Daleside Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Improvements had been made since our last assessment in the recording and reporting of safety related events which occurred. Incidents were consistently recorded and reported to other agencies when required. This included the CQC. The provider, and the management team ensured systems were in place to review safety related events which occurred to identify themes and trends and to look at ways these events could be avoided in the future.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. We received mixed feedback from family members. A family member told they were always involved in decisions and were kept informed of any changes in their loved one’s care. They said, “[Name] has been admitted a few times to hospital, and I get a phone call and then I meet [Name] there.” However, another family member described their loved one’s transition to Daleside Nursing Home and told us they had not been asked about the persons needs or preferences. They told us they assumed staff must have obtained any information from hospital staff who did not know the person as well.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Systems were in place to protect people from the risk of abuse. Referrals had been made to the local authority safeguarding team when abuse had been suspected, and investigations had been completed. People told us they felt safe. One person commented, “I feel safe, I would talk to one of the girls if I didn’t.” Staff received training and understood the actions they must take if they felt someone was being harmed or abused.

Several people were being deprived of their liberty through the deprivation of liberty safeguards (DoLS) framework. Records of this had improved since our last assessment and authorised restrictions were accurately reflected in peoples care plans.

The provider did not always work well with people to understand and manage risks. Risk assessments and care plans had been reviewed and improved since our last assessment however, some still needed more detail to assist staff to support people safely. The provider needed to ensure risk assessments and care plans were updated in a timely manager following a person’s needs changing or an event occurring. We shared this feedback with the management team who took appropriate action. Staff provided care to meet people’s needs that was safe and supportive. For example, we observed staff using safe practices when assisting people to mobilise.

The provider did not always detect and control potential risks in the care environment. Whilst there had been improvements since last inspection further improvements to the environment were needed. Routine checks on the environment and equipment were up to date and certificates were in place to demonstrate this. People had the equipment they needed to keep them safe. The service was well maintained; areas of the service had undergone redecoration and refurbishment since our last assessment. Bedrooms were personalised according to people’s preferences, however, some bedrooms showed areas of wear and tear and required fresh redecoration. We raised this with the provider and were provided with a copy of an environmental improvement plan. This demonstrated planned maintenance and redecoration of the service was ongoing. At our last assessment, we found bedrooms did not have room numbers which could be confusing for people who used the service as well as new staff. During this assessment, we found numbers had been put back on bedroom doors however, in a small number of cases the number had changed but documentation had not always been updated to reflect this. Whilst staff we spoke with had a clear understanding of who resided in which bedroom, we raised this with the management team and were told immediate action would be taken.

The provider did not always make sure there were enough qualified, skilled and experienced staff. We observed a lack of staff always present in communal areas at busy times of the day, such as mornings when other people were being assisted with their morning routine. We discussed this with regional manager who told us they would immediately review and increase staffing levels to address this. We received mixed feedback from people about the consistency of the staff team. Comments included, “I haven’t noticed any differences so must be the same”, “We have the same staff all the time I think” and “[Staff] change all the time.” Rotas demonstrated there was some reliance on agency workers to maintain staffing levels, although where possible, the same agency workers were deployed to cover shifts.

Since our last assessment, recruitment records had improved and demonstrated staff were recruited safely. Appropriate checks were in place to ensure staff were suitable for their role. Staff, including agency workers, received an induction when they commenced employment. One staff member commented, “The induction was good. The seniors did a booklet and showed me round home. I am happy working here and I was given enough time to get to know people’s needs.” Staff confirmed they received ongoing training to enable them to undertake their role effectively and training records supported this.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Some equipment needed deep cleaning, for example, hoist frames and some wheelchairs. Provider audits had previously identified this was a cleaning task which needed focus however it was not an area of improvement which had yet been resolved. Overall, the service was much cleaner and less cluttered than our previous assessment however, some parts of the home still had malodours, which were more prominent at certain times of the day. We discussed this with the provider, and we received assurance of ongoing plans to address environment improvements which were still needed, including the replacement of some bathroom facilities. People told us they were generally satisfied with the cleanliness of the home. Comments included, “Yes, it’s clean” and “Yes, [domestic staff] do a good job.” Staff had access to adequate and appropriate personal protective equipment (PPE). PPE was observed to be appropriately worn by staff. A family member commented, “[Staff] always seem to have aprons and gloves on when I come in.”

Systems to ensure people receive their medicines safely had significantly improved since our last assessment. People received their medicines as prescribed and regular checks were made to ensure safe administration and storage. Some improvements were still needed to ensure records accurately reflected people’s needs. For example, one person had an agreed plan in place to receive their medicines in a covert manner, however, the medication administration record (MAR) did not reflect this for every medicine which was to be administered in this way.

Protocols were in place to guide staff when to offer a person medicines which were to be administered on a ‘as required’ basis. However, a person’s medicines records contained outdated medicines information. A person who had recently moved into the service did not yet have a complete set of records in place. We shared out findings with staff and all shortfalls were addressed during the assessment.