Archived: Dalewood View

Updated 19 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 and 10 December 2015. This was an unannounced inspection which meant no one at the service knew we would be visiting. The inspection team on the first day consisted of three adult social care inspectors and a specialist advisor who was a registered nurse. On the second day of the inspection, the team consisted of two adult social care inspectors and a pharmacist inspector. The inspection focussed primarily on nursing care and provision due to concerns we identified at our last inspection, as well as ongoing concerns, within this area.

Before our inspection we reviewed the information we held about the service and the provider. For example, notifications of safeguarding concerns, deaths and serious incidents. We also gathered information from the local authority contracts and safeguarding team, the CCG (clinical commissioning group) and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used a number of different methods to help us understand the experiences of people who lived at the service. We spent time observing the daily life in the service including the care and support being delivered. We looked around different areas of the service including communal areas and people’s rooms.

We spoke with fifteen people and ten relatives and friends of people, living at the service. We spoke with the director of operations, the home manager, the regional operations manager, the regional support manager, two nurses, four care workers, the cook and kitchen assistant, and a domestic worker. We also spoke with the local GP, a CCG professional and a member of the SALT (speech and language therapy) team who attended the home at different times during our inspection.

We reviewed a range of records including eight people’s care records, medication administration records, four staff files and records relating to the management of the service.

Updated 19 February 2016

We carried out an inspection on 8 and 10 December 2015. This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The service was last inspected on 19 May 2015 and was not meeting the legal requirements of the regulations for person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper persons employed.

At our last inspection of May 2015 we found the service was in breach of six regulations. These related to; person centred care, safe care and treatment, safeguarding people from abuse, good governance, staffing and fit and proper persons employed. As a response to this, the provider sent an action plan of the steps they would take to meet the legal requirements of these regulations. We undertook this latest inspection to establish what progress the service had made to meet these requirements.

Dalewood View is a nursing home that provides care for up to 60 people. At the time of the inspection there were 31 people living at the service. The service has three floors; a lower ground floor where the service’s activities room is based, the ground floor which is primarily for people requiring nursing care and the first floor which is primarily for people requiring residential care. At the time of the inspection there were fourteen people requiring nursing care on the first floor.

There was no registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new home manager had commenced employment the week of the inspection who was being supported by a regional support manager. The regional operations manager who had managed the service for a period of time was still involved with overseeing the service.

Although people we asked told us they felt safe, we found that care delivered, particularly to people in receipt of nursing care was not safe. Systems and processes to identify safeguarding concerns were not suitably robust to protect people. For example, we found little investigation into wounds and bruising people had sustained. The service did not have appropriate arrangements in place to manage medicines safely and we found a repeat of issues in regard to medicines that we had identified at our last inspection. Individual risks to people were not appropriately assessed and managed to maximise safety and the level of risk to people was not always clear due to conflicting information.

There was evidence in peoples care plans of involvement from other professionals such as doctors, opticians, and speech and language practitioners. Professionals we spoke with felt the service did not always accommodate people’s needs. We found that people were not always supported by staff in accordance with their needs and the care provided was inconsistent.

Deployment of staff needed improvement at times as we saw instances where people who needed assistance to eat did not receive this. People and relatives commented that staff often changed which impacted on the continuity of care people received.

We found recruitment procedures were not effective as appropriate checks had not been undertaken to ensure the suitability of staff prior to commencing employment. Staff told us they received supervisions and felt supported but we found some shortfalls in the training staff received appropriate to their roles and responsibilities. Competence and skills of nursing staff was not effective to meet people’s needs.

Consent was not always sought in accordance with the Mental Capacity Act 2005. There was evidence of some decisions being made in people’s best interests but this was not consistently applied.

Although staff interactions were primarily positive and staff were polite and courteous, these interactions were mainly centred around tasks. People and their relatives gave mixed comments about staff and how they were cared for.

There was an activities worker in post and we saw activities take place however there was limited stimulation available for people who were not able to attend these. ‘Relatives and residents’ meetings were available for people to keep updated about the service and give feedback. There was a complaints process in place.

Although assessment, auditing and monitoring of the service took place, this was insufficient and not designed in a way to address existing shortfalls and make improvements. Despite continued breaches at previous inspections, little improvement was seen in relation to these which meant people were still being put at risk.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.