Archived: Dallington House

We found that there had been improvements to peoples' care on this inspection. Not all issues had been dealt with in respect of having a fully detailed care plans, and that the staff had not read all of the care plans to be able to fully promote peoples' needs. We found that the risk to people's welfare had been reduced and therefore we have issued a compliance action rather than taking stronger enforcement action. We will continue to monitor the service to ensure peoples' needs are protected.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff supporting them and from looking at records.

We have taken enforcement action against Dallington House to protect the health, safety and welfare of people using this service.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People told us they felt safe living at Dallington House. One person told us: They treat me well, I feel safe with them.' Staff spoken with knew what to do if they suspected that someone was being abused. One care worker explained: 'I would tell the senior and if nothing was done, I would tell the owner or go even higher to the CQC (Care Quality Commission).'

We checked the daily records for three people who used the service and identified that on 26 June this year, some people are not received their medication. This meant that the people who used the service had been at risk of harm, because they were not receiving prescribed medication in line with their doctor's instructions.

Records kept to monitor how much food and fluid people had consumed during each day were not up to date, or accurate. This showed us that people were not protected from the risk of malnutrition or dehydration.

We found a person had not received the care needed to avoid the risk of developing pressure sores. We observed staff not carrying out the proper moving and handling of the person in line with assessed care needs. This meant that the person received inappropriate and unsafe care.

People told us they felt safe. However, some staff had not been trained in how to protect people from harm. The provider had not acted on staff concerns about people's safety. There was no detail in care plans regarding how to manage people's behaviour.

Staff did not know about the risk management plans that had been written for some people with particular needs. This was putting these people at unnecessary risk of harm.

There was no system in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This means that people were not benefiting from a service that was taking on board any lessons learnt.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe.

Potential risk issues had not been assessed in the home. Lighting levels in some areas were dim. They did not protect people from the risk of accidents. Fire systems had not been fully serviced and reviewed which put people at risk of incidents of fire. Unoccupied rooms, used as storage rooms, had not been locked, which was a tripping risk. There were puddles of water in two shower rooms, which was a slipping risk.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping the home safe.

Is the service effective?

People's health and care needs were assessed, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Specialist dietary needs were not always included. Some staff had not read all the care plans. Care plans were therefore not able to support staff consistently to meet people's needs.

People's mobility and other needs were not fully taken into account in relation to building adaptation as door widths were tight for wheelchairs, which did not enable people to pass through doorways in comfort and safety.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff but this was not always the case. We saw that one care worker did not show always show patience or give encouragement when supporting people. A relative told us; 'the care that staff give my mother is good'.

There was no evidence that people using the service, the home's staff and other professionals involved with the service had completed an annual satisfaction survey. People were therefore at risk of not having their concerns and needs properly taken into account.

There was some information about people's preferences, interests, and needs recorded in their care plans. However, the information was lacking in detail. Because of this there was a greater chance that care and support was not fully provided in accordance with people's wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We discussed with the manager the lack of dementia friendly practices such as how to properly communicate with people who have dementia, provide suitable stimulation and there was a shortfall of facilities regarding the design of the premises, taking account of expert bodies such as the Alzheimer's society.

Is the service well-led?

Staff said that if they witnessed poor practice they would report their concerns.

The service did not have a comprehensive quality assurance system to assess and monitor the quality of service provision. The system did not ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

There was evidence that the service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

What people told us:

The majority of people have communication difficulties. However, we briefly spoke with five people who lived in the home. They all told us that staff helped them.

We spoke with a relative. The relative said; 'care that the staff give has been very good'.

We observed life in the home to see if people were treated properly and their needs were met. We found that while most staff were friendly and helpful, this was not always the case.

There were a number of suggestions: to have more staff on duty when new people are admitted into the home; to make sure the home is attractively decorated; to have more outings; for people to be able to sit out in the garden, and to provide more meaningful activities to people with dementia.

During our inspection of 4 October 2013, we spoke with four people using the service, three relatives visiting their family members and six members of staff working at Dallington House. We found that the provider did not have suitable arrangements in place for assessing people's mental capacity and obtaining, and acting in accordance with, the consent of people using the service in relation to the care and treatment provided for them.

During our desk based follow up review of 5 February 2014 we did not speak with any people using the service, relatives or members of staff. We asked the provider to send us information and we have reviewed this information.

We found that the provider had suitable arrangements in place for assessing people's mental capacity and obtaining, and acting in accordance with, the consent of people using the service in relation to the care and treatment provided for them.

We found the provider had introduced new policies and procedures relating the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and consent to treatment. The majority of staff had received training in the MCA 2005 and DoLS since our inspection of 4 October 2013. The provider informed us that people using the service and/or their family members were involved in the care planning process, and care plans were signed indicating their involvement in the process.

People using the service were able to make informed decisions about their care and support, However, we found the provider did not have formal systems and procedures in place for assessing people's mental capacity and obtaining, and acting in accordance with, the consent of people using the service in relation to the care and treatment provided for them.

We found people experienced care and support that met their needs and protected their rights. One person told us 'the staff are very kind and the food is nice. I like it here." Two relatives told us 'the care is tremendous, it's absolutely great. We are very pleased.' Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

We found there were effective systems in place to reduce the risk and spread of infection.

We found staff were supported in their work and were confident that they were able to provide the care required. Members of staff told us there was good support, supervision and training in place. One member of staff told us 'I feel well supported here. I only started working here a few weeks ago and I have already started a NVQ in Social Care.'

We found the provider had a complaints policy in place. People using the service, and their relatives, we spoke with told us they were aware of the provider's complaints policy and how to make a complaint.