommendations; that the service ensure that all appropriate deprivation of liberty safeguards have been correctly applied for, that staff receive further training and guidance in relation to medicine administration, that action be taken to improve people's and their representatives' awareness of safeguarding people from abuse and that advice be sought with regard to the provision of varied and meaningful activities.