All inspections: Dalewood View - Care Quality Commission

We carried out an inspection on 8 and 10 December 2015. This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The service was last inspected on 19 May 2015 and was not meeting the legal requirements of the regulations for person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper persons employed.

At our last inspection of May 2015 we found the service was in breach of six regulations. These related to; person centred care, safe care and treatment, safeguarding people from abuse, good governance, staffing and fit and proper persons employed. As a response to this, the provider sent an action plan of the steps they would take to meet the legal requirements of these regulations. We undertook this latest inspection to establish what progress the service had made to meet these requirements.

Dalewood View is a nursing home that provides care for up to 60 people. At the time of the inspection there were 31 people living at the service. The service has three floors; a lower ground floor where the service’s activities room is based, the ground floor which is primarily for people requiring nursing care and the first floor which is primarily for people requiring residential care. At the time of the inspection there were fourteen people requiring nursing care on the first floor.

There was no registered manager in post 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new home manager had commenced employment the week of the inspection who was being supported by a regional support manager. The regional operations manager who had managed the service for a period of time was still involved with overseeing the service.

Although people we asked told us they felt safe, we found that care delivered, particularly to people in receipt of nursing care was not safe. Systems and processes to identify safeguarding concerns were not suitably robust to protect people. For example, we found little investigation into wounds and bruising people had sustained. The service did not have appropriate arrangements in place to manage medicines safely and we found a repeat of issues in regard to medicines that we had identified at our last inspection. Individual risks to people were not appropriately assessed and managed to maximise safety and the level of risk to people was not always clear due to conflicting information.

There was evidence in peoples care plans of involvement from other professionals such as doctors, opticians, and speech and language practitioners. Professionals we spoke with felt the service did not always accommodate people’s needs. We found that people were not always supported by staff in accordance with their needs and the care provided was inconsistent.

Deployment of staff needed improvement at times as we saw instances where people who needed assistance to eat did not receive this. People and relatives commented that staff often changed which impacted on the continuity of care people received.

We found recruitment procedures were not effective as appropriate checks had not been undertaken to ensure the suitability of staff prior to commencing employment. Staff told us they received supervisions and felt supported but we found some shortfalls in the training staff received appropriate to their roles and responsibilities. Competence and skills of nursing staff was not effective to meet people’s needs.

Consent was not always sought in accordance with the Mental Capacity Act 2005. There was evidence of some decisions being made in people’s best interests but this was not consistently applied.

Although staff interactions were primarily positive and staff were polite and courteous, these interactions were mainly centred around tasks. People and their relatives gave mixed comments about staff and how they were cared for.

There was an activities worker in post and we saw activities take place however there was limited stimulation available for people who were not able to attend these. ‘Relatives and residents’ meetings were available for people to keep updated about the service and give feedback. There was a complaints process in place.

Although assessment, auditing and monitoring of the service took place, this was insufficient and not designed in a way to address existing shortfalls and make improvements. Despite continued breaches at previous inspections, little improvement was seen in relation to these which meant people were still being put at risk.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out an inspection on 19 May 2015. This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The service was last inspected on 16 and 17 December 2014 and was not meeting the legal requirements of the regulations for care and welfare of people who use services, meeting nutritional needs of people who use services, the management of medicines, and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report of the action they would take to meet the legal requirements in relation to each breach in regulation. The provider informed us they would be fully compliant by the end of April 2015.

Dalewood View is a nursing home that provides care for up to 60 people. It is a purpose built care service. At the time of the inspection there were 43 people living at the service. The service has three floors, a lower ground floor where the service’s activities room is based, the ground floor which is primarily for people requiring nursing care and the first floor which is primarily for people requiring residential care. At the time of the inspection there were seven people requiring nursing care on the first floor.

There was not a registered manager for this service in post at the time of the inspection. One of the provider’s supporting managers and the regional operations manager had been managing the service. A new manager had been appointed; they had only been in post for approximately two weeks. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt “safe” and satisfied with the quality of care they had received. Relatives spoken with felt their family member was safe. Relatives spoken with had mixed views regarding the quality of care their family member had received.

