Dale Park

Dale Park is a residential care home, providing accommodation for persons who require nursing or personal care. The service provides support for up to 54 people; younger adults, older people and people living with dementia. At the time of our inspection 18 people were using the service.

The property is set over 2 floors with lift access to the upper floor. There were several communal areas both downstairs and up, multiple shared bathrooms and an accessible rear garden. Aids and adaptations were in place to meet people’s individual needs.

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

We spoke with people, their relatives and staff at Dale Park. Most told us the standards of the home had improved since our last inspection.

Changes to the management structure within the service had been instrumental in the improvements found during our inspection. Staff spoke positively about managers and how they were approachable and supportive. People and their relatives told us they had seen improvements to the standard of care and were complementary about the management and staff team. One relative said, “One of the first things I noticed about the home is that all the staff care about [person], from the cleaners to the manager.” A person living at Dale Park told us, “This is a good home, I am happy here. The staff are all friendly and supportive.” People we observed seemed happy and relaxed during our visit, there was a calming atmosphere.

We observed increased staffing levels, resulting in a more person-centred approach. Auxiliary staff were recruited to support the nursing and care team with the running of the home; contributing to checks and ongoing improvements.

Care records were complete and up to date. Risks to people's health and well-being were appropriately assessed and detailed plans were in place to help manage these and keep people safe. Staff responded quickly to changes in people's needs and relevant referrals to external professionals were made in a timely manner. People told us they felt safe and relatives were confident people were well-looked after.

Accidents, incidents and safeguarding concerns were regularly reviewed and analysed by managers. Appropriate action was taken to try and prevent incidents from occurring in the future.

Medicines, including ‘when required’ medicines were managed safely by nurses who received regular reviews of their practice. People received their prescribed medication on time and relevant records were completed accurately.

Safe recruitment processes were followed, and relevant checks completed on new applicants to make sure they were appropriate for the role. Robust systems were in place to make sure that agency staff had relevant experience. Staff training had improved since our last inspection.

The home was clean and hygienic and in the process of being refurbished. Staff received training in infection, prevention and control and were provided with regular updates following changes to guidance; particularly in response to COVID-19. The service supported family members to regularly visit their relatives safely.

People were supported to maintain a balanced diet and mealtimes were now a more relaxed, sociable occasion. There was still a lack of planned, quality activities but the provider assured us they would allocate more resources to activities and people’s wellbeing following our feedback.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 January 2022) and there were breaches of regulations. 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.

At our last inspection we recommended that ‘when required’ medicines guidance was kept up to date. At this inspection we found improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow Up

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Dale Park is purpose built and can accommodate 46 people who are living with dementia. It is managed by HC-One Limited. There were 26 people in residence at the time of the inspection.

People’s experience of using this service

We spoke with relatives of people living with dementia at Dale Park. Most told us that the standards in the home had deteriorated since our last inspection at the home in June 2021. Lack of consistent staffing and lack of consistent leadership and management were the two main themes.

On our inspection we found major concerns with the management and oversight of the home which increased the risk to safe care for people living at Dale Park.

We were told by relatives and staff there was a lack of visible management and leadership in the home. At the time of our inspection the home was in the process of changing managers and was being supported by interim managers. One relative commented, “I don’t know the name of the manager; interim now. The last manager went on holiday and never came back." Another relative said, “There’s been a series of managers.”

We found the inconsistencies in management had contributed to failings in record keeping and attention to dealing with complaints. People and their relatives had not been consulted effectively about the running of the home.

We were told there was poor staffing levels including nursing staff, care staff and ancillary staff with no chef and no maintenance person. There was an increased use of agency staff to cover shifts and this had meant care had become less personalised and more institutional. One relative commented, “Care has gone downhill and it’s impacting on them physically. [Relative] gets a bath once a week. They can’t offer more – they say they can’t help as they are short staffed.” Another relative told us, “There is not enough regular staff. Staff are fed up with Head Office turning their backs on them so leaving.” These sentiments were also reiterated by all staff we spoke with.

Records such as care records, assessments and care plans, contained information that was possibly incomplete as the records had not been properly evaluated and updated. Other records such as complaints investigations were also incomplete. We could not fully assess whether complaints had been responded to appropriately.

We found that people were receiving their medicines as prescribe, however some medicines paperwork needed to be updated. We made a recommendation regarding this.

