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Reports


Inspection carried out on 4 July 2016

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 22 and 23 September 2015. At which a breach of legal requirements was found. This was because the provider had failed to ensure there were sufficient numbers of suitably qualified, competent, skilled and experienced staff in the home deployed to meet the needs of the people living there.

After this comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focussed inspection on the 22 and 23 March 2016 to check that the provider had made and sustained the improvements they had told us they would make. At that inspection, we found that some improvements had been made in terms of staffing levels, but the provider remained in breach of the regulations. We also found in a breach relating to the management of risks to ensure the health, safety and welfare of people living in the home.

After the focussed inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches that were found. We undertook this fully comprehensive inspection on the 4 July 2016 to check that the provider had made and sustained the improvements they had told us they would make.

Dingle Meadow provides accommodation and personal care for up to 46 older people. Some people lived with dementia. On the day of the inspection, 34 people were living at the home and there was a registered manager in post. On the day of the inspection the registered manager was on extended leave and we spoke with the acting manager. 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.

People told us they felt safe and were supported by staff who had received training in how to recognise different types of abuse. Staff were confident that if they raised any concerns then the appropriate action would be taken.

People who used the service and staff told us that they thought there were enough staff in post to meet their needs in a timely manner. People told us that they received their medicines on time. Our observations confirmed this to be the case.

Staff felt supported and well trained to do their job. They were encouraged to access training that was made available to them.

Staff interacted well with people. People’s consent was sought before they were supported and where they lacked capacity their human rights were protected as required within the Mental Capacity Act (2005).

People were supported to have a nutritionally balanced diet and adequate fluids throughout the day and were offered a choice at mealtimes. People were supported to access a number of healthcare services such as their GP, the dentist and optician.

People were supported by staff who were caring and kind but people’s privacy and dignity was not always consistently met.

People were involved in their care plans and asked how they wished to be supported. Staff understood people’s preferences and choices and what was important to them.

People and their relatives were invited to meetings to provide to discuss the service and the quality of care provided. Visitors were encouraged to complete an electronic feedback survey at every visit. There were plans in place to send out surveys to people and their families, later in the year.

Activities were available for people to participate in and efforts were made to provide people with the opportunity to mix with people on other units to engage in activities they enjoyed.

There was a system in place for people to raise complaints and for those that had, we saw that they had been investigated and recorded appropriately.

People, their relatives and staff described the

Inspection carried out on 22 March 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 22 and 23 September 2015. At which a breach of legal requirements was found. This was because the provider had failed to ensure there were sufficient numbers of suitably qualified, competent, skilled and experienced staff in the home deployed to meet the needs of the people living there.

After this comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focussed inspection on the 22 and 23 March 2016 to check that the provider had made and sustained the improvements they had told us they would make.

This report covers our findings in relation to those requirements. It also covers some additional information that we looked at on the day. You can read the report from our last comprehensive inspection, by selection the ‘all reports’ link for Dingle Meadow on our website at www.cqc.org.uk.

Dingle Meadow provides accommodation and personal care for up to 46 older people. Some people lived with dementia. At the time of our inspection 40 people were living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service us run.

At this focussed inspection of 22 and 23 March, we found that some improvements had taken place to ensure staffing levels in the home reflected the dependency levels of the people who lived there.

We found that people living at the home had not received their medication the evening prior to the inspection taking place. This had impacted directly on the health and wellbeing of some people living at the home.

We found that appropriate arrangements had not been made to ensure that agency staff were given an induction and handover prior to them commencing on shift at the home.

Systems in place to ensure that sensor mats were regularly checked to ensure they were working effectively were not consistently applied, leaving people at risk of harm.

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

Inspection carried out on 23 and 24 September 2015

During a routine inspection

This inspection took place on 23 September 2015 and was unannounced. The inspection was carried out by two inspectors. The home had previously been inspected in May 2014 and at that time was found to be fully compliant in the areas we inspected. The home is split into two units, the residential unit on the ground floor and the unit for people with dementia type illnesses on the first floor.

Dingle Meadow provides accommodation and personal care for up to 46 older people. Some people lived with dementia. On the day of the inspection, 42 people were living at the home and there was 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.

People who used the service, their relatives and staff told us that they did not think there was always enough staff on duty to meet people’s needs. Our observations confirmed that people’s needs were not met in a timely manner.

People felt safe in the home and were confident that they were supported by staff who were well trained to do their job and keep them safe from harm. Staff had been trained to recognise different types of abuse and were confident that that if they raised any issues then the appropriate action would be taken.

Staff felt well trained to do their job and had access to a range of training to provide them with the level of skills and knowledge to support people safely. Not all staff received regular supervision but felt supported by the registered manager who was approachable and accessible.

Medicines were stored and secured appropriately. People told us that they received their medicines on time.

Communication systems were in place but some staff felt that information was not always passed on to them in a timely manner.

Staff sought people’s consent before supporting them and were able to provide us with a good account of how they would safeguard someone if their liberty was restricted.

People were supported to have a nutritionally balanced diet and adequate fluids throughout the day and were offered a choice at mealtimes.

People were supported to access a number of healthcare services such as their GP, the dentist and optician.

Staff were seen to be caring and kind however there were instances where people had their dignity compromised by having to wait long periods to be supported to use the bathroom. People told us they were involved in their care plan and asked how they wanted to be supported.

People and their relatives were asked to provide feedback about the service received through surveys and meetings.

Care plans were personalised and staff understood people’s preferences and choices. Staff were not always aware of people’s life history and documentation relating to this was not always completed.

Activities were available for people to participate in but on one of the units, there was very little in the way of activities and stimulation for people living with a dementia type illness.

People told us they had raised complaints and they had been dealt with, however there was little documentary evidence available to demonstrate that complaints were fully investigated and acted upon.

