The Dales

The Dales is a residential care home providing personal care to 22 people at the time of the inspection. The service supports older people. The service can support up to 40 people.

We found the following examples of good practice

The service facilitated visiting in-line with government guidance. Procedures were in place for all visitors entering the service. Appropriate checks were carried out to prevent visitors spreading infection on entering the premises.

The registered manager and deputy manager recognised the importance of contact with friends and family to people’s wellbeing. Alternatives to in-person visiting, such as virtual visits and telephone calls were supported.

Staff understood and followed good Infection Prevention and Control (IPC) procedures, which helped protect people from the risk of infection. Personal Protective Equipment (PPE) was available throughout the service. Used and soiled PPE was disposed of in-line with best practice guidance.

IPC procedures were understood and audits were regularly completed to monitor IPC practice across the service. The provider did not have an IPC policy in place, the registered manager and deputy manager agreed to develop and implement this.

The service was clean and free from malodour. Regular cleaning following a cleaning schedule helped to reduce the risk of people catching or spreading COVID-19.

Cohorting was used to good effect in the service. Cohorting is a way of separating people that live at the service that have COVID-19 from those that do not, with the aim of preventing the spread of infection. This helped to reduce the risk of transmitting infection.

We found the following examples of good practice.

The provider had good procedures for preventing visitors from catching or spreading infection. The service was in recovery from a Covid 19 outbreak and, in line with guidance, all but essential visiting had been suspended.

The provider had set up visiting areas external to the building, where people and their visitors could safely communicate. The visiting pods had a glass wall and a microphone system allowing people to communicate safely.

The staff team had supported people to isolate during the outbreak of Covid 19 and people had understood the reasons for isolating. Almost everyone in the home had recovered from the virus and no longer needed to isolate. Good arrangements were in place so that people kept a safe distance in lounges and in the dining room

The provider had followed safe procedures when people were admitted to the home. People received a negative COVID-19 test result before admission and were supported to self-isolate in their rooms for 14 days after moving to the home.

The staff and the people who lived in the home had been tested routinely. Those who had a negative test continued to be tested and had received the Covid 19 vaccine. There were plans in place to recommence testing and to ensure people received the vaccine, when appropriate.

The home was clean and hygienic. The staff had been advised and supported during the outbreak and rigorous systems were in place to ensure good levels of hygiene. There were cleaning schedules in place and other systems to ensure good infection prevention and control measures. Staff understood how to use and dispose of personal protective equipment.

The provider and most of the staff had been unwell with Covid 19. The home had been supported by the local authority and they confirmed that the staff team had followed their advice and guidance. Arrangements had been put in place to ensure the staff could return to work safely. There were planned changes to rosters to support staff and staff could also access counselling.

The Dales is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

The care home is an older property which has been adapted and extended to provide suitable accommodation for older adults. There are suitable shared areas and outside seating. The home has a specialist wing for people living with dementia. The dementia care unit also has a secure garden area.

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

People told us they felt safe and well cared for. They were relaxed in the home and responded positively to staff. Staff had received suitable training about protecting vulnerable adults. Accidents, incidents, complaints and concerns were responded to appropriately.

Staffing levels ensured that people received suitable care and support. Recruitment was suitably managed. New members of staff had been suitably vetted and inducted. They understood individual needs of people in the home.

Staff were appropriately trained to give the best support possible. Staff knew people's needs and preferences and were skilled in working with people in the home. These included personal care skills, dementia care and moving and handling strategies.

People saw their GP and health specialists. The district nursing team visited regularly to undertake nursing tasks and give advice to staff. The staff team completed assessments of need with health professionals and social workers. Medicines were suitably managed and people had reviews of their medicines on a regular basis.

People told us the meals were of a high standard. One person said,“The food is very varied, well you can’t please everyone, but they give it a good try”. People were supported and encouraged to eat as healthily as possible.

