Archived: Dale House Care Centre

At this inspection we found the provider had made the necessary improvements and the service was removed from being in ‘special measures’. However at the time of this inspection these systems were still being embedded and the provider had not yet had the chance to demonstrate that the improvements would be sustained.

Dale House Care Centre is situated in Wellingborough in Northamptonshire. The service provides nursing and residential care for up to 66 older people, requiring nursing and dementia care. At the time of our inspection 22 people were using the service. The service was in administration, as the business was being sold to a new provider.

We were informed that the registered manager had recently resigned and the management of the service was being overseen by the deputy manager, supported by a representative from the administration company. 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.

Systems were in place to ensure that appropriate recruitment checks were carried out. However background checks requiring further investigation had not always been recorded.

All staff treated people with dignity and respect. However there was a need to further support and develop the staff to effectively support and enhance the well-being of people living with dementia.

The staffing levels were sufficient to meet people's needs. People felt safe and staff were aware of their responsibilities to protect people from harm. Systems were in place to ensure medicines were being managed safely and people received their medicines as prescribed.

Systems were in place to ensure staff received training and on-going support through one to one supervision to discuss their work, training and development needs.

The staff followed the principles of the Mental Capacity Act 2005 when caring for people that lacked the capacity to make their own decisions. Consent to arrangements for care, treatment and support was sought from people or other relevant people and best interests’ decisions were in place where appropriate.

An activity person had been appointed and a programme of daily activities was in place, people had been consulted about the activities they wanted to have in place.

People received a varied and nutritious diet that met their likes and dislikes, food intolerances, allergies, medical and cultural needs. People’s healthcare needs were met, and they were supported to access the advice and support of other healthcare professionals as and when required.

Care plans had been reviewed and updated to reflect people’s current needs. A resident of the day programme had been implemented; each day one person’s care was fully reviewed to ensure the care they received was relevant to their current needs. The provider had systems in place to receive and respond to any complaints or feedback brought to their attention and they took appropriate action to address complaints in line with their complaints policy.

The quality assurance procedures at the service had been fully reviewed, a range of scheduled audits were being carried out. Areas identified for further improvement had action plans in place with deadlines for the actions to be achieved.

Dale House Care Centre is situated in Wellingborough in Northamptonshire. They are registered to accommodation for nursing and personal care, as well as treatment of disease, disorder or injury and diagnostic and screening procedures. They can accommodate up to 66 older people at the service, some of whom may be living with dementia. At the time of our inspection there were 22 people living at the service, over two floors.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service did not have a registered manager in post, however; there was a manager and they were in the process of registering with us. 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 had been improvements to the way that risk was assessed and managed by the service, however; we observed that staff practice did not always ensure that risks to people were minimised. Medicines were not always well managed. We found concerns in the way that some medicines were recorded, stored and administered. The systems in place for checking this, had failed to ensure that medicines were robustly managed.

New tools had been introduced to determine the required staffing levels at the service, however; these did not always provide a reliable figure of staffing requirements and the staff on duty did not always match what the tool stated was required. The distribution of staff was not always effective in ensuring that people's needs and preferences were being met. Staff members had however been through a robust recruitment process to ensure they were suitable for their roles and to work at the service.

Consent to arrangements for care, treatment and support was not always sought from people or other relevant people where appropriate. We observed staff providing care without seeking consent. There a lack of documentation in respect of consent within people's care plans. The principles of the Mental Capacity Act 2005 had not always been followed for those people who lacked the mental capacity to make their own decisions.

There was a lack of person-centred care at the service. People were not provided with regular activities which engaged and stimulated them, they were not supported to take part their own individual hobbies or interests. Care plans had been redeveloped but still lacked key person-centred information about people's individual needs and preferences. There was also a lack of involvement of people and their relatives in the production and review of care plans.

Improvements had been made to the quality assurance procedures at the service. There were an increased range of checks and audits being carried out, however; they were not always effective in identifying those issues we found during our inspection. Concerns were not always identified as part of these processes and the action plans which were in place were not effective in driving improvements.

In general staff treated people with dignity and respect and worked to develop positive relationships with them, however; there were times when we found that care was task-orientated and staff provided people with little or no interaction or communication.

There was improved training for staff at the service however; staff supervisions were still a work in progress and staff did not all receive regular and consistent supervision opportunities. Staff members did feel that the manager was approachable and were able to go to them if they had any issues or concerns. Staff culture was positive and they were motivated to perform their roles and meet people's needs, although this was not always in a person centred manner.