There was a lack of arrangements in place to help ensure the environment was safe for people. For example, on the day of the inspection the heating was faulty, and people were seen to be shivering and complaining of cold. Managers organised a maintenance check on the day of the inspection and remedial action was taken; we were reassured the heating was satisfactory. However, we were concerned there was a failure of initial monitoring and awareness by managers and staff.

The environment has been adapted to meet the staffing shortages rather than the needs of people living with dementia. Most people had been moved to one floor of the home; some away from their initial bedroom surroundings.

There was a good standard of cleanliness in the home and the home was free of unpleasant odours. There was a lack of maintenance of décor and furnishings in some instances which meant some areas may have been difficult to clean.

People’s dietary needs were managed with reference to dietary support when needed. Because of changes to meal time arrangements and staff shortages, mealtimes were observed to lack individual attention when staff supported people and did not make for a relaxed social occasion.

Rating at last inspection and update:

The last rating for this service was Good (published 3 July 2021)

Why we inspected:

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from ‘Good’ to ‘Requires improvement’. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see all the key questions reported on in this report.

The provider took immediate action to mitigate some of the issues we identified and keep people safe.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and the overall governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service

People we observed were supported and relatives we spoke with told us they felt the home was safe. One relative told us, “Mum is very settled; the care is second to none.”

Arrangements were in place for checking the environment to ensure it was safe in relation to infection control and the threat of Covid-19. We found the policies and procedures in place followed current national guidance. We sign posted the manager to good practice guidance when admitting visitors to the home.

People were settled in the home and any risks in relation to their wellbeing, such as risk of falls, had been carefully assessed.

The home was staffed appropriately. There was a core of staff in the home who had good knowledge and rapport with the people they supported. The use of agency staff was minimal. Some staff reported dissatisfaction with staffing levels on occasions; we advised the manager to follow this up. The duty rotas confirmed stable staff numbers.

Since the last inspection there had been three changes of managers. There was no current registered manager. The provider had ensured continuity of management however and there was a senior ‘Turnaround Manager’ commencing in the home while a new manager was recruited.

Staff were varied in their feedback regarding leadership in the home although most reported a generally settled approach. One staff commented, “The managers have been good, but we would benefit from a longer-term manager to provide leadership.” Most staff we spoke with felt supported by the management and enjoyed working at Dale Park.

Rating at last inspection:

The last rating for this service was Good (published 16 October 2018).

Why we inspected:

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks. We had concerns about the staffing of the home, care for a person at the end of life and a safeguarding concern about the way staff responded to managing clinical risk for people.

The Care Quality Commission have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up:

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.

For more details, please see the full report which is also on the CQC website at www.cqc.org.uk

The home was last inspected in August 2017 and was rated ‘Requires improvement’. All the previous outstanding breaches of regulation had been met. There was fresh leadership in the home which had provided a positive focus for staff, people using the service and visitors. The service remained ‘Requires improvement’ because achieving the rating of ‘Good’ would require good practice being sustainable over a longer period.

On this inspection we found standards and improvements had been maintained. We have rated the service as Good.

A registered manager was in place. 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.

We found management and overall governance was stable. The registered manager was a consistent and positive lead in the home and had been effective in building a positive staff team and ensuring a consistent approach to care.

Staffing numbers ensured people’s care needs were consistently met. We found this had continued to improve. Feedback from staff, people using the service and visitors was positive in that staffing levels had been consistently maintained to ensure safe standards of care.

People’s nutritional intake was supported appropriately. Meal times were seen to be a relaxed and enjoyable experience for people. People’s nutritional state was very well monitored.

Staff told us there were good systems in place to support them in their work such as training and supervision.

Observations and feedback from people and their relatives evidenced people’s dignity was protected and maintained.

Staff were motivated to provide meaningful activities and a more consistent programme of social activities had been developed.

People’s risks regarding their health care were being adequately assessed and monitored. There was good referral and liaison with community health care professionals who worked with the home to help ensure people’s health care needs were met. We had previously made a recommendation regarding the specific need to ensure best practice around the assessment and monitoring of people who have challenging behaviour; this had improved.

We found medicines were administered safely. We found medication administration records (MARs) were clear and met best practice. People received their medicines consistently.

We looked at how staff were recruited and the processes to ensure staff were suitable to work in the home. We saw checks had been made so that staff employed were suitable to work with vulnerable people.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. Planned development / maintenance was assessed and we were made aware of the refurbishment of the home that had taken place.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

There were people being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found these were being monitored by the registered manager of the home.