Staff were kind and patient. They supported people in a respectful way. People said, "The girls are fine, I’ve no complaints” and “The staff are nice, the girls are very good to me”.

Confidentiality, privacy and dignity were maintained when delivering personal care and when assessing and responding to need. People had the support of advocates if necessary. Relatives said, “It’s excellent, we can’t fault it” and "[My relative] is very comfortable, staff are so kind to them”.

Risk assessments and care plans had been updated and developed in the service. They were now detailed and up to date. The plans reflected the person-centred care being delivered.

Staff could access specialists if people needed communication tools like sign languages.

The home provided a range of activities with entertainment and outings on offer. People told us they wanted a cinema room and this had been provided. The home also had a bar and a quiet room. People were encouraged to follow their own hobbies.

The management of the service good. An action plan had been developed to support improvement in the home. Quality monitoring was in place, with staff at all levels completing audits. People were consulted through meetings and individual reviews of their care and support.

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.

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 31 August 2018). 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

When we last visited the home in June 2017 we judged the home to be in breach of Regulation15 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because some areas were not as orderly as they might be and unlocked cupboards and tools left out could pose a threat. At this visit when we walked around we saw that cupboards were locked and that the home was somewhat tidier than before. We judged the service to no longer be in breach of this regulation in relation to environmental risks.

In June 2017 we also found a breach of Regulation12 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because staff were not using personal protective equipment appropriately and some parts of the environment needed to be improved. At this visit we saw that gloves, aprons and cleaning materials were readily available. We saw that staff had recently completed training in infection control. Some lavatories and bathrooms had been updated with impervious surfaces and improved drainage. Further work was under way. We judged the service to no longer be in breach of this regulation.

We did, however make a further requirement because the service was in breach of Regulation12 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because risk assessments and risk management plans were not in place for some individuals.

We found at the inspection in June 2017 that there was a breach of Regulation17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the monitoring of quality and the governance arrangements were not robust. At this inspection in June 2018 we judged that the service remains in breach because the governance arrangements were still unclear, the quality monitoring system had not been re-established and some recording needed to be improved.

We also judged that the service was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because two people had no care plan and other plans were out of date or incomplete. Care plans did not always reflect the person centred care that was being delivered. Staff said they did not read the care plans on a regular basis. Risk assessments and analysis of falls were not completed in a consistent fashion. Nutritional planning was not as robust as it could be. Staff could access specialists if people needed communication tools but some people did not have these needs and how to meet them recorded in their notes.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. This was completed in detail but the actions in the plan had not all been addressed when we visited in 2018.

The Dales is a 'care home' providing care for older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Dales accommodates up to 40 people in the main building and in the separate unit specialising in providing care to people living with dementia. There were 32 people in residence when we inspected.

The home is situated in Ellenborough which is a village near Maryport. The home is near to the local services of the village. Accommodation is in single, ensuite rooms and the home has some larger rooms that can be shared. There are a number of small lounge areas and shared bathrooms and toilets. The home has a small patio area and a secure garden.

The Dales is a family run service and one of the family is the 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 staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training. Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. The registered manager was aware of his responsibility to report any accidents or incidents to the Care Quality Commission.

The senior team kept staffing rosters under review as people's dependency changed. We judged that there were suitable care and support staffing levels in place by day and night. There were suitable numbers of ancillary staff employed in the home.

Staff were appropriately inducted, trained and developed to undertake their job role. We met team members who understood people's needs and who had suitable training and experience in their roles. Further training and changes to the supervision model were being developed.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. The team made sure that strong medicines and any sedation were kept under review with the local GPs.

People told us they were very happy with the food provided and we saw well prepared meals that staff supported and encouraged people to eat. We have made a recommendation about nutritional planning because some of the work done by the cook and the care staff was not recorded in care files.

