Dale Mount

Dale Mount is a ‘care home’ for up to 13 older people or people living with dementia. People in care homes receive accommodation and 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.

There were 13 people living at the service at the time of our inspection. The service was set on a large site together with Dale Lodge which is another care service run by the provider.

At our last inspection on 6 February 2017 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained ‘Good’.

A registered manager continued to be employed at the service. 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 continued to be sufficient numbers of staff who had the skills and knowledge they needed to support people living at the service. Staff were appropriately supervised. New staff had been recruited safely and pre-employment checks had been carried out.

People continued to be protected from abuse. Staff understood how to identify and report concerns. Medicines were managed safely and people received their medicines when they needed them. Risks were assessed and there were actions in place to minimise risk and keep people safe.

Peoples’ care met their needs. Care plans continued to accurately reflect people’s needs and included information on their religious, sexuality and cultural needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of people’s decisions and respected their choices.

The service continued to support people to maintain their health and wellbeing. People confirmed that they had access to healthcare services. People were supported to maintain their weight and received appropriate support with staying hydrated.

People were treated with respect, kindness and compassion. People’s privacy was respected and they were supported to lead dignified lives. People were supported to maintain their independence. People were encouraged to express their views and were listened to. There were systems in place to seek feedback from people, relatives and community professionals to improve the service and feedback was listened to.

The service was clean and the environment pleasant and welcoming. The environment had been adapted to meet people’s individual needs. Staff were aware of infection control and the appropriate actions had been taken to protect people.

Staff, relatives and community health and social care professionals told us the service was well-led. The service was regularly audited to identify where improvements were needed and actions were taken.

Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon. Lessons learnt were shared and trends were analysed. The service worked in partnership with other agencies to develop and share best practice.

Further information is in the detailed findings below.

There was a registered manager in post who had applied for registration with the CQC. 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.

The registered manager had ensured that all notifications were being sent to the CQC. This included notification for Deprivation of Liberty Safeguards, serious injury and adult safeguarding.

Auditing and quality assurance systems were in place to identify shortfalls within the service and drive forward improvements at the service.

People and staff spoke positively about the registered manager.

The registered provider had up to date policies and procedures and these were being communicated to staff.

The service had a registered manager in post. 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.

Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, fall assessments and choking.

There was sufficient staff to provide care to people throughout the day and night. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.

Medicines were stored safely at the service. Staff had been trained in handling medicines and followed safe practice to do so. The registered manager reviewed medicines.

Staff had regular supervision and told us they were supported by the registered manager to develop. Staff received training that was suited to the needs of the people living at the service.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

People were asked for consent for their personal care. Staff were seen to be asking people for consent before carrying out an activity.

Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Staff supported people who required assistance with eating. People told us that they were happy with the quality of the food and the range available.

People were supported to access health care professionals for routine appointments and when required. Staff were aware of the processes in place to report concerns about people’s health.

Staff communicated with people in ways they understood when giving support. Staff were kind and caring towards all people at the service.

Staff and the registered manager had got to know people well. Staff provided care based on guidelines and good communication. This means that staff could build relationships with people to fully understand their needs.

People were involved in the planning and review of care plans. Each person had a dedicated member of staff who would spend time with them to review and update care plans.

Staff respected people’s privacy and dignity. The management ensured that those that needed it only accessed all confidential information and information was passed between staff in a dignified way.

People’s families and friends were made welcome and they spoke positively about the service. The staff at the home were welcoming to friends and relative’s pets.

Staff had guidance and information to care and support people in a person centred way. Each person had a named member of staff who would work with them to develop their care plans that reflected their needs and wishes.

People were encouraged to be involved in all aspects of the home and their independence valued and supported. People could decorate rooms to their own tastes and could choose their daily routines.

The registered manager ensured that information on how to complain was available to people living at the service. People and relatives knew how to complain if they needed to.

Although the feedback related to the registered manager was positive, we found the service was not always well led. The provider had not informed the CQC of outcomes of deprivation of liberty safeguards and safeguarding investigations through statutory notifications.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately.

The registered manager had acted on the results of a recent resident and family survey that identified shortfalls in the service.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found

Is the service safe?

The systems in place to monitor the health and safety of the service were now used effectively. Risk assessments had been completed in respect of people's care and environment and decisions had been documented to show that any risks to people had been considered.

At this inspection we found that appropriate arrangements were now in place in relation to medicines. Medicines were handled appropriately and kept safely. Appropriate arrangements were in place in relation to the recording of medicines. This meant that evidence of medication prescribed and a complete and accurate history of the medication administered was available for future reference.

