Dale Lodge

Dale Lodge is a residential care home that accommodates up to 20 older people, including people living with dementia. At the time of the inspection there were 18 people living at the service.

People’s experience of using this service:

The service continued to meet the characteristics of Good and had improved to a rating of Outstanding in the Responsive domain.

Staff went the ‘extra mile’ to respond to people’s choices and preferences and in providing activities that were meaningful. Special family events were arranged which celebrated significant times in people’s lives. A relative complimented the service by writing, “This event was a true testament to the dedicated, hardworking management and staff who I see running around to keep all happy on this day of total enjoyment”. Music was an important part of enhancing people’s well-being. Links had been developed with a local nursery so that children visited and sang and in return people read to the children.

People continued to be treated with kindness, dignity and compassion and involved in decisions about their care. 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 supported this practice.

The registered manager was central to creating a positive culture at the service. People had developed trusting relationships with staff and as a result felt safe. There were enough skilled staff available to spend time with people and meet their individual needs. Staff received effective support from the management team and were motivated to provide personalised care.

Risks to people’s well-being and in the environment continued to be effectively managed. The environment had been adapted and designed to meet the needs of older people and people living with dementia.

People’s needs were including their health and nutritional needs were assessed and developed into a comprehensive care plans. People continued to receive their medicines when they were needed. The service worked in partnership with health and social care professionals.

People knew how to make a complaint but had not needed to as any issues they raised were dealt with. Regular feedback was sought from people and their relatives who were kept up to date with the running of the service. Quality assurance processed meant that lessons were learned with things went wrong and improvements implemented.

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

Rating at last inspection: Good (last report published 25 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

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 had good knowledge of safeguarding and knew what actions to take if they suspected abuse was taking place. The provider had ensured that appropriate employment checks had taken place to ensure that staff were safe to work with people at the home. There were sufficient numbers of staff to keep people safe. The provider had a system in place that allowed the registered manager to recruit more staff when the numbers of people living at the home increased. The provider gave staff appropriate training to meet the needs of people living at the service. Staff received supervisions and appraisals from the registered manager.

The provider had ensured that medicines were stored safely at all times. Medicine administration records were kept up to date by staff. Only staff trained to administer medicines did so.

The principles of the Mental Capacity Act 2005 (MCA) were applied. People were being assessed appropriately and best interests meetings took place to identify the least restrictive methods. Staff had training on MCA and had good knowledge. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. People were supported with their diets and maintaining a healthy lifestyle. People were given options of what they would like eat. The provider had to systems in place to identify if anyone required further support managing their diets or with eating. People and their relatives told us they were involved with the planning and reviews of the care plans.

People were being referred to health professionals when needed. Staff were referring people to their GP, dentists and dieticians when it was identified that a person had a change in need.

The provider had ensured there were systems in place to reduce the risk of people obtaining a pressure sore. Clear policies and procedures gave staff guidance on how to identify those at risk and how to manage a pressure sore.

People, relatives, visitors and health professionals spoke positively about staff. Staff communicated with people in ways that were understood when giving support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overhead. Staff would not discuss people’s personal information in public areas. People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback on their experiences. People took part in surveys and meetings and these were used to make improvements to the service. The provider had ensured that there were quality monitoring systems in place to identify shortfalls and drive forward any improvements that needed to be made.

People and staff spoke positively about the registered manager. The registered manager had an open door policy that was used by people, relatives and staff.

Is the service safe?

At our previous inspection on 2 July 2014 we found some shortfalls in relation to safe management of medicines and we issued a compliance action with a minor impact. Following that inspection the provider sent in an action plan informing the Commission that improvement had been implemented. At this inspection we looked at medicine management to check that safe practices were followed. We found that arrangements were not always in place to ensure that people were protected from the risks associated with the handling and recording of people's medicines.

Below is a summary of what we found

Is the service caring?