Our discussions with staff told us they were aware of how to raise any safeguarding concerns. However, some staff spoken with told us that they felt unable to raise concerns about individual staff competencies and staff interactions between some nurses and care staff. This meant people were not protected against the risks of improper treatment because the provider had not made sure that they had, and implemented robust procedures and procedures that make sure people we protected.

People told us they were treated with dignity and respect and this was supported by their relatives.

We observed that the interaction and communication between staff and people was mainly focussed around completing tasks. The service had an activities worker who provided a range of activities for people to participate in. They were not working on the day of the inspection.

We checked to see whether improvements had been made to the management of medicines and whether these had been maintained. We found that the provider had not made enough improvements to protect people against the risks associated with the unsafe use and management of medicines.

There was evidence in peoples care plans of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s preferences and dietary needs were being met, we found the arrangements to ensure people received support with eating and drinking had improved since the last inspection.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. We saw the process in place to record the checks that had been completed could be more robust. We found the provider did not have appropriate processes for assessing and checking that nurses had the competence, skills and experience required to undertake the role. This meant people who required nursing care were at risk of not being cared for by competent staff.

We found that sufficient improvement had not been made to ensure staff received training suitable for their roles. We found that staff had received supervision sessions since the last inspection. However, some staff spoken with told us they did not feel supported by senior staff within the service.

There was a complaint’s process in place in the service, people and/or their representative’s concerns had been investigated and action taken to address their concerns.

Meetings had been held with people living at the service and/or their relatives or representative since the last inspection. This meant people and/or their relatives or representatives did have opportunities to be kept informed about information relevant to them.

Our findings demonstrated the provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided. This meant they were not meeting the requirements to protect people from the risk and unsafe care by effectively assessing and monitoring the service being provided.

We saw evidence that checks were undertaken of the premises and equipment and action was taken to ensure peoples safety.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

As a result of concerns made to the Care Quality Commission a responsive inspection took place on 16 and 17 December 2014. This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The service was last inspected on 22 July 2014 and was not meeting the requirements of the regulations for care and welfare of people who use services and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report of the action they would take to become compliant to the Care Quality Commission. The provider informed us they would be compliant by the end of November 2014.

Dalewood View is a nursing home that provides care for up to 60 people. It is a purpose built care service. At the time of the inspection there were 54 people living at the service. The service has three floors, a lower ground floor where the service’s activities room is based, the ground floor which is primarily for people requiring nursing care and the first floor which is primarily for people requiring residential care. At the time of the inspection there were seven people requiring nursing care on the first floor.

There was not a registered manager for this service in post at the time of the inspection. The current manager had been in post since August 2014, at the time of the inspection they had not made an application to register. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt “safe”. Some people who lived at the service had complex needs and we were not able to verbally communicate with them so they could share their views and experiences with us. Our observations did not identify any concerns regarding safeguarding of people who lived at the service. However, during the inspection we observed that one person had not been appropriately supported by a staff member and did not ensure that the welfare and safety of the person was maintained. We shared this information with the manager and the regional operations manager who assured us that they would speak with the staff member as soon as possible /immediately. Relatives spoken with felt their family member was safe and were satisfied with the quality of care their family member had received.

Most staff had received training in safeguarding vulnerable adults as part of their induction training. Our discussions with staff told us they were aware of how to raise any safeguarding concerns.

People told us they were treated with dignity and respect and this was supported by their relatives, but this was not always supported by our findings/observations. For example, we observed two staff entering rooms without knocking on doors and one staff not ensuring the doors were closed whilst providing personal care.

We observed that the interaction and communication between staff and people was mainly focussed around completing tasks. The service had an activities worker who provided a range of activities for people to participate in. People spoken with who joined in the activities told us they enjoyed participating in them.

We found the service did not have appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as suitable to work at the service.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. However, we found one person’s risk assessment had not been reviewed after sustaining a fall.

