The Dales Care Home

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

There was a friendly and relaxed atmosphere at the home. We observed many kind, friendly and thoughtful interactions between people living at the home and staff members. Staff promoted people making choices for themselves. People and their relatives told us they liked the home.

Care planning was person centred and focused on outcomes for people. People’s care plans now identified what was important to them, along with their needs and any risks in their care. This meant that staff had the up to date information they needed to provide safe and appropriate care that met people’s needs and preferences.

The provider had changed the systems in the home in relation to how they assessed, recorded and mitigated risks in people’s accommodation, care and support. These systems were effective in ensuring that staff had the most important and relevant information at hand, to enable them to be effective in supporting people to be safe.

Improvements had been made regarding the governance of the service. However, some of the governance systems had not been consistently maintained or had not always been effectively implemented. In relation to some areas of the providers oversight and governance, the service remained in breach of regulation.

The provider had made significant improvements in other areas of oversight of the service, which had led to improvements in the quality and safety of the service being provided. For example, the safety and effectiveness of people’s care and their care plans were checked upon and audited.

The standard of people’s accommodation and the furnishings and equipment people used had all improved. Areas of the home had been refurbished and the home’s environment was pleasant and clean. There was ongoing maintenance and a series of safety checks taking place at the home. This helped ensure the home’s environment was safe.

The home manager and staff at The Dales worked effectively in partnership with others and were engaging with local systems to support people’s needs. Family members told us that they had good communication with the home manager and staff at The Dales. Staff told us that they felt supported and listened to by the provider and home manager.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 14 July 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations in relation to; Safeguarding service users from abuse and improper treatment (Regulation 13), Safe care and treatment (Regulation 12) and, Fit and proper persons employed (regulation 19). Improvements had been made in relation to Good governance (regulation 17). However, the provider remains in breach of this regulation.

This service has been in Special Measures since 14 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We previously carried out an unannounced inspection of this service on 10 and 16 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Key Questions, “Is the service safe?” and “Is the service well-led?” which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Dales Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 a breach in relation to governance of the service 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.

The Dales Care Home provides accommodation for up to 31 people who require nursing or personal care. At the time of the inspection 25 people lived in the home. Some people at the home were living with dementia.

People's experience of using this service

At this inspection, we identified serious concerns with the management of risk, the delivery of care, infection control practices, safeguarding people at risk of abuse, record keeping and the leadership and governance of the home.

Staff did not always have sufficient or accurate information about people's needs and did not utilise risk assessments to keep people safe from the risk of harm.

People were not supported to have maximum choice and control of their lives and staff did not support them to make choices about what time they got up each morning.

There was little evidence to show that infection control protocols were in line with government guidance or that they were followed to protect people and staff from the risk of infections such as COVID-19.

The home was visibly dirty and smelled very badly of urine and was unsanitary in some areas. This placed people at increased risk of infection.

Staff did not understand how to manage accidents, incidents or safeguarding concerns safely. This meant that these were not consistently fully explored, and people were at increased risk from harm and abuse.

Record keeping in relation to people's care and the management of the service were poor. It was difficult to see what support people needed and what support they had received.

The systems in place to monitor quality and safety were ineffective. The management of the service was ad-hoc, with little oversight of care delivery. The acting manager did not demonstrate they understood the requirements of the health and social care regulations in respect to providing safe and appropriate care. The registered manager who was also the provider had been absent from the home for around six months and did not have appropriate oversight of the service being provided. This placed people at significant risk of avoidable harm.

The registered manager/provider responded very quickly to the findings of the inspection and when we returned to the service for the second day, significant improvements had already been made. There was a robust action plan provided to CQC and reassurances that action was being taken to address all of these issues.

There were enough staff on duty to support people. Staff were observed to be kind and caring. People told us they felt safe at the home. People and their relatives were generally positive about the service.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 02 December 2020) and there was a breach of regulation. At this inspection we found that there had been a deterioration in the quality and safety of the service and the provider remained in breach of regulations.

