Archived: Dallington House Care Home

In six inspections since June 2015 the provider has been rated either Inadequate (twice) or Requires Improvement. The service has improved from an overall rating of Inadequate in June 2018 to Requires Improvement in December 2018 but failed to achieve Good rating. This demonstrates the provider has not been able make required and sustainable improvements.

What life is like for people using this service:

People told us they felt safe at Dallington House. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People received care from enough staff that had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

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 understood their responsibilities under the Mental Capacity Act, 2005 (MCA). They obtained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff.

Staff had a good understanding of people's needs and preferences. Staff involved people’s relatives in decisions about their care and kept them informed about their family members.

Staff supported some people to follow their interests and hobbies. Some people were supported to visit places of interest. However, a minority of people had little by way of stimulation or interesting things to do.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

Rating at last inspection: Requires improvement (published 9 January 2019).

About the service:

Dallington House Care Home provides accommodation and personal care for up to 16 older people, some of whom were living with dementia or learning disabilities. On the day of our visit, there were 13 people using the service.

Why we inspected:

We carried out this inspection to follow up from our inspection in December 2018 where we found the service required improvement.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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The provider had made essential improvements to the home to become compliant with fire safety and food hygiene regulations. They had improved the décor and cleanliness of the home. People were much happier; they had been involved and kept informed of the changes that were being made.

The provider and registered manager had implemented systems to monitor the safety and quality of the service they provided. The audits informed them of the actions required to improve the service. However, the quality monitoring was not robust enough to identify some areas that continued to require improvement. The provider had not embedded all the systems for health and safety as systems to protect people from accessing the kitchen and stairs were not reliable. We discussed our findings with the registered manager and they responded by implementing further checks and audits to help maintain people’s safety.

The provider had not always implemented all the necessary employment checks, or ensured people were supported to engage in meaningful activities. Following our feedback, the provider took action to improve these areas.

People received care from enough staff that had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

There was a positive culture within the service where staff communicated well and people’s needs were met.

The improvements seen at this inspection were recently implemented; the provider had not had the opportunity to demonstrate these improvements had been embedded into practice or sustained over a period of time. For this reason, we have rated the service as requires improvement.

Rating at last inspection: Inadequate 26 June 2018.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

About the service:

Dallington House Care Home provides accommodation and personal care for up to 16 older people, some of whom were living with dementia or learning disabilities. On the day of our visit, there were 12 people using the service.

Why we inspected:

We carried out this inspection to follow up from our inspection in June 2018 where we found the service to be Inadequate. We had varied the conditions of their registration; this inspection was to assess the progress the provider had made in meeting the regulations.

Follow up:

We will continue to monitor the service in conjunction with other agencies such as the fire service, environmental health and the local authority. We will carry out a further inspection in the next six months.

Dallington House Care Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 16 older people, some of whom were living with dementia or learning disabilities. On the day of our visit, there were 13 people using the service.

This was the fifth comprehensive inspection carried out at Dallington House Care Home since they registered with CQC on 9 December 2014. During the previous four inspections since June 2015 the provider had been in continuous breach of two regulations relating to safe care and treatment and governance. The provider had showed repeated lack of improvement. We served requirement notices and took enforcement actions however these did not lever improvements.

The provider has continually failed to demonstrate they have the skills and knowledge to implement governance systems which would assess, monitor and improve the safety and quality of the service. The provider’s reliance on outside agencies to identify risks and areas for improvement demonstrate the provider’s lack of ability to self-govern. Each inspection and assessment by outside agencies have raised recurring themes which indicate the provider’s lack of ability to improve the service.

The provider has failed to provide the financial resources required to make essential and on-going repairs, decoration, upgrading of the home and invest in staffing. The home has deteriorated into disrepair, putting people’s safety at risk in the event of a fire or through poor food hygiene.

The provider did not respond to people’s feedback; they failed to act on people’s request for improvements to their environment.

Although people continue to receive care that meets their basic needs, this was due to their good relationships with staff overseen by the registered manager. The registered manager does not have access to the resources needed to make the necessary improvements. There is a lack of provider oversight of the outcomes of the audits that do take place; issues remain unresolved.