People felt safe living at the service and had confidence in the staff that supported them. Staff members were trained in abuse and safeguarding procedures, to ensure that people were protected from harm. People were happy with the food and drink provided and we found that their nutritional needs and preferences were well catered for. Appointments with healthcare professionals were also supported and facilitated by the service, to help ensure that people were as healthy as possible.

People were also aware of the manager and felt they were accessible when they needed them. They were responsive to complaints or feedback and took action to address any issues they raised.

Full information about the CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.

Dale House Care Centre is situated in Wellingborough in Northamptonshire. they are registered to accommodation for nursing and personal care, as well as treatment of disease, disorder or injury and diagnostic and screening procedures. They can accommodate up to 66 older people at the service, some of whom may be living with dementia. At the time of our inspection there were 35 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service did not have a registered manager in place, however; a manager had been appointed and they were in the process of registering with the Care Quality Commission (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.

Risks to people's health, safety and well-being were not effectively managed. There was a lack of sufficient assessment of risks to people and where risks had been identified; staff did not have guidance in how to manage those risks and work to keep people safe. Monitoring of specific health needs was not completed on a regular basis, which increased the risk of harm to people.

Staffing levels were inconsistent and people's needs had not been thoroughly assessed to identify the numbers of staff needed by the service. A dependency tool was in place, however; it was not used to demonstrate the staffing levels required. Staff were able to meet people's basic care needs, however; there were not enough of them on shift to provide people with stimulation and engagement in activities.

People's medicines were not always administered safely. Topical medicines, such as creams and ointments, had not been administered correctly which increased risks to people's well-being. Stock levels for some medicines had not been well-managed and staff were not able to account for the quantities of stock at the service.

Consent to care, treatment and support had not been sought by members of staff. Care plans failed to demonstrate that people had been involved in making decisions about the content of those plans, or that they had agreed to the way they would be cared for. Where people were unable to make their own decisions, the service had failed to work in accordance with the Mental Capacity Act 2005 and there was no evidence to show that decisions had been made following a best interests' process.

Care plans did not contain person-centred information. They failed to demonstrate the specific needs and wishes of each individual person and did not provide staff with guidance about how to meet people's needs. There were limited activities at the service, which meant that people spent much of their time with little stimulation or activity.

Quality assurance procedures at the service were not effective. Audits were carried out however; they failed to highlight key areas of the service in which improvements were required. There was a lack of management and oversight systems in place, which meant the manager and provider were unable to monitor, assess and drive improvements at the service.

Staff members were aware of safeguarding procedures and worked to make sure people were protected from abuse. They were aware of the requirement to report any suspected abuse and were prepared to follow whistleblowing procedures to ensure people were safe. Incidents were reported appropriately and the manager sent the CQC statutory notifications of incidents at the service.

People were provided with their choice of food and drink and were supported to maintain a healthy and nutritious diet. Staff encouraged independence and provided people with the support they needed with eating and drinking. They also made referrals to health professionals such as people's GP, dieticians or district nurses, to ensure their health needs were being met.

Staff members treated people with kindness and compassion. They worked to develop positive relationships with the people they cared for and treated them with dignity and respect. Visitors were welcomed to the service and staff members spent time getting to know them and working alongside them to ensure people's needs were met.

There was a positive culture at the service. Staff were motivated to perform their roles and felt well supported by the manager. They were able to talk to the manager about any concerns they had, as well as to share ideas about the development of the service. Feedback was welcomed by the provider and there were systems in place to manage complaints if they were raised.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We asked the provider to submit an action plan to tell us how they would meet these regulations in the future; they stated that they would have met them by 31 May 2016. During this inspection we returned to see if the service had made the improvements they stated in their action plan. We found that the provider was now meeting these regulations.

We undertook this focused inspection on 20 June 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Dale House Care Centre' on our website at www.cqc.org.uk.

Dale House Care Centre is located in Wellingborough in Northamptonshire and is registered to provide nursing and personal care for up to 66 older people, who may be living with dementia and have other associated care needs. At the time of our inspection, there were 36 people living at the service.

The service did not have a registered manager; however a new manager had been appointed and was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 service was still in administration when we carried out this visit, therefore the care management company, appointed by the administrators, were still responsible for the oversight and management of the service.