There was evidence in peoples care plans of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

Although people’s preferences and dietary needs were being met, we found the arrangements to ensure people received support with eating and drinking could be improved.

Staff received induction training suitable for their roles when they started employment at the service. However, we found that staff had not completed training in some areas of training relevant to their role. For example, one staff member had started working at the service in June 2014. The spreadsheet and their training records showed that they had not completed training in the following areas: food hygiene, moving and handling and health and safety. Staff had not received regular supervisions and appraisals, which meant their performance was not formally monitored and areas for improvement may not have been identified.

There was a complaint’s process in place in the service, people and/or their representative’s concerns had been investigated and action taken to address their concerns.

Meetings and completed surveys had been held with people living at the service and/or their relatives or representative. This meant people and/or their relatives or representatives did have opportunities to be kept informed about information relevant to them. We found examples where people and relative’s views and suggestion had resulted in changes in the service. However, we found examples where their views and experiences had been sought and no action plan had been completed.

Our findings demonstrated the provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided. This meant they were not meeting the requirements to protect people from the risk and unsafe care by effectively assessing and monitoring the service being provided.

We saw evidence that checks were undertaken of the premises and equipment and action was taken to ensure peoples safety.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

On the day of the inspection an adult social care inspector and a specialist advisor visited the service. At the time of this inspection, forty nine people were living at Dalewood View including two people receiving respite care. Twenty nine people were receiving nursing care support; five of these people were located on the residential unit on the first floor. We observed the care those people received; spoke with thirteen people and two relatives. We also spoke with the manager, the regional operations manager, one nurse, seven care workers, two domestic staff, the activities coordinator, two administrators and a maintenance worker. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

We found there wasn't an effective process in place to ensure staff recorded and reported incidents appropriately so they could be monitored and reviewed to ensure people were receiving appropriate care and to minimise the risks to people's health, welfare and safety.

Some staff had received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Most of the people spoken with told us they felt 'safe' and had no worries or concerns. However, one person told us they didn't feel 'safe' in their room. The person had not been protected by the negative effect of another person's behaviour at the home.

Is the service effective?

We found staff taking time to ensure people were comfortable and that most people were well groomed. This promoted their dignity, but we found five occasions when this had not been effective in practice.

An annual risk assessment and care plan review was completed for each person. Staff reviewed each person's risk assessments and care plans on a monthly basis. We found evidence that some people's care plans and risk assessment had not been reviewed each month and/or responsively to meet their changing needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people's care and welfare.

Is the service caring?

We observed individual staff members demonstrating compassion and respect for people's dignity. Staff also explained their actions when they were assisting people and gained their consent before carrying out any tasks.

People spoken with told us they were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: 'they [staff] are brilliant and they are lovely' 'I get plenty of drinks' and 'we are treated quite well, they [staff] are very kind'.

Is the service responsive?

During the inspection we visited people in their rooms and found staff had not ensured that a call buzzer was in reach for three people in case they needed to call for assistance. For example, one person was sat in their wheelchair but their call buzzer was lying on their bed.

The provider's complaints process was displayed in the reception area.

Is the service well led?

The home held resident and relative's meetings in January and February 2014. The provider had recently sent out a survey to people and their representative/relative and the manager was in the process of collating the findings.

There was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. However, our findings indicated the audits in place had not effectively identified the concerns we found during the inspection.

The audits in place did not cover all aspects of the service with the regards the reporting, monitoring and analysing of incidents within the home. The analysis of incidents help identify, assess and manage risks relating to the health, welfare and safety of service users and where necessary make changes to the treatment or care provided.

We spoke with the manager who told us that a dependency assessment had not been completed to reflect the change in the number of people requiring nursing care. This told us that the home had failed to regularly assess and monitor the quality of care being provided and adequately responding to concerns raised by staff about staffing levels. The manager told us that an additional nurse had worked from nine am to five pm on the day before the inspection and there was a plan for this to continue from the day after the inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to identifying, assessing and managing risks to health, safety and welfare of people who use the service and others.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People's needs were assessed and care and treatment were planned and delivered in line with their individual care plans. This was confirmed when we checked five care plans; spoke with people who used the service, their visitors and the staff on duty.

