Dalling House

Dalling House is a residential home providing personal care for older people, some of whom were living with an early diagnosis of dementia. The service can accommodate up to 20 people, some of whom were in receipt of respite care. At the time of the inspection there were 18 people using the service.

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

Not everyone had a care plan that was up to date and accessible to staff. The service was in the process of transferring records from paper onto a computerised system. Those not yet transferred were not easily accessible. Risk assessments for people were incomplete with some risks not being assessed and mitigated. For example, falls, diabetes and medicines. Up to date as and when required (PRN) medicine protocols were not in place. Accidents and incidents had been reported but there was no system in place for capturing learning from repeat incidents.

Auditing process were in place but were not robust. For example, people who had experienced several falls each month an audit recommended reminding people to use their call bells. No analysis of cause had taken place and few were in place to minimise or prevent further falls. Auditing had failed to pick up on non-prescribed PRN medicines being administered for several weeks to two people. There were some quality assurance measures in place but no regular process for capturing feedback from people, relatives or professionals. The processes needed developing so that feedback could be captured and trends then identified and acted upon to ensure the continuous improvement of the service.

Some care plans lacked detail about people’s personal history. People told us they were not involved in reviews of their care plans. Although an activities co-ordinator was employed for two days each week, this was not enough to occupy people and there were times when people had nothing to do. Staff did what they could but there was a need for more activities for people. Staff were able to tell us the important things about supporting people towards the end of their lives but it was agreed with the registered manager that staff would benefit from end of life training.

Safeguarding policies were in place and staff knew what steps to take if they felt someone needed protecting from harm. Fire and safety checks had been completed. Medicines were stored and disposed of safely. People and their relatives told us they felt safe. There were enough trained staff on duty each shift to support people. Infection prevention and control measures were in place and government guidelines had been followed during the recent pandemic.

Most people, relatives and staff spoke well of the registered manager who was clearly a visible presence at the service and was approachable and accessible to everyone. Staff feedback was captured through supervision meetings and monthly team meetings. The registered manager was aware of and had complied with, the duty of candour. The service had a keyworker system of care which meant staff got to know people well.

A pre-assessment process was in place which ensured that the service had the correctly trained staff to meet people’s needs. Staff were recruited safely and were supported with regular supervision meetings and ongoing training. People told us they enjoyed the food and that a good choice was offered daily. People were supported to attend health and social care appointments. The service had undergone some redecoration and more had been planned. The laundry room was next to the kitchen and some redesigning was required to make this area a safer environment. The registered manager acknowledged this. 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.

Staff were caring and treated people with respect and dignity. People’s privacy was respected and their independence promoted whilst not compromising safety.

People’s communication needs had been considered. A complaints policy was in place and people and relatives told us they were confident in raising issues and complaints if needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 17 December 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 27 April 2019.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety which included missing care plans and risk assessments, no PRN protocols and no lessons learned from accidents and incidents. Also, a lack of meaningful auditing processes and limited quality assurance work at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice. The home had a booking in system for visits from relatives. This prevented overcrowding the home and provided precise timings for visits to start which people and relatives liked. Proof of negative covid-19 tests before entry to the home was mandatory and test kits were provided to people who had not recently taken a test.

Dalling House is a residential home providing personal care for older people, some of whom were living with dementia. The service can accommodate up to 19 people and at the time of the inspection there were 16 people living at the home.

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

Auditing processes were in place but greater oversight from the registered manger was needed. This was acknowledged during the inspection. Care plans contained all information required to inform staff about person centred care but were large and cumbersome and difficult for staff to find information. Similarly, this was accepted by the registered manager and work was being done to improve care plans.

Risks to people were managed at the service and people were protected from harm. Accidents and incidents including falls were reported, immediate action taken to support people and lessons learned carried forward. A person told us, “It’s very safe here.” Manual handling training had been completed by staff and yearly refresher training was scheduled. Training had been completed online during the pandemic.

Medicines were managed safely. People’s information and details of their medicines were being entered onto medicine administration records (MAR). Medicines were ordered, stored and disposed of safely. Separate protocols were in place for ‘as required’ (PRN) medicines for example, pain relief. A lockable trolley was used on medicine rounds which helped guarantee the right medicines were provided to the right people during medicine rounds.

Infection prevention and control was managed well and appropriate use of personal protection equipment (PPE) was observed and supported by national and service policies.

Staffing levels at the service were adequate and the registered manager was in the process of recruiting more staff.

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 27 April 2019)

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The concerns were about people's safety relating to manual handling and provision of medicines, infection prevention and control and the governance of the service. We inspected using our targeted methodology developed during the Covid-19 pandemic to examine those specific risks and to ensure people were safe.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.