People, their relatives and staff described the registered manager as supportive and approachable. The registered manager undertook a number of regular checks on the quality of the service and action plans were in place to follow up any areas of improvement.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 19, 20 May 2014

During a routine inspection

We visited this service and talked with people, staff and visitors and observed interactions between people and the staff caring for them. This helped us to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were 39 people living in the home at the time of our visit. We spoke with two visitors, twelve people living there, four staff and the quality assurance manager.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask.

Below is a summary of what we found.

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

Is the service safe?

All of the people spoken with said that they were happy at the home. One person told us, “They’re all nice here.” Our observations showed that people were happy in the presence of staff and smiled and chatted with them. A visitor to the home told us, “People look content.”

We saw that people's individual needs and associated risks had been assessed and plans to provide care safely were in place. There were enough suitably trained staff to care for people. This meant people’s needs were met safely.

We saw that medicines were managed safely so that people received their medication as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications to restrict anyone’s liberty had been made. The staff and managers understood how this legislation applied to people and protected their rights.

All of the staff spoken with were alert to the signs of, or the potential for, abuse of vulnerable adults. Procedures were in place to safeguard people from harm and they were reviewed regularly to prevent the risk of abuse. We sampled some staff files and found that they all contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.

There was a system in place to record accidents and incidents. These were reviewed and an analysis undertaken to identify potential trends so that lessons could be learnt to minimise the risk in the future . We saw that equipment such as pressure mats were used to alert staff when people at risk of falling got up so that they could be attended to quickly.

Is the service effective?

We saw that people’s care and health needs were met at the home and where appropriate referrals were made to health care professionals. One person told us that they were happy to be home after a stay in hospital.

We saw that people were supported to take part in individual activities that were planned for. We observed people taking part in meaningful activities.

The environment was safe and clean and met the needs of the people living there because the appropriate adaptations were in place to support people to move around freely and for their needs to be met appropriately.

Staff training was sufficient to meet all the needs of people using the service.

Is the service caring?

Staff responded to people’s needs in a caring and appropriate way ensuring that they were comforted. Staff spoke with people in a tone that expressed friendship and support and offered people choices throughout the day. Conversations with staff showed that they considered people to be an individual and expressed respect for them and their relatives.

All the people we spoke with told us that the staff were kind. One person told us that they thought staff were, “Kind.” Another person told us, “They look after me great here.” A relative told us, “I am happy with X’s care.”

People that used the service and their relatives were asked for feedback about the quality of the service provided so that improvements could be made where needed.

Is the service responsive?

We saw that care plans and risk assessments were reviewed regularly so that people’s changing care needs were identified and actions taken to ensure they were met.

We saw that people with dementia were supported appropriately so that their emotional needs were met. We saw that staff had received training in caring for people with dementia. This meant that staff skills were developed in response to people’s needs.

We saw that complaints were looked into and responded to in a timely manner.

Is the service well led?

There was a registered manager in post and the provider ensured that they were supported to ensure the service continued to improve and meet people’s needs.

We saw documented evidence that showed that the provider worked with other health care professionals and made referrals for advice and guidance when needed. One visiting professional told us that they felt that the home provided good care.

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

There was a robust system in place to monitor the quality of the service they provided. This included regular audits of all aspects of the care and support given to people and the views of relatives and professionals who visited the home. Action plans were produced and implemented when necessary.

Inspection carried out on 29 August 2013

During an inspection to make sure that the improvements required had been made

At the time of our visit there were 36 people living in the home. We spoke with five people, two relatives, five staff, the manager and the quality assurance manager.

We saw that people were treated with dignity and respect. Three people told us they were happy in the home. One person said, “We have a lovely room that is kept clean.” Another person said, “We have choices at mealtimes and can get an alternative if we don’t want the choices.”

We saw that people were dressed in individual styles that reflected their age, gender and personality. People's health and care needs were met in a personalised way with support from staff and a variety of health professionals. Two relatives told us that they were kept informed about their relative’s health.

The medicines administration system had not ensured that people had access to their medicines at all times and that the administration of medicines was accurately recorded.

Staff were knowledgeable about people's needs and staff were supported to carry out their roles safely. The staff we spoke with staff told us they liked working in the home.

Systems in place ensured that people living in the home were protected from the risks of abuse and unsafe care. One person told us, "I would tell the staff if I wasn't happy with something."

The provider ensured that there were systems in place to monitor the service and take account of the views of people using the service.

Inspection carried out on 28 December 2012

During a routine inspection

At the time of our visit there were 35 people living at the home. We spoke with seven people, five staff and the acting manager.

People were treated with dignity and respect. Throughout the day we saw staff communicating with people respectfully and in the way that they could understand.

We saw staff support people to be as independent as possible when eating their meals.

People were dressed in individual styles that reflected their age, gender and personality.

People’s needs were met in an individualised way and we saw that their health needs were met with support from staff and a variety of health professionals. One person told us, “Everyone here is well looked after.”

Staff were knowledgeable about people’s needs and staff were supported to carry out their roles safely. The staff we spoke with staff told us they liked working in the home

Systems in place ensured that people living in the home were protected from the risks of abuse and unsafe care. One person told us, “I would tell the staff if I wasn’t happy with something.”

The provider ensured that there was adequate monitoring of the service to ensure that people received a good service that met people’s needs.

Inspection carried out on 24 January 2012

During an inspection in response to concerns

We inspected this home because of concerns raised in relation to the care and welfare of people who used the service.

We found that record keeping needs to be improved. This would help make sure that people's needs are recognised and are met by the staff who support them.

We found shortfalls in the care and welfare of people who used the service. The organisation will need to improve upon this.

There are quality monitoring systems in place. The organisation has already identified and planned to action many of the concerns raised in this report.