Health, safety and welfare of people were protected because the staff at the home worked in co-operation with other agencies for the benefit of the people who lived at the home. We were informed by community health professionals that nurses and the care workers at the home had a good rapport with them, organised appointments and co-operated with them.

Dedicated members of staff were seen carrying out cleaning duties throughout the home during our inspection. One person said, 'I like my room it's lovely and clean. The girls take care of it for me.' All staff at the home had received training on infection control and two staff told us the actions they took to minimise the risk of infection.

Medicines were prescribed and given to people appropriately. People were given time to take the medicine. We witnessed the nurse asking people whether they were in pain or discomfort during the routine medication round.

There was an effective recruitment and selection policy in place. All necessary checks had been carried out and satisfactory outcomes had been gathered before staff were recruited to the post at the home.

We carried out an unannounced inspection of Dalewood View on 12 July 2012. At the inspection we found the provider was not compliant in two outcome areas. We therefore issued two compliance actions which required the provider to address their non-compliance. An unannounced inspection to the premise was made on 2 October 2012 to check what that improvement had been made.

We spoke with 20 people during our visit. We spoke with people in a group, when they had finished activities. We also spoke with five people individually. Thirteen people made positive comments about the service. Five people told us they liked living at Dalewood View and the staff were very good. They said that they were involved in the planning of care and the reviews. They also told us that they were able to see the GP or optician when they wanted. Two people said that it was not their ideal choice to live in a care home, but they were satisfied with the support they received from the staff at Dalewood View.

We asked four people whether they felt safe at the service. All four people said they were safe at the home and the staff made sure of this. They said people from outside could not walk into the home without permission and visitors had to be let in by the staff.

People who lived at the service told us that they had plenty of activities and not everyone wanted to join in. Three people said that they enjoyed all activities. One person said that they like going out with staff.

People were broadly positive about their experience of using services at Dalewood View. One person told us 'breakfast is good' and another said 'the staff are good'. People experienced a good range of opportunities to be involved in making decisions about the way the service was run, which they said they valued. Two people said they were unhappy about the provision of some equipment within the home, and another said they wanted more activities in the evening.

We carried out this inspection to check out the progress made with the compliance actions made at the last inspection in August 2011. Shortly after that inspection a new provider registered with CQC and took over the running of Dalewood View. The new provider gave assurances to us that improvements would be made and that all areas of non compliance identified by us would be addressed.

A new home manager was also appointed at the home five weeks ago.

During this visit people told us that overall they were happy living at the home and satisfied with the level of service provided.

Individual comments included

'The staff are marvellous,things are getting better here.Staff are always checking you are O.K.I speak with the owner when he comes he seems interested in our views and wants to run a good home.'

We spoke to two relatives who were visiting the home and they confirmed that they were very satisfied with the care provided. One told us "There have been a lot of changes, but I think things are generally better, I'm happy with the care mum receives."

Due to some people's communication needs we used informal methods of observation during the site visit. We observed care practices and saw how staff and people interacted with each other.

From our observations, we found that people were generally happy living in the home and had friendly relationships with the staff. We saw people sitting comfortably in communal lounges. The building was warm and homely.

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding and they told us that they had recently visited Dalewood View and found overall improvements with the service and had not identified any concerns affecting people's health and welfare at the home.

They told us that the new manager was "Making a significant difference." at the home.

Archived: Dalewood View

All Inspections

8 and 10 December 2016

During a routine inspection

19 May 2015

During a routine inspection

16 and 17 December 2014

During a routine inspection

22 July 2014

During a routine inspection

12 July 2013

During a routine inspection

2 October 2012

During an inspection looking at part of the service

19 June 2012

During a routine inspection

5 March 2012

During an inspection looking at part of the service