The Dales is an older property that has been extended and adapted to accommodate up to 40 people. There is a separate dementia care unit that has been specially designed to keep people safe and secure. The house was warm, clean and comfortable on the day we visited. The home was tidy and more orderly than previously and several areas had been improved. Suitable equipment was in place to help people with things like mobility.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We have made a recommendation that group decisions made on a person's behalf be recorded as a 'best interest' meetings rather than just referred to in daily notes.

People who lived in the home told us that the staff were very caring. We observed kind, patient and appropriate care being provided. Staff knew people and their families very well. They made sure that confidentiality, privacy and dignity were maintained. People were encouraged to be as independent as possible. Staff were trained in end of life care and we saw evidence to show that this kind of care had been done to good effect for many years.

We learned that the home had regular entertainers, activities and parties. Staff took people out locally and encouraged people to follow their own interests and hobbies. People were supported to be as independent as possible.

We noted that this home had good links to the community and had a locally based culture. The registered manager ensured that staff understood the vision and values of the service and good practice was discussed on an informal basis. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

We had evidence to show that concerns or complaints were dealt with appropriately.

The service did not have a comprehensive quality monitoring system in place but people were asked their views in a number of different ways and quality audits had started to be used. There had been a number of changes in the governance arrangements with the appointment of a general manager and a deputy manager supporting the registered manager. These roles were still being defined and tasks needed to be deployed appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

The Dales is an older property which has been extended and adapted to provide care for up to forty older adults. The home also has a specialist unit for people living with dementia. At this visit there were twenty nine people in residence. The home had suitable shared areas and facilities. The home is situated in the centre of the village of Ellenborough which is a suburb of Maryport. The home is served by good public transport links.

The home had a suitably qualified and experienced 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.

At this visit we judged that some areas of the home needed to be upgraded to ensure they remained safe for vulnerable people. We judged the home to be in breach of Regulation15 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because some attention was needed to ensure the environment was safe. You can see what action we told the provider to take at the back of the full version of the report.

We also noted that there were some problems related to infection control. The home is in breach of Regulation12 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because arrangements for good infection control needed to be improved. You can see what action we told the provider to take at the back of the full version of the report.

The staff team were aware of their responsibilities in keeping vulnerable people free from harm and abuse. Suitable training had been given and management staff were aware of how to manage any potential abuse. Accidents and incidents were monitored appropriately.

Staff recruitment and disciplinary matters were well managed. Staff received training and were given supervision and appraisal. The home had sufficient staff to give people good levels of support.

Medicines were ordered, administered, stored and disposed of correctly.

The staff team understood their responsibilities under the Mental Capacity Act 2005. Where people were judged to be deprived of their liberty the registered manager ensured that there were appropriate steps taken to authorise this. People were asked for consent to all interactions. Restraint was not used in the service.

People told us they enjoyed the food provided and people were well nourished.

The home had good support from the local primary health team and supported people with any health care needs. Health care professionals were happy with the support people received and were complimentary about end of life care in the home.

The building had been suitably adapted and designed to meet the needs of older adults and people living with dementia.

We met a caring team of staff. People were positive about the way they supported them. We saw that staff treated people with dignity and respect and helped maintain their independence where possible.

The management team were updating the care plans for people in the home. People received good levels of personal care support.

We recommended that care planning be reviewed and that some areas were improved to ensure that high quality care continued to be delivered.

People told us they were happy with the entertainments and activities on offer. People were supported to follow their own chosen lifestyle.

Complaints were suitably managed by the registered manager. The home had complaints policies and procedures in place.

The home had a person centred culture and the staff team displayed appropriate values that met the vision of the management team.

The home had a new management team in place who were updating all aspects of the home. The home had a quality monitoring system but this had not been operating effectively for some time.

This was a breach of Regulation15, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

This service trained and supervised the staff team appropriately so that they delivered the right levels of care and people were kept safe in their environment. We had evidence to show that the management team were able to make safeguarding referrals correctly.

We also noted that appropriate systems were in place to recruit people who had the right kind of background for working with vulnerable adults. We also saw that the management team were able to deal with any issues of poor performance.