We saw written care plans were formulated and reviewed regularly. We saw that people and their relatives were involved in the care planning and reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

A complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. There were records of complaints made and the provider or registered manager had provided a response to these.

The management structure within the home was clear and supported the home with clear Iines of accountability and responsibility.

There were systems in place to get feedback from people so that the service could be developed with respect to their needs and wishes.

The registered manager was aware of their responsibility to notify us [CQC] of any notifiable incidents in the home.

The home was last inspected over a month in December 2016 and January 2017 when we found five breaches of regulations. The home was rated as ‘Requires Improvement’. The ‘Well led’ domain) was rated as ‘inadequate’.

This inspection took place over two days commencing on 23 August 2017. We found the home had improved in its provision of service to people. All of the outstanding breaches of regulation had been met. In particular the home was found to have adequate staffing levels which were being maintained at the time of our inspection. There was fresh leadership in the home which had provided a positive focus for staff, people using the service and visitors.

A registered manager was in place. 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 the last inspection we found there had been inconsistent and inadequate leadership in the home. Some key areas of management such as maintaining adequate staffing levels had not been monitored effectively. This had caused instability resulting in fluctuating levels of care which exposed people to risk. On this inspection we found management and overall governance had improved. The registered manager had been in post since the last inspection and was a consistent and positive lead in the home. This had been effective in building a positive staff team and ensuring a more consistent approach to care.

Previously we found there had not been enough staff on duty at all times to help ensure people’s care needs were consistently met. We found this had improved and the breach in regulation had been met. Feedback from staff, people using the service and visitors was now positive in that staffing levels had been consistently maintained. Some staff and visitors voiced anxiety regarding new proposals for staffing and the registered manager was aware of this.

Previously there had been concern with respect to the monitoring of people’s nutritional intake as they were not always supported appropriately at meal times. This had improved. Adequate staffing ensured people were supported at meal times. People’s nutritional state was very well monitored. The breach was now met.

Staff said they were better supported by the new registered manager. Previously there had been a lack of consistency regarding support systems for staff such as training and supervision. We found this was much more consistent. Staff told us they felt supported in their work. The breach was now met.

At our last inspection we found the service in breach of regulations regarding the need to maintain people’s dignity. On this inspection we found improvements. Observations and feedback from people evidenced people’s dignity was protected and maintained. The breach was now met.

Previously, limited activities had been organised in the home and we were told it had been difficult to organise activities due to lack of staff. We found improvements. Staff were motivated to provide meaningful activities and a more consistent programme of social activities had been developed. The breach was now met.

We saw that people’s risks regarding their health care were being adequately assessed and monitored. There was good referral and liaison with community health care professionals who worked with the home to help ensure people’s health care needs were met. We have made a recommendation regarding the specific need to ensure best practice around the assessment and monitoring of people who have challenging behaviour.

We found medicines were administered safely. At the last inspection we made a recommendation regarding the recording of some medicines such as creams and ‘thickeners’ which are added to drinks for people who have swallowing difficulties. We found medication administration records (MARs) were now clearer and met best practice.

We looked at how staff were recruited and the processes to ensure staff were suitable to work in the home. We saw checks had been made so that staff employed were suitable to work with vulnerable people.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. Planned development / maintenance was assessed and we were made aware of the refurbishment plans for the home.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

There were people who were being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found these were being monitored by the registered manager of the home.

We saw written care plans were formulated and reviewed regularly. We saw that people and their relatives were involved in the care planning and reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

A complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. There were records of complaints made and the provider or registered manager had provided a response to these.

The management structure within the home was clear and supported the home with clear Iines of accountability and responsibility.

There were systems in place to get feedback from people so that the service could be developed with respect to their needs and wishes.

The registered manager was aware of their responsibility to notify us [CQC] of any notifiable incidents in the home.

The service was last inspected in August 2016 when we found three breaches of regulations regarding medicines management, safe recruitment of staff and respect for people’s dignity. The service was rated as ‘Requires Improvement’.

This inspection took place over three days commencing on 5 December 2016 and following up on 11-12 January 2017 in response to concerns that had been raised with us. During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, dignity and respect, support at meal times and good governance. Respect for people’s dignity was a continued breach from the last inspection in August 2016.