Why we inspected

This focused inspection followed information of concern received by CQC regarding the safety and wellbeing of the people living in the home and the management and governance of the service overall. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to a failure to assess and mitigate risks in people’s care, poor infection control practices, safeguarding adults from the risk of abuse, ensuring staff were suitable to work in social care and poor record keeping and a lack of managerial oversight of the service being provided for people.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the 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 Dales Care Home is a residential care home providing accommodation and personal care for up to 31 people. The home is over three floors over two joined up Victorian properties in a residential area of Wirral. Each floor was accessible via a lift. At the time of our inspection 27 people were living at the home.

The Dales is also registered to provide personal care for people in their own homes. However, at the time of our inspection nobody was being provided with this service.

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

When we arrived three staff members were not following COVID-19 personal protective equipment (PPE) guidance when supporting people. They were not wearing face masks and did not have them on their person. Face masks had been provided however; the box of masks had been left on the top floor of the home. This indicated that night staff were not consistently using face masks when supporting people

Infection control audits had taken place and the provider also completed audits of cleaning and domestic duties within the home. However, the provider had not ensured that there was a culture of safety amongst the staff team during the COVID-19 pandemic.

The provider had taken steps to ensure that the homes environment was safe; there were a series of risk assessments and regular checks of the safety of the environment and fire safety procedures.

We recommended that the provider assess the safety of the carpet.

There had been improvements made in the safe administration of people’s medication. However, we recommended that the provider review the safe storage of medication.

At our last inspection we recommended that the provider review how they determined the number of staff they deployed at the home. We saw that there had been recent staffing pressures due to COVID-19; however, the deployment of staff had been reviewed and the number of night-time staff had been increased from two to three staff members during the late evening and overnight.

The atmosphere at the home was pleasant and homely. People appeared to be comfortable with staff members. We spoke with people who told us that they were happy with the time they got up. We saw that some people who preferred to get up later were still in their rooms. Staff were aware of people’s preferences.

There had been an improvement in the frequency and quality of the checks and reviews of people’s care plans. We also saw that care plans had been regularly updated when people’s needs changed.

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 members told us that the home manager was very approachable. The provider had held video calls with the day and night staff teams during some evenings; to help maintain communication.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 4 February 2020) and there were breaches of regulation.

At this inspection we saw that the provider had made improvements in relation to the breaches of regulation. However, during this inspection, the provider was in breach of regulation in a different area. Therefore, this is the second inspection when the service has been rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about people receiving appropriate personal care and receiving care that safely met their needs and preferences. A decision was made for us to conduct a focused inspection to review the key questions of “Is the service safe?” and “Is the service well-led?” to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the “Is the service safe?” and “Is the service 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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Dales Care Home on our website at www.cqc.org.uk.

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.

We have identified breaches in relation to infection control practices and monitoring the safety of the service.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Dales Care Home is a residential care home providing accommodation and personal care for up to 31 people. The home is over three floors, with access via a lift over two joined up Victorian properties in a residential area of Wirral. At the time of our inspection 22 people were living at the home.

The Dales is also registered to provide personal care for people in their own homes. However, at the time of our inspection nobody was being provided with this service.

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

The registered manager had not ensured consistent and effective assessment of the quality and safety of the service provided for people; and the assessing and managing of risks within the environment of the home had not been thorough. We found no evidence that people had been harmed. However, the approach was inconsistent, and, in some areas, systems were either not in place or robust enough to demonstrate safety was effectively managed. This was a breach of Regulation.

The registered manager, who is the provider are legally obligated to inform the CQC of certain events; this is by way of a statutory notification. During this inspection we became aware of notifiable events that the registered manager had failed to inform us about. This was a breach of Regulation.

Some aspects of care planning had been responsive to people’s changing needs and in other areas care planning and record keeping required improvement.

We have made recommendations with regard to how the provider works out staffing levels; safe recruitment processes; adaptations to the building that may help people with dementia remain independent; and how people’s care plans were reviewed.

There was a calm, friendly and relaxed atmosphere at the home. We many natural and friendly interactions between staff and people living at the home. One person told us, “They look after me here.” Another person said, “I like the staff; they are nice.” We saw that when people were upset and confused that staff gave people reassurance in a kind way. People’s relatives told us that they were always made to feel welcome and comfortable when visiting.

