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Inspection carried out on 3 December 2018

During a routine inspection

The Dales is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Dales is owned by Barchester Healthcare and is registered to provide nursing care for up to 56 people. The home is in the small village of Draughton, which is close to the town of Skipton. Accommodation is on two floors. There is a passenger lift. The home has three separate communities each offering a different service. The upper floor community is called Memory Lane, which was for people living with dementia and two communities on the ground floor are called Pemberton and Clifford and was for people with residential and nursing needs. Of the 56 bedrooms, 20 have en-suite facilities and five rooms are able to be used as double rooms. There are attractive gardens and car parking is available on site. At the time of the inspection there was 45 people living in the home.

At our last inspection in 2016 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.

This inspection took place on 3 December 2018.

The registered manager was supported by a deputy manager and roles were clearly defined. The registered manager was not present at the time of the inspection. 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 remained safe at the home. Systems and processes were in place to keep people safe and risks associated with people’s care needs had been assessed. The home was clean and infection control measures were in place. Medicines were managed safely and staff responsible for administering medicines had received the relevant training and their competency assessed.

Recruitment procedures were robust and new staff received appropriate induction. People were supported by sufficient numbers of staff. Staff training was provided to meet people’s care and support needs. Staff received supervision and annual appraisals.

People’s nutritional and healthcare needs were met. Staff enabled people to access healthcare professionals when required. The management team worked in partnership with other organisations to support people’s needs.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice. People were offered choice, such as, what they wanted to wear and what they wanted for their meals.

Staff knew people well and care plans were, detailed and provided staff with guidance on how to meets people’s needs. Where required, people’s end of life wishes were recorded in their care plan. Observations showed staff were caring and patient. Staff respected people’s privacy and dignity and encouraged people to remain independent. People’s social support needs were met through a range of activities that were available for people to take part in.

There was a complaints policy in place and the complaints procedure was made available to people and their relatives. Complaints were appropriately responded to and outcomes were actioned.

Accidents and incidents were monitored by the management team. There was a range of quality audits in place, which were effective and identified actions were followed up. People and relatives

Inspection carried out on 20 December 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 18 February 2016. We found that the service required improvement to become safe. This was because the systems for medicine administration did not protect people from the associated risks. We identified this as a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection the provider submitted an action plan telling us the action they would take to make the required improvements.

This inspection was focussed to review the progress made by the provider in making sure people were kept safe from the risks associated with medicines management. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Dales on our website at www.cqc.org.uk.

This focussed inspection took place on 20 December 2016 and was unannounced.

The Dales provides nursing and personal care up to 56 older people, some of whom may be living with dementia. The home is located in the small village of Draughton, which is close to the town of Skipton. Accommodation is on two floors accessible by a passenger lift. There are secure and attractive gardens and car parking is available on site. At the time of our visit 52 people were living at the service.

The service had 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.

The system for administering medicines had been improved to make sure that people received their medicines safely. This meant that the previous breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had now been met.

Inspection carried out on 18 February 2016

During a routine inspection

This inspection took place on 18 February 2016 and was unannounced. At the last inspection on 3 December 2013 we found the service was meeting the regulations we inspected.

The Dales provides nursing and personal care up to 56 older people, some of whom may be living with dementia. On the day of the inspection there were 52 people living in the home. The home is located in the small village of Draughton, which is close to the town of Skipton. Accommodation is on two floors accessible by a passenger lift. There are secure and attractive gardens and car parking is available on site.

The home 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 able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home had sufficient suitable staff to care for people safely and they were safely recruited. The environment of the home was safe for people and safety checks were regularly carried out.

Medicines were not consistently managed safely to protect people. This was a breach of Regulation 12(2) 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 end of the report.

Staff had received training to ensure that people received care appropriate for their needs. Training was up to date in areas such as infection control, health and safety, food hygiene and medicine handling and also in specialist areas of health care appropriate for the people being cared for.

Staff had received up to date training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood that people should be consulted about their care and that they should approach people with the assumption of capacity. They understood what needed to happen to protect the best interests of people whose mental capacity was impaired and we saw evidence that this was taking place.

People’s nutrition and hydration needs were met. People enjoyed the meals which were of a good quality. Clinical care needs were met in consultation with health care professionals and people were accompanied to appointments when needed.

People were treated with kindness and compassion. We saw staff treated people with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well as a team.

People were supported to engage in daily activities they enjoyed and which were in line with their preferences and interests. Staff were responsive to people’s wishes and understood people’s personal histories and social networks so that they could support them in the way they preferred. Care plans were kept up to date when needs changed, and people were encouraged to take part in their reviews and to give their views which were acted upon.

People told us their complaints were responded to and the results of complaint investigations were clearly recorded. People we spoke with told us that if they had concerns they were always addressed directly with the registered manager who responded quickly and with courtesy.