We looked at quality monitoring checks and we discovered that there were good systems in place to ensure that the environment was safe.

One person told us:

"I'm safe here and well looked after. I wouldn't want to live anywhere else."

Is the service effective?

We spoke to a number of healthcare professionals on the day of our visit and they were able to tell us that when people had any health issues the staff not only dealt with these appropriately but started to deal with the problems before any healthcare professional visited. They judged that this was because the staff worked well with them and that they were appropriately trained.

We spoke to a number of people who could tell us about the care and support they had received that have given them a better quality of life. We spoke to one person who was able to tell us about the actions put in place to help them.

"The staff noticed this' I didn't but they made sure that this problem was dealt with. I am fine now."

Another person said:

"I have only been here for a few weeks and have a lot of problems but I am getting a lot of help and have decided to live here as I need their support."

Is the service caring?

During our visit we saw numerous warm, caring and sensitive interactions between the staff team and the people who lived in The Dales. People were keen to tell us that:

"We have nice carers' They are great! I don't have a problem with any of them. They treat me properly."

"The staff are fantastic' They really care about the person and about their family."

We observed warm, patient and sensitive care being delivered in the dementia care unit.

Is the service responsive?

People told us that:

"Anything you want, anything you need is right there!"

"I just have to say and it is done. Some things are done before I even realise they need doing."

Social workers and healthcare professionals told us that this home was very good at responding to needs. They also told us that the staff team were good at pre-empting any problems and would put things in place before any issues arose.

Is the service well-led?

The Dales was owned by a family who were actively involved in the day-to-day management of the home. One person was the registered manager, another dealt with the environment and maintenance and the third person dealt with all aspects of care provision. They worked well together and were well known to everyone who lived in or visited the home.

They had looked at the way the home was managed and they had promoted some staff and recruited others so that the home operated more smoothly. The home had a well qualified and experienced management team and were developing a senior care team so that all aspects of the home would be appropriately led. This had allowed the management team to focus on improvement and development of the service. Their audits of quality and business planning helped them to develop a high quality dementia care unit.

We had a lot of comments about how well led home was. People we spoke to told us that the home was "excellent", "wonderful" and "outstanding".

"The staff are brilliant' We are both very happy living here."

"Everyone in the home is very good they would do anything for you."

"I have settled very well even although it was difficult. The staff are very good at reassuring me."

"I feel safe here."

We walked around the home and found that the home was clean. We also judged that the home was tidier than it had been in the past. We saw that redecorating and refurbishing different areas of the home was an ongoing project.

In the summer of 2013 the providers completed an upgrade to one part of the home. This area with a large dining room and lounge was a specialist unit for people with dementia or related illnesses. This part of the home had been refurbished to a very high standard.

We also checked on the equipment in the home and we found that there was enough equipment to give people the right levels of support.

We spoke to people in the home and to staff and we looked at rosters. We judged that there were enough staff to give suitable levels of care and support.

We looked at a selection of records held in the home. We saw that the service had good systems for recording every aspect of the work of the home. We did note minor non-compliance because some of these records needed updating.

We had evidence to show that personal and health care was delivered appropriately. One person told us

"I get very good care here and am treated respectfully. I am listened to and things are done the way I want."

The service had good working relationships with health care providers and they managed medicines appropriately.

Everyone we spoke to told us that they were happy with the food provided.

"The food is very good here...plenty of choice and good stuff. The cooks know what they are doing...good bakers too!"

No one was undernourished and people were helped to eat healthily.

New staff were not employed until the manager was sure they were the right kind of person to work with vulnerable older people. Suitable background checks were made on new staff.

No one we met had any complaints but they were fully aware of how they would make a complaint if they had to.

One person said:

" I speak up and ask for what I want...but they ask the quiet people. There are ways to make a complaint if you don't feel confident but most of us just speak out...it is that sort of place...very open."