The Dale Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. People were not always protected from the risk of incidents recurring because the provider did not effectively use incident audits to identify themes, trends or opportunities for learning. Although incident audits were completed in a timely manner, leaders had not consistently reviewed the information to identify learning or ensure this was shared and embedded across the service. As a result, the provider could not demonstrate that learning from incidents was consistently used to improve practice and outcomes for people. We identified incidents that had not been reported to the CQC in line with regulatory requirements. When we requested evidence of oversight of accident, incident and safeguarding records, the registered manager was unable to provide a system to demonstrate effective oversight, monitoring or analysis of these events.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People had hospital passports in place to support safe and effective transitions between the service and hospital settings, providing key information about their care and support needs. One professional told us, “The home is responsive to our service and reach out to us when they need to.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately. We could not be assured there were effective processes in place to monitor safeguarding concerns and the actions taken. We asked whether the local authority had been informed of a recent safeguarding concern; however, the registered manager was unable to provide evidence this had been completed or where this was recorded. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). One person was subject to a DoLS authorisation at the service. However, we found another person who had not been appropriately assessed to determine whether a DoLS application was required prior to the new MCA ruling. However, we found Mental Capacity assessments were detailed and staff demonstrated a good understanding of safeguarding procedures, including how to protect people from harm. One staff member told us, “I have access to safeguarding policies. If I suspected abuse, I would report it to my senior/manager, and if needed safeguarding, CQC or the police.” The registered manager confirmed further training relating to DoLS would be sought.

The provider did not always work well with people to understand and manage risks. Systems for identifying, assessing and monitoring risks were not always effective. We found several risks that had not been identified or addressed through the service's quality assurance processes, demonstrating that risk management systems were not sufficiently robust to identify, assess and manage risks to people effectively. Oversight of safeguarding concerns and accidents required improvement. Current systems did not effectively identify trends, monitor outcomes or demonstrate learning to reduce the risk of recurrence. However, people's care plans and risk assessments were detailed and provided staff with clear guidance on how to support individuals in line with their assessed needs and preferences.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. environmental risks that had not been effectively managed. We found a lack of window restrictors fitted to first-floor windows, and large items of furniture in people’s bedrooms which had not been secured to the walls. We also found there was no legionella risk assessment in place or evidence of regular flushing and cleaning of water outlets, particularly in vacant rooms. Although weekly fire safety checks were completed; the service had not carried out fire evacuation drills to ensure staff were prepared to respond in an emergency. There was also no emergency grab bag containing essential information about people living at the service to support a safe evacuation. The registered manager promptly addressed the environmental issues we raised during the assessment.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. We found recruitment records were not always robust. Staff records did not consistently contain evidence of relevant qualifications, explanations for gaps in employment, completed induction records or up-to-date supervision records. We also identified gaps in staff supervision and infrequent team meetings. Despite this, staff told us they were happy in their roles and felt supported by management.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service had an up-to-date infection prevention and control (IPC) policy, which staff were aware of and followed in practice. Sufficient supplies of personal protective equipment (PPE) were readily available to support safe care delivery. Staff received training in infection prevention and control and demonstrated an understanding of when and how to use PPE correctly. A member of staff told us, “Yes, I always have access to the appropriate PPE, including gloves, aprons, masks when this is required. There is PPE equipment available in all bathrooms and in some corridors around the home and are always well stocked.”

The provider made sure that medicines and treatments met people’s needs, capacities and preferences. However, there was no maximum/minimum thermometer available to monitor medicine storage temperatures. PRN (As required) protocols were not in place for people prescribed PRN medicines as described in the service’s policy. Although some people had pain care plans, these did not cover all PRN medicines to provide staff with clear guidance on when these medicines should be administered and whether they have been effective. Leaders at the service have now taken action to resolve the concerns raised.