Our observations showed that people had a positive experience of their care and appeared happy, settled and relaxed. They were provided with the support they needed from staff. Staff treated people with respect. We saw that staff addressed people by the name they preferred and used respectful language in conversations with people. Staff created a relaxed and pleasant atmosphere, for example, we saw staff engaged people in conversation using humour which people appeared to enjoy. We saw that staff approached people in a kind way. Staff used touch in an appropriate way to provide warmth and reassure people who were distressed.

People we spoke with were positive about the care they received. Comments included 'The staff are like angels'. Relatives we spoke with were happy with the care their relative's received. Comments included 'The staff are very kind', 'They give them a cuddle and a kiss'.

Is the service responsive?

We saw that people's needs were assessed before they moved into the service.

We saw that the brakes on one person's wheelchair were ineffective at keeping it steady. It moved away from the person being supported into it. We spoke with the staff member involved who told us it was the first time this had happened and they reported such matters to the manager. We saw that they did this and records showed that the brakes were repaired that day. While waiting for the wheelchair to be repaired, two staff supported to the person to transfer into the wheelchair, ensuring it was steady and another wheelchair was also used.

There was evidence that staff responded to incidents that took place and appropriate changes were implemented.

Is the service safe?

Appropriate arrangements were not always in place in relation to the recording of medicine. The system used to record when staff administered medication was not always used effectively. There was no system in place to monitor this effectively.

We saw that there was a gap in an entry on one person's chart used to record when they were given medication. The manager checked and told us that the person was given their medication but the staff member had not signed the record confirming this. Staff had not reported this to the manager. People were not always protected against the risks associated with medicines because the provider did not always have appropriate arrangements in place to manage medicines.

There were systems in place to monitor health and safety within the service. These checks included water temperature checks and fire safety checks.

There were arrangements in place to deal with foreseeable emergencies.

Is the service effective?

There were enough staff on duty to meet people's needs effectively. People we spoke with were positive about the care they received. Comments included 'The staff are quite pleasant. They will always listen to you'. Relatives we spoke with were happy with the care their relative's received. Comments included, the service was 'Absolutely marvellous', 'The staff are very kind', 'They are very nice to [their relative]'. One relative told us that their relative was 'rejuvenated' from the care the staff had provided.

Staff ensured people's privacy and dignity was upheld. One person we spoke with told us that staff always asked their permission before entering their bedroom. One relative we spoke with told us that their relative was 'Always nice and clean and covered'. We saw that people appeared well groomed and during the inspection some people had their hair done by a visiting hair dresser.

People were supported in promoting their independence. We saw that two people's care records showed what personal care tasks they were able to complete for themselves. One staff member we spoke with knew the abilities of one of these people and told us how they provided support to ensure their safety while promoting their independence.

People were given opportunities to participate in activities they enjoyed. We saw one person knitting, another person sat out in the garden, and other people spoke with visitors.

People's health needs were met and we saw that people's appointments with health professionals were recorded. We spoke with a visiting health care professional and they told us that the staff were 'Helpful' and looked after people well. They followed instructions they gave them about managing one person's pressure area on their skin. They added that 'It is a good home'.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included meetings with people who lived at the service and their relatives. Surveys provided to people and their relatives. There was a system in place to provide staff with the opportunity to feedback about the service. Staff meetings were held and one staff member we spoke with told us that these meetings were useful to discuss people's needs and any concerns.

We saw that there was a complaints process in place and there were systems in place to monitor staff training and competency.

We found the provider did have an effective system in place to assess and monitor the quality of service that people receive.

We found that the provider had taken action to ensure that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that the provider had taken action to ensure that people experienced care, treatment and support that met their needs and protected their rights.

We found that the provider had taken action to ensure that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that the provider had taken action to ensure people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We also carried out a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

People we spoke to told us they were happy living at the home. Comments included 'I like the food' and 'I like sitting in the garden'.

Relatives we spoke to told us they were happy with the care delivered by the home. Comments included 'The manager is hands on', 'The home is a friendly family orientated home, I can come and visit at any time' and 'The staff take the time to chat to people individually.

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.