People were supported with their personal appearance to ensure it was how they liked it to be. One person showed us that staff had helped them to paint their nails; they told us that they were happy with this and it made them feel “looked after”. People received appropriate healthcare and the home manager and staff worked effectively with health care professionals.

People’s opinions and preferences were sought, and staff then responded to these. They told us that they felt listened to and their opinions were respected. 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.

People described the staff at the home as, “fantastic” and “very helpful” in their approach towards them. We saw that staff treated people with dignity and respect in their interactions; and staff adapted their communication style to enable themselves to be understood and communicate effectively with people. Staff told us that they were well supported in their roles; they had a training program with periodic training refreshers that they told us helped them to be effective in their roles.

People’s care plans were person centred, covered all the different areas of a person’s support and care needs and contained detailed information about what was important to a person. For example, one person liked a glass of port, another person liked two pillows.

People and their relatives told us that if they had any concerns they would raise these with a staff member, or at the “residents’ meetings” and they would feel comfortable doing this.

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 19 April 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Dales is a residential home providing accommodation and support for up to thirty people. It is

an adapted detached house based in a residential area of Wirral. Accommodation is provided over three floors with a passenger lift available to the first and second floor. The majority of bedrooms are single rooms with people sharing adapted bathrooms and shower rooms and a large lounge and dining room.

The home has 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.

People living at the home told us that they had found staff caring towards them. One person said “I get the attention here.” And a second person confirmed this saying “They look after me all right.” People’s relatives held similar opinions. One person’s relative described the staff as, “Lovely, attentive”. During our time at the home we saw that support was offered to people in a kind, respectful and patient manner.

We saw that people were provided with information about the home and how it operated. Throughout the day when they received support their feedback was sought.

Visitors and people’s relatives we spoke with told us they thought the home was safe. We saw that steps had been taken by the home to help ensure people were safe. For example policies were in place to guide staff on how to recognise and report any safeguarding incidents that may occur; appropriate risk assessments were in place in relation to the building and its environment and regular checks on equipment and services took place.

The home was responding to the risk of people falling by recording any accidents, reviewing and learning from this information. The home was also working alongside partner organisations in trialling new ways to further reduce risks.

During our visit we saw that sufficient staff were available to provide support in a patient and unrushed manner. Although staff were busy they were able to respond to people’s requests for support in a timely manner. We also saw that the building had been adapted to help meet people’s support needs safely.

We looked at how medication was ordered, managed and administered. We saw that this was done in a safe manner and there were appropriate records in place. We also saw records in place relating to supporting people with their health needs and people’s relatives told us that their family members were well supported with their health needs. The home was working alongside people’s GPs and the local authority to achieve better outcomes for people.

We saw that the food provided for people looked and smelled appetising. People told us that they enjoyed the food and we saw that people were offered a wide variety of choice.

We saw that people’s care records were clear, person centred and had been regularly reviewed. The care plans highlighted areas that were important to people. We also saw that people’s spiritual needs were recognised and supported. The service was operating within the Mental Capacity Act (2005). People who would benefit from the protection of a Deprivation of Liberty Safeguard had one in place.

The home had employed staff to specifically support people to engage in activities that they found interesting. People we spoke with told us that they loved the activities in the home and enjoyed days out.

There was a registered manager in place who relatives told us was approachable. We were told that any concerns they had received had been responded to quickly. We saw that there was a program of audits in place to monitor the quality of the service being provided, any issues identified were responded to quickly. Policies and procedures were in place to guide staff. Staff received regular support, supervision meetings and training to help them to be effective in their role.

The registered manager sought feedback from people and their relatives in a variety of ways. We also saw that the service was engaging with other organisations such as people’s GPs and the local authority with the aim of improving the care people received.

All of the people living at the home were registered with local GPs. People's health care needs were documented in their records as was contact with other health professionals such as the falls team, community psychiatric nurses and district nurses.

We saw that senior staff who administered medication in the home had received training to do so.

We found the home had been well maintained and some areas of the home had been redecorated recently.

We were told the following:

"The staff are lovely", "The staff are very good, I have no concerns" and "The staff are brilliant, they could not have possibly done more."

Staff had access to a wide range of training.

We found that the home had a comprehensive complaints procedure.