Following the first day of the inspection, on 5 December 2016, we found serious concerns and breach of regulations concerning staffing of the home and found this was having an effect on the safety of the care provided. We sent the provider a letter [called a section 64 letter] asking for urgent action to address the concerns. The letter also asked the provider to not admit any more people to the home until the areas of risk we identified had been addressed. We visited again on 11-12 January 2017 to complete a full inspection and check to ensure people were safe.

This report and outcome is based on the evidence we found over the three days of the inspection.

The previous registered manager had not worked in the service since November 2016. A new manager was in place. 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 new manager said they were applying for registration.

There had been a lack of consistent leadership and management since April 2016 when a previous long term registered manager had left. Some key areas of management such as maintaining adequate staffing levels had not been adequately monitored. This had caused some instability resulting in fluctuating levels of care which exposed people to risk in some key areas.

We found the home had not provided enough staff on duty at all times to help ensure people’s care needs were consistently met. This had improved over the past month, following our initial concerns, but consistency of staffing in the longer term remained an issue and we continue to have concerns regarding the sustainability of standards and will therefore continue to monitor the service closely.

We found people were being monitored with respect to their nutritional intake although we saw people were not always supported appropriately at meal times so there was risk that requirements around nutrition and hydration could be compromised. We told the provider to take action.

Staff said they were better supported by the new manager but we found a lack of consistency since the last inspection regarding support systems for staff such as training and supervision.

At our last inspection we found the service in breach of regulations regarding the need to maintain people’s dignity. On this inspection we also made observations which raised concerns that people’s dignity was not always protected and maintained.

Limited activities were organised in the home. We were told it had been difficult to organise activities due to lack of staff. Staff were motivated to provide meaningful activities but the programme needed to be developed further.

You can see what action we took with the provider at the back of the full version of the report.

We found medicines were administered safely. This was an improvement from the last inspection when we found the service in breach of regulation. The breach had now been met. We have made a recommendation regarding the recording of some medicines such as creams and thickeners added to drinks so that administration records are clearer and meet best practice.

We made a recommendation regarding this.

We saw that people’s risks regarding their health care were being adequately assessed and monitored.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people; this had been a breach at the last inspection. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people. This breach had been met.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report any concerns they had. The home had liaised and worked with the local safeguarding team following a recent referral.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. Planned development / maintenance was assessed so that people were living in a comfortable environment.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

There were people who were being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found these were being monitored by the manager of the home.

We saw written care plans were formulated and reviewed regularly. We saw that people and their relatives were involved in the care planning and reviews were held. Relatives told us they felt involved in the care.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. The regular staff were able to explain each person’s care needs and how they communicated these needs. Most people we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care. People and relatives we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of their input.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. There were records of complaints made and the provider or registered manager had provided a response to these.

We found the new management structure within the home was clear and supported the home with clear Iines of accountability and responsibility.

There were some systems in place to get feedback from people so that the service could be developed with respect to their needs and wishes.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

This was an unannounced inspection which took place on 2 & 3 August 2016. The service was last inspected in September 2014 and at that time was found to be meeting standards.

The service did not have a registered manager in post. 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 service was in the process of recruiting a new registered manager. Meanwhile the home had been managed by a stand in ’turnaround’ manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely. We found examples whereby some medicines such as prescribed thickeners for drinks [to help people swallow] and external medicines [creams] were not being recorded appropriately. We told the provider to take action.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found some anomalies with the staff files we checked and some details were missing such as adequate references. We told the provider to take action.

We recorded some negative comments by relatives and made observations that supported the view that aspects of people’s personal care and attention compromised their dignity and could be better monitored. We told the provider to take action.

The manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. We were concerned that, despite fairly well developed systems in place, some areas had not been effectively monitored and issues had been missed. These included the medication issues we highlighted and the lack of thorough recruitment checks for some staff.

We found that the home had undergone major changes in the past six months and this had caused some unrest in response to the changing culture of the home. We found some improvements had been made but there were many planned improvements that still needed to be implemented. The changes around staffing and management approach needed to be further embedded.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed most staff had undertaken safeguarding training and this was ongoing. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The managers had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were completed and were being monitored by the manager.

Activities were organised in the home and these were appreciated by some of the people living at the home. Staff were motivated to provide meaning full activities but the programme needed to be developed further.

We made a recommendation regarding this.