The new manager and provider had implemented systems to review accidents and incidents appropriately. Incidents were now stored centrally and were analysed, to review what happened and to identify those incidents which needed to be reported externally. Where necessary, the manager had reported incidents of potential abuse to the local authority and CQC, and had put steps in place to ensure they were managed appropriately.

Systems had been introduced to ensure the service was following the principles of the MCA and DoLS. Capacity assessments were being carried out where it was suspected that people may lack mental capacity and DoLS applications were submitted where necessary. Systems were being devised to track and manage these and staff had been provided with training to improve their understanding.

Care plans had been fully reviewed and a new care plan template had been introduced. This new template was more streamlined and ensured people and staff were able to access the information they needed easily. The new care plans were also more person-centred and there were plans in place to review these care plans on a regular basis to ensure they were accurate and up-to-date.

The provider and manager had implemented a number of checks and audits to help them monitor the quality of care being delivered at the service. These were used to analyse the performance of the service and identify areas for improvement.

We carried out an unannounced comprehensive inspection of this service on 22 December 2014 and rated it 'Good'. On 06 November 2015 we carried out a responsive inspection following information of concern which was received by the Care Quality Commission. These concerns were in relation to pressure care and the diet and nutrition of people using the service. We were unable to substantiate them, therefore there were no changes to the rating of 'Good', and no breaches of regulation were identified.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dale House Care Centre on our website at www.cqc.org.uk.

We carried out our second unannounced comprehensive inspection on 26 February and 01 March 2016. Prior to this inspection we had received concerns in relation to the care people were receiving and the management of the service. In addition, we learned that the service had gone into administration and therefore needed to ensure that people's care would continue to be delivered in line with the fundamental standards.

The service did not have a registered manager. 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. In the previous year, the provider had appointed a manager who was due to register with the Care Quality Commission; however they left the service without progressing their application. The area manager assumed the role of managing the service, however they also planned to leave the service; with their last day being the first day of our inspection.

The administrators had appointed a care management company to assume management of the service, whilst it was in administration. They had appointed a peripatetic manager to lead the service until a new registered manager had been appointed.

The provider had failed to ensure there was effective quality assurance and audit systems in place at the service. There was no effective oversight of the service, or the quality of care people were provided with. The checks implemented failed to identify safety concerns, or the specific care needs of the people living at the service. Risks to people receiving care had not been appropriately assessed and acted upon by the provider. There was a negative atmosphere amongst staff at the service which meant that the care provided was not always the best it could be. Staff members did not feel well supported by the previous manager and the provider, and were concerned about the future of the people who lived at the service and for their job roles as the service was in administration.

Safeguarding incidents at the service had not been managed appropriately.People felt safe at the service and we found that incidents relating to safeguarding people had been reported to the provider by members of staff; however they had not been reported to the appropriate external organisations. This meant that there were ineffective measures in place to protect people should they be subjected to abuse.

Risks to people and the environment had been assessed, however they were not user friendly and did not provide staff with the information they needed to minimise risk. In addition, risk assessments did not empower people to take positive and meaningful risks whilst living at the service. Staffing levels at the service were variable which meant that, at times, people's needs were not being met. Agency staff were relied upon to cover shifts which meant that people were not provided with consistent care. People's medication was managed by the service to ensure it was given as per the prescriber's instructions.

The service did not have systems in place to ensure the principles of the Mental Capacity Act (MCA) were being followed. There was a lack of evidence to show that people had consented to their care or that decisions made on their behalf were in their best interests. Staff did not receive regular supervision or support to identify areas for development; however they did receive regular training. People were happy with the food at the service and felt that this was improving. People's nutritional needs were assessed to ensure they were met. People were also supported to see health professionals in the service or local community when required.

Due to changes to the staff team within service, and the regular use of agency staff, people were unable to build close and meaningful relationships with members of staff. People and their families did not get the information they required from the service and were not involved in producing their own care plans. People were treated with dignity and respect by members of staff, who worked to promote their privacy at all times.

People did not receive person-centred care from staff at the service. Care plans did not always provide staff with sufficient guidance to meet people's specific needs and wishes and were not user-friendly. Care plans had been reviewed; however there was no evidence to show that people or their families had been involved in reviewing them. Activities were organised by the service, however these were not specific and therefore not relevant for all the people living there. There was a system for receiving complaints, however not all the people or their families were familiar with this, or confident that they would be listened to. Verbal complaints and feedback had not been logged, and there was no evidence to show that written complaints had been investigated in full.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.