Written instructions were now available to staff about when to give one person medication to manage a behaviour that might be described as challenging. We saw that these instructions had been regularly reviewed to ensure they were up to date. This meant that arrangements were in place to meet this person's needs.

Is the service effective?

We saw that staff knew how to meet people's needs. We saw that people's health needs were monitored and met. There was flexibility in people's routines and staffing was sufficient to accommodate this.

Is the service caring?

People received support from staff who were caring towards them. People we spoke with were positive about the staff who worked at the service. One person told us 'The staff are very nice', another person told us 'The staff are very friendly'. We spoke with a relative who told us 'The staff are brilliant. They are so lovely with [their relative]'. During our observations we saw staff responded to people's needs promptly and with kindness. We saw one person indicated that they were cold and a staff member promptly adjusted the air conditioning unit near to them and checked they were more comfortable.

Is the service responsive?

We saw that people's needs were assessed before they moved into the service and their ongoing needs were monitored and reviewed to ensure their welfare. Guidance was sought from health professionals when needed in response to people's health concerns.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included providing a survey to people to gather feedback about the service and a complaints process was in place. There were systems in place to monitor staff training and the majority staff had undertaken training related to their role.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe? We found that people's medicines were handled well however some improvements were needed to ensure medicines were managed safely.

Below is a summary of what we found

Is the service safe?

People were cared for in an environment that was clean and well furnished. Areas of concern in relation to the maintenance of the premises identified at the last inspection were in the process of being addressed and we saw evidence of this. However, there were not always systems in place to effectively monitor the health and safety of the service and where they were in place they were not always used effectively. Risk assessments had been completed in respect of some aspects of people's care, however not all decisions had been documented to show that any risks to people had been considered.

Is the service effective?

Concerns related to the processes in place to assess people's capacity to consent identified at the last inspection had been addressed. We saw that staff knew how to meet people's needs. We saw that people's health needs were monitored, however health matters were not always followed up. There was flexibility in people's routines, however staffing levels were not always sufficient to accommodate this.

Is the service caring?

One person we spoke with told us they were happy living at the service. Their comments about the staff included 'They are very kind, very nice people' and 'I am well looked after'. A relative we spoke with told us 'I can't fault them', they said their family member 'Seems happier here than at home' and '[Their relative] always looks lovely'.

We saw examples where staff had been caring towards the people who lived there. We saw positive interaction between staff and people that included affection towards people. However, staff did not always talk to people respectfully and did not always have the time to take care when supporting people.

Is the service responsive?

We saw that people's needs were assessed before they moved into the service and ongoing needs were monitored and reviewed to ensure their welfare. Guidance was sought from health professionals when needed in response to changes in people's needs.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included providing a survey for relatives to gather feedback about the service and a complaints process was in place. There were systems in place to monitor staff training and competency that showed that not all staff had undertaken training related to their role.

We met two relatives of a person who uses the service who told us the staff were friendly and very caring and they had seen staff being affectionate and giving hugs to people.

We met two visiting care managers who told us they had no concerns about the home.

We found that where people had mental capacity the registered person had suitable arrangements in place for obtaining and acting in accordance with their consent in relation to the care, medication and restrictions provided for them. However, where people did not have capacity the provider did not act in accordance with legal requirements.

The last inspection report recorded a shortfall under outcome 4 (regulation 9) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people experienced care, treatment and support that met their needs and protected their rights.

The last inspection report recorded a shortfall under outcome 9 (regulation 13) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The last inspection report recorded a shortfall under outcome 14 (regulation 23) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We concluded that people who use the service, staff and visitors, were not always protected against the risks of unsafe or unsuitable premises because the grounds contained hazards, the building was not secure, a toilet and both bathrooms were not suitably designed to be kept hygienic and clean or keep people safe from injury, part of a ceiling was insecure, window restrictors were not fitted in some windows, some windows were unsafe due to a lack of maintenance, broken glass in windows presented a hazard, heater's sharp covers presented a risk of injury, the building heating and insulation was inadequate, and the provider had allowed people to wedge fire doors open, making the door's fire and smoke protection measures obsolete.

However our findings also showed that as a result of non-compliance with the regulations or part of a regulation, there was a potential risk that people who use the service did not always experience care and treatment that met their needs. Our evidence showed that improvements were required in relation to improving care planning documentation and ensuring that records relating to staff training, supervision and appraisal were easily accessible and up to date. We also found that there were gaps in staffs training particularly around the specialist needs of older people. Medication practices and procedures required improvement so as to safeguard people living at the service.