Dalemain House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Care plans were not always in place to support people safely or had not been updated to reflect people’s current needs. For example, there was no wound care plan or wound monitoring in place for one person. Their care plan stated, ‘Wounds have now healed’, however, this was not the case. Notes from district nurse visits and confirmation from the manager confirmed the person had current wounds which were being treated. This lack of up-to-date information placed people at risk of deterioration and delayed treatment.

However, relatives told us communication with the home was good, and they were updated if there was any change in the needs of their family member.

The provider planned delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. For example, repositioning charts, food diaries and fluid balance charts were in place for people who needed them and were completed regularly in line with their care plan. Staff followed best practice guidance when completing these.

The provider worked well across teams and services to support people. Staff knew the people they were supporting very well. Daily handovers were in place to share concerns and ensure consistent communication between shifts. Most staff felt the team worked well together with comments including, “I work with a good team of people who know their job” and “The team is good.” Contact with professionals was good; however, updates or action plans were not always reflected in care plans.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Some family members raised concerns regarding the level of activity and stimulation, with comments including, “I don’t believe they have offered any activities to her” and “There isn’t much stimulation.” Some staff agreed, stating, “I think it impacts on the deterioration and behaviour side.”

Some family members raised concerns about people being isolated and spending long periods in their room with no stimulation. Activity care plans were in place for people, but these were not followed. For example, one care plan stated, “[Name] spends her days in the lounge” however, we observed this person to be in bed throughout the day.

Another care plan stated, ‘We have also started taking [Name] out for a few hours each day, which has positively contributed to overall engagement and well-being’, but daily care notes did not evidence this was happening.

Some family members were satisfied with the level of activities provided. People did have access to healthcare and other professionals when required.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

For example, for people with wounds and catheters, documentation was not updated accurately or not in place, which made it difficult to monitor progress and ensure appropriate care was provided.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

For example, one person’s records stated they had given consent for a range of decisions, including the use of bed rails, with the method of consent recorded as ‘Stating yes’. It was unclear how consent had been assessed or whether appropriate legal frameworks had been followed, as there was no documented mental capacity assessments or best interest decisions to support these entries. A further entry from the manager recorded this person could not consent to bedrails and had been assessed as lacking capacity to make some decisions relating to their care. This inconsistency and lack of documentation meant this person could have received care that was not in their best interest or without proper consent or protection, which may have breached their rights under the Mental Capacity Act 2005.

However, we observed staff asking people for consent before delivering daily care, and the provider had a tracker in place to ensure applications for Deprivation of Liberty Safeguards were in place and up to date.