Archived: Dale House

We previously inspected Dale House on 25 July 2014, at which time the service was compliant with all regulatory standards.

Dale House is a residential home in Dipton, Stanley, County Durham, providing accommodation and personal care for up to 9 people living with learning disabilities. There were 9 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 and their relatives expressed confidence in the ability of staff to protect people from harm.

There were sufficient numbers of staff on duty in order to safely meet the needs of people using the service and to maintain the premises. All areas of the building including people’s rooms, bathrooms and communal areas were clean. Where one room required refurbishment we saw this was factored into the service development plan for the year.

Staff displayed a good knowledge of safeguarding principles and what they would do should they have any concerns. We saw evidence of concerns being raised promptly and decisive action being taken to keep people safe.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

Risk assessments were in place to manage the risks people faced. These were reviewed regularly and staff displayed a good knowledge of how to reduce these risks.

There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff were trained in areas specific to meeting people’s needs, for example Makaton training, which supports people to use symbols to communicate with others. We also saw staff were trained in areas the provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity.

Staff were supported through regular supervision and appraisal processes as well as regular team meetings.

We saw people who required specialised diets had their needs met and people had choices at each meal, as well as a range of alternatives.

Group activities including fortnightly outings took place and improvements were planned to ensure people who could not choose to engage in group activities had more one-to-one support.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was vibrant and welcoming. People who used the service, relatives and external stakeholders told us staff were compassionate and we saw numerous friendly and caring interactions by staff.

Person-centred care plans were in place and regular service user forums ensured people’s preferences were acted on. We saw regular reviews took place with the involvement of people, their family members and relevant professionals.

The service had built and maintained good community links, pro-actively involving the community in fundraising.

Staff, people who used the service, relatives and an external professional we spoke with had confidence in the registered manager, particularly with regard to their passion and competence in providing high quality care to people who used the service.

During this inspection we checked to make sure that people or their representatives had been fully involved and consulted about their care treatment and support needs. To make sure there were systems in place to gain and review consent from people who used services, and act on them.

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service safe? Is the service effective?

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

Is the service safe?

People told us they were treated with respect and with dignity by the staff.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We found relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant people were safeguarded as required.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People's health and care needs were assessed with them, and they or their representatives were involved in writing their plans of care. Specialist dietary, social, mobility, equipment and learning disability care needs had been identified in care plans where required. Some people said they had been involved and consulted in them and they reflected their current needs.

Is the service caring?

People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes. We saw people were supported by kind and attentive staff. The support workers showed patience and gave encouragement when supporting people. People told us they were treated with dignity and were supported to make choices and remain independent. We observed people to be relaxed and we saw lots of positive interactions between staff and people who used the service. Two staff were present and they spoke with people respectfully and involved people in conversation. We saw they actively listened to people and they took time to address people questions and responded positively to their requests.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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 were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about applications that they planned to be submitted, these had already been discussed with the Local Authority who agreed these would be appropriate for referral. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas, they told us they took people's care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required. People's relatives/representatives had not been involved or consulted in the content of people's plans of care or consulted about any associated risk assessments. We made a compliance action to make sure this issue was addressed by the provider.

Specialist dietary, social, mobility, equipment and learning disability care needs had been identified in care plans where required. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.

Two people who used the service confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

Two people told us they were supported by kind and attentive staff. We saw support workers showed patience and gave encouragement when supporting people. One person commented, 'The staff are very good. They help me with all the things that I need.' Another said, 'This is a good place to live. They look after me very well, the food is good. It's nice here."

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, we saw these had been addressed by the provider. People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We saw the majority of people had been on holiday during the last twelve months, to Blackpool, Skegness, and Kielder Forrest. Two people we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

The relationships between staff and the people who they cared for were good and personal support was provided in a way that promoted and protected their privacy and dignity. This was confirmed when we spoke with people who used the service.

Suitable arrangements were in place for protecting people from abuse. There was a competent staff team who had the training, skills and experience to meet the specific conditions of the people they supported.

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People who used the service were given appropriate information and were involved in making decisions about their care and treatment.

People told us they were treated with dignity and were supported to make choices and remain independent.

The provider may wish to note, on receipt of the June inspection report, no action plan was submitted to CQC regarding the action they intended to take.

During this visit on 03 October 2012 we saw how the provider had introduced a new electronic care plan recording system.

There were arrangements in place to review and update each persons care records, and transfer these onto the new system.

We saw these entailed an effective, personalised care and support plan for each person.

When we visited the service on 18 June 2012 we asked the provider to make some improvements as we were concerned because, for one person who required additional one to one funded support, this support was not always fully available.

During this visit on 03 October 2012 we saw how the provider had recruited additional support staff. When we checked the staffing rota, this showed us sufficient staff were employed to meet this persons care and support needs.