Continued improvement is required with the communication within the home to ensure people’s current needs are known to all staff.

People did not have all the information they required in a format they could use to make a complaint.

People received their medicines safely. Staff treated people with dignity and respect. People had the freedom to practice their own religion as they preferred.

At this inspection we found that Dallington House Care Home was in breach of three regulations relating to the safe care and treatment, premises and equipment and governance. Using our enforcement policy and decision tree, we have taken further enforcement action. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

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.

At a previous inspection carried out on 29 September and 3 October 2016 we asked the provider to make improvements. We found that the provider did not ensure that risks associated with people's care were managed safely or that people were always referred to health care professionals in a timely manner. The provider did not ensure that people's medicines were managed safely. We asked them to improve their practices in relation to their arrangements for monitoring the quality of the service and notifying Care Quality Commission (CQC) of significant events at the service. When we inspected the service again on 17 and 19 January 2017 we found that the provider had not made the required improvements to comply with the regulations and the service was rated inadequate. We placed a condition on the provider’s registration to prevent any admissions to the service without the prior written agreement of the Care Quality Commission.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that most of the improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Dallington House provides accommodation and care and support for up to 16 older people. There were 11 people that used the service at the time of our inspection, some of whom were living with dementia or similar conditions.

At this inspection we found improvements had been made but further improvement was required before the service could meet the regulations.

There was a registered manager in place who had returned to work following a period of temporary absence. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe. Staff knew their responsibilities to help people to remain safe. The registered manager took action where there were concerns for people’s well-being.

Risks associated with people’s care were assessed and reviewed to provide guidance for staff. Staff took the appropriate action when an accident or incident occurred.

The provider carried out checks on the environment and people’s equipment to help people to remain safe. However, doors had been wedged open posing a risk to people should a fire occur. The provider planned to make further checks to make sure furniture was secure where it posed a risk to people.

Staffing numbers were sufficient to provide the support people required. The registered manager followed the provider’s recruitment processes. However, on one occasion they did not fully check all of the information available to them before a staff member started to work at the home and records were not kept of the interviews for new staff. We have made a recommendation about this.

People received their medicines when they required them. Staff knew their responsibilities for handling medicines safely.

Staff had the knowledge and skills they required to support people well. There were plans to improve the knowledge of staff where people lacked the mental capacity to make decisions for themselves. People received support from staff members who received training and on-going guidance on their work. New staff received an induction when they started work and they knew their responsibilities. Staff felt supported by the registered manager.

Where there were concerns about people’s ability to make decisions for themselves, the registered manager had undertaken assessments to determine people’s level of understanding. They planned to make some improvements to these assessments so that they could be sure staff had all of the guidance they required when caring for people.

People were satisfied with the food available to them. Staff knew people’s food preferences and their dietary requirements. People had access to a range of health care services to help them to remain healthy.

People were cared for by staff who were compassionate and kind. People’s dignity was protected. People's sensitive and personal information was mainly stored securely.

The provider had systems in palace to assess the needs of people moving into the home. People were involved in decisions about their care where they were able to be. People received care and support that was based on their preferences Staff knew the people they cared for and encouraged them to retain their skills.

People had some opportunities to take part in activities that they were interested in. The registered manager planned to make improvements to the range of activities available to people.

People and their relatives had opportunities to give feedback to the provider. They told us that improvements had been made since we last visited the service. People and their relatives knew how to make a complaint or to raise a concern.

The provider had carried out a range of checks on the quality of the service to drive improvement. However, further improvements were required to the provider’s recording of their quality checks and recruitment process and to make sure that any identified actions were completed in a timely manner. We have made a recommendation about seeking guidance on good record keeping.

The registered manager was aware of their responsibilities. They had submitted the required notifications to CQC.

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

At the last inspection completed on 29 September and 3 October 2016, we found the provider had not met the regulations for people's safety, good governance and the safe recruitment of staff. At this inspection we found the provider had not made all the required improvements and the regulations were still breeched. We found a further breach of regulation.