The service had an effective quality assurance system in place. The Dales was well managed, and staff were well supported in their role. The manager had a clear understanding of their role and they consulted appropriately with people who lived at the service and the people who mattered to them, staff and health care professionals to identify any required improvements and to put these in place.

Inspection carried out on 28 April 2014

During a routine inspection

The Dales is a care home with nursing and provides nursing care for up to 56 older people. At the time of our visit there were 47 people accommodated in the home with three additional people in hospital. The home is located in the small village of Draughton on the outskirts of Skipton. Accommodation is on two floors linked by a passenger lift. The home has three separate units called Pemberton, Clifford and Devonshire (also known as Memory Lane). Devonshire unit provides nursing care for older people with dementia.

We spoke to 12 people who lived in the home. All told us they were happy with the service and they felt safe and well cared for. We found people were involved in decisions about their care and were supported to make choices as part of their daily life. All people had a detailed care plan which covered their needs and any personal wishes. We saw the plans had been reviewed and updated at regular intervals. This meant staff had up to date information about people’s needs and wishes. Records showed there was a personal approach to people's care, and they were treated as individuals.

Each person had an allocated member of staff known as a key worker. Keyworkers spent at least ten minutes every day giving them their undivided attention. This enabled people to talk about any personal issues or pursue an activity of their choice. All people spoken with said they had a good relationship with the staff.

There was a full programme of varied activities provided on a daily basis. We observed several activities on the day of our visit including an interactive dance session and a quiz. Some people also went out on a bus trip round the local area. All people spoken with told us they enjoyed the activities and confirmed there was plenty to do to occupy their time.

We saw those people who required assistance were supported to eat and drink and there was a pleasant atmosphere at mealtimes. During the midday meal staff were seen to be understanding of people’s needs and were observed talking to people about things which were interesting to them. People living on Devonshire unit may benefit from information displayed about the meals served each day.

We found there were appropriate arrangements in place to manage medicines.

The home had appropriate paperwork in relation to the Mental Capacity Act and the Deprivation of Liberty Safeguards. (The Deprivation of Liberty Safeguards provide a legal framework to protect people who need to be deprived of their liberty for their own safety). Although there had been no applications made to the local authority, staff and the management team had been trained to understand when an application should be made.

Staff spoken with were positive about their work and confirmed they were well supported by the management team. Staff were knowledgeable of people’s needs and preferences. We observed kind and sensitive interactions with people living in the home throughout our visit. Staff were given regular training to make sure they had the skills and knowledge to meet people's needs. They were also given regular supervision and an appraisal of their work performance. This meant they were given opportunities to discuss their role in the home and identify any future training needs.

The home had an established registered manager and management team. We saw there were arrangements in place to check the quality and safety of the service provided. This included consultation with people living in the home and their relatives. We noted action plans had been drawn up and acted upon in order to address any problems or suggestions for improvement. This meant the registered manager was always looking for ways to develop and improve the service.

Inspection carried out on 3 December 2013

During a routine inspection

We spoke with twelve people who lived at The Dales and ten visitors. The comments from everyone were positive. These included, �The staff are handpicked, they must have been to provide the care they give.� And, �I�m very happy here. It�s lovely.� Another person told us, �I�ve lived here a lot of years. I get a really good service.� The visitors we spoke with had no complaints. One person told us, �I am delighted with the care here. There has been a remarkable change in my [relative�s] condition.� They went on to describe how their relative greeted them with a smile when they arrive and that they felt �cared for� too when they visited.

We saw people looked well cared for and we noted some people had developed friendships since moving into The Dales. The atmosphere, throughout our inspection, was friendly and there was a lot of activity and light-hearted banter between everyone.

We found people�s consent was routinely sought before care or support was provided.

People received safe, consistent and appropriate care that met their needs.

People told us the service was kept fresh and clean, and there were processes in place to minimise the risk of a spread of infection.

People were cared for by staff whose backgrounds are properly vetted, to ensure they are suitable to work with vulnerable people and in the care sector.

There was a robust complaints procedure in place and people told us they knew how to complain should they wish to.

Inspection carried out on 7 December 2012

During a routine inspection

We spoke with seven people who used the service and some visitors. Everyone we spoke with told us they were satisfied with the care and support received. We saw records that showed people who used the service were involved in developing their care plans. In some instances relatives had also been involved if the person was unable to give their views. People we spoke with said they understood the care plans and that staff had explained things to them in detail. We also saw how staff worked with people, at their own pace, to make sure they knew in detail what support was needed and how best they could meet that need.

We found that all of the records we reviewed were accurate, up to date and had been regularly evaluated.

We looked at staff records and found staff were well trained and saw there were good systems in place to ensure they were well supported in their work.

People told us they thought that staff were knowledgeable regarding their individual care needs. They said they were treated well and their experiences in the home were positive. Five people told us that if they had a complaint they would talk to the manager and they were confident any issues would be dealt with properly.

Staff talked positively about their work. Staff said they made every effort to provide a person centred service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Reports under our old system of regulation (including those from before CQC was created)