Dalling House

Updated 10 June 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Dalling House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. Dalling House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

Inspection activity started on 12 April 2022 and ended on 22 April 2022. We visited the service on 13 April 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and what improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with seven people who lived at the service, four relatives, two professionals and seven members of staff. This included the provider, the registered manager, the cook and four care assistants. We looked at all areas of the home meeting people and staff. We reviewed a range of records including five care plans, accident and incident reports and documents that related to auditing. We looked at three staff files and medicine records. The registered manager sent us a range of policy documents after the inspection, via e-mail.

Updated 10 June 2022

About the service

Dalling House is a residential home providing personal care for older people, some of whom were living with an early diagnosis of dementia. The service can accommodate up to 20 people, some of whom were in receipt of respite care. At the time of the inspection there were 18 people using the service.

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

Not everyone had a care plan that was up to date and accessible to staff. The service was in the process of transferring records from paper onto a computerised system. Those not yet transferred were not easily accessible. Risk assessments for people were incomplete with some risks not being assessed and mitigated. For example, falls, diabetes and medicines. Up to date as and when required (PRN) medicine protocols were not in place. Accidents and incidents had been reported but there was no system in place for capturing learning from repeat incidents.

Auditing process were in place but were not robust. For example, people who had experienced several falls each month an audit recommended reminding people to use their call bells. No analysis of cause had taken place and few were in place to minimise or prevent further falls. Auditing had failed to pick up on non-prescribed PRN medicines being administered for several weeks to two people. There were some quality assurance measures in place but no regular process for capturing feedback from people, relatives or professionals. The processes needed developing so that feedback could be captured and trends then identified and acted upon to ensure the continuous improvement of the service.

Some care plans lacked detail about people’s personal history. People told us they were not involved in reviews of their care plans. Although an activities co-ordinator was employed for two days each week, this was not enough to occupy people and there were times when people had nothing to do. Staff did what they could but there was a need for more activities for people. Staff were able to tell us the important things about supporting people towards the end of their lives but it was agreed with the registered manager that staff would benefit from end of life training.

Safeguarding policies were in place and staff knew what steps to take if they felt someone needed protecting from harm. Fire and safety checks had been completed. Medicines were stored and disposed of safely. People and their relatives told us they felt safe. There were enough trained staff on duty each shift to support people. Infection prevention and control measures were in place and government guidelines had been followed during the recent pandemic.

Most people, relatives and staff spoke well of the registered manager who was clearly a visible presence at the service and was approachable and accessible to everyone. Staff feedback was captured through supervision meetings and monthly team meetings. The registered manager was aware of and had complied with, the duty of candour. The service had a keyworker system of care which meant staff got to know people well.

A pre-assessment process was in place which ensured that the service had the correctly trained staff to meet people’s needs. Staff were recruited safely and were supported with regular supervision meetings and ongoing training. People told us they enjoyed the food and that a good choice was offered daily. People were supported to attend health and social care appointments. The service had undergone some redecoration and more had been planned. The laundry room was next to the kitchen and some redesigning was required to make this area a safer environment. The registered manager acknowledged this. 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.

Staff were caring and treated people with respect and dignity. People’s privacy was respected and their independence promoted whilst not compromising safety.

People’s communication needs had been considered. A complaints policy was in place and people and relatives told us they were confident in raising issues and complaints if needed.

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

Rating at last inspection

This service was registered with us on 17 December 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 27 April 2019.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety which included missing care plans and risk assessments, no PRN protocols and no lessons learned from accidents and incidents. Also, a lack of meaningful auditing processes and limited quality assurance work 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.