We saw written care plans were formulated and reviewed ongoing. We saw that people and their relatives were involved in the care planning and regular reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. Most people we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care. The majority of people were satisfied with living in the home and relatives told us they felt the care offered met care needs. People and relatives we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed.

We saw people’s dietary needs were managed with reference to individual needs. Meal times were, on the whole, relaxed and well-paced with support offered by care staff.

People and relatives told us their privacy was respected and maintained.. When we observed staff interacting with people living in the home they showed a caring nature with appropriate interventions to support people.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

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

Is the service safe?

People told us they felt safe and well cared for. People enjoyed living at Dale Park and found the staff team supportive. We told about many examples of good care and support that showed people's safety and wellbeing were being consistently monitored.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents and events that affect people's clinical care and safety. This reduces the risks to people and helps the service to continually improve.

The home had supporting policies and information around mental capacity and consent to support people who may not be able to make decisions about their care or treatment. The manager and senior nurses on each unit showed a full understanding of the Mental Capacity Act 2005 which is the legislative framework for the decision making process regarding people who may lack mental capacity.

Currently the home had one person placed on a Deprivation of Liberty [DoLS] authorisation. These are safeguards in law under the Mental Capacity Act 2005 to make sure that any restrictions placed on people's liberty are assessed and monitored to ensure their rights are maintained and any action is taken in the persons 'best interest'. Dale Park was acting appropriately in this instance and was continuing to review the person concerned. This ensured the person's rights were maintained.

Is the service effective?

People's health and care needs were assessed with appropriate referrals being made to external professionals who were able to assess and support the care of people in the home. Care needs had been identified in care plans and these had been reviewed. Care plans reflected people's current needs. The home was particularly effective at assessing peoples personal preferences regarding their health and social support and providing a framework where a more individual approach was supported.

Visitors confirmed that they were able to see people at any time as visiting times were flexible. They said that staff kept them informed and they were therefore always up to date with any changes to people's care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People living at the home and their relatives commented, 'The staff do reviews of the care and this keeps us involved and up to date', 'Staff are very good and they seem to interact with residents well' and ' My relative always looks well cared for and is generally very settled here.' 'There is always enough staff around.' 'It's very good here ' not institutional at all. My [relative] has improved no end and is very settled.' 'The care is excellent. The staff can't do enough and are very friendly and helpful.' 'My [relative] has had some very difficult times and has been unsettled but the nurses and staff have sorted things out, including reviews with the consultant and community nurses and [relative] has improved in every way.' 'The care is good. The staff always make sure [relative] is kept clean and comfortable.'

People using the service and/or their relatives completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed. There were other regular forums where people's supporters and relatives had input into the running of the home.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities. People were supported as their care needs changed. This was particularly evident with changing medical and nursing care needs.

We spoke with a visiting health care professional. We were told that the home liaised well and referred people appropriately and promptly, so people were assessed in a timely manner and their care needs addressed. We were told the staff in the home were welcoming and took any advice and support positively to ensure people were getting the best care.

Is the service well-led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

The home had a registered manager who is registered with the Care Quality Commission and is able to provide ongoing support and leadership.

We looked at how people's health care needs was organised and saw that people experienced care, treatment and support that met their needs and protected their rights.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People living at Dale Park and their relatives were positive about the staff and the care provided. One relative commented, 'Things have improved since the new manager has arrived. Staff are more consistent.'

We found the provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at the various audits [checks] carried out on a routine basis by the company and found these to be thorough. These audits helped ensure the home was run appropriately and safely.

We spoke with five visiting relatives and collected their comments and opinions. People told us they were happy with the care and support they and their relatives received.

We talked to staff about the care and support people received at the home. This along with our observations showed people received care and treatment, which was planned and delivered in a way that ensured people's safety and welfare. There had been appropriate liaison with health and social care professionals during the many reviews of care to monitor people's health and well being. For example we found two of the four people we reviewed had been referred to the dietician and a plan of care had been devised to support the people appropriately.

Those people spoken with and their relatives were very relaxed around staff and said they were listened to, so any concerns could be addressed. We saw people were engaged with staff. This helped ensure people had good feelings of wellbeing.

There have been recent concerns by visiting social services officers regarding some care issues as well as overall staffing levels in the home. The home had worked with social services to help address these issues. The service demonstrated they have systems in place to continually monitor the health safety and wellbeing of people in the home.