The service had a registered manager who had been away on a long term absence. In their absence the service was managed by an interim 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.

Dallington House provides accommodation for older people who require personal care and support. Some people who used the service lived with dementia or similar conditions. There were 11 people that used the service at the time of our inspection.

People did not always feel safe with the staff that support them. They told us that some night staff were not kind and compassionate when they supported them. The provider did not have systems in place to report and investigate incidents that had occurred at the service and did not report incidents to other relevant authorities such as the Care Quality Commission or the local safeguarding authority.

Staff did not consistently follow the provider’s protocols to manage people’s medicines. Medicines audits were not completed in line with the provider’s guidance which meant that the provider could not be assured that people’s medicines were managed safely.

The provider did not always assess the risks associated with people’s care. Where risks had been identified, they did not manage them to ensure that people received safe care. This included where people may behave in a way that may challenge others.

People were not supported in accordance with relevant legislation and guidance. Staff demonstrated a limited understanding of the Mental Capacity Act 2015. Where people were deprived of their liberty, staff did not adhere to the conditions stated on their Deprivation of Liberty authorisation to ensure that any restrictions were lawful.

People were supported to access their doctor when needed. However, we saw that staff did not refer people to other health professionals where there was an identified need for such support.

People were supported with their nutritional needs. They had access to a choice of meals.

People told us that staff who worked the day shift were caring and kind to them. They told us that staff treated them with dignity and respected their privacy. We found the people’s information was not always managed confidentially.

People were socially isolated. They were not supported to engage in meaningful activities. They were not supported to maintain links with their local community.

The provider did not maintain oversight of the service to ensure that people received a high standard of care. The service lacked good leadership to make the required improvements. The provider did not use their own systems to monitor the quality of the service. They did not ensure that they made the improvement to satisfy the relevant regulations.

The provider continued to breach of two regulations of the Health & Social Care Act 2008 Regulated Activities Regulations 2014 and was in breach of one regulation of the Care Quality Commission (Registration) Regulations 2009.

We have taken enforcement action against the provider, the details of our enforcement is at the end of the main report.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's 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 will continue to monitor the service whilst the condition on their registration is in place, that is to prevent any admissions to the service without the prior written agreement of the Care Quality Commission.

Dallington House provides accommodation for older people who require personal care and support. Some people who used the service lived with dementia or similar conditions. There were 14 people that used the service at the time of our inspection.

The service had a registered 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 felt safe at Dallington House. Staff had a good understanding of their responsibilities and knew the provider’s procedure to keep people safe from harm and abuse. There were enough staff on duty to meet people’s needs.

The provider did not always complete relevant pre-employment checks which would have assured them that staff were safe to work with people.

Staff did not consistently assess and manage identified risks associated with people’s care needs to ensure that they received care in a safe manner.

The provider did not have safe practice for the management of people’s medicines. They did not have skills and protocols in place to check the people received their medicines in a safe manner. This meant that they could not be assured that people received their medicines as prescribed by their doctor.

People felt that staff had the relevant skills and experience to support them. Staff told us that the registered manager had ensured that they received the training they required. The registered manager had plans in place to improve the training available to staff. Staff demonstrated they understood the requirement of Mental Capacity Act (MCA) 2005 and how they would apply them in their role.

People had access to a variety of meals, but they did not always enjoy their meals. Staff did not always support people with their health needs. They did not always refer them to health professionals for the support they required.

Staff treated people with kindness and compassion. People felt that staff respected their dignity and privacy and promoted their independence where possible. We observed that staff practice did not always promote people’s dignity and privacy.

People who did not have dementia or similar conditions did not feel that the provider supported them to avoid social isolation. This was because they did not access to meaningful activities. People knew how to raise concerns or complaints and were confident that their concerns would be dealt with.

People complimented the registered manager and were happy with the way the home was managed. Staff felt supported by the registered manager and were confident that they would improve the service.

The provider quality assurance processes included a limited range of audits. We saw that their audits and checks were not completed regularly. We found that the provider had not made the improvement they told us they would at their previous inspection.

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