Dalling House

We identified one breach of the legal regulations. The provider had failed to ensure that the premises where care and treatment were delivered was clean and maintained, and the equipment was in good working order. For example, people and relatives we spoke with expressed concern regarding the lift being regularly out of order and this restricting their day-to-day routine. There was a stairlift available to use, however, this was described as slow. People had also been stuck in the lift previously, causing them distress. During our site visit, a staff member slipped and fell on the kitchen floor. It was reported to the inspector that this is not the first time this had happened. However, there was no clear indication of what action had been taken to minimise future risk to staff and people. Cleaning records were not completed or detailed to ensure oversight. Inspectors found some surfaces to be sticky and equipment such as chair covers cracked, making them difficult to clean. Although staff were seen to be using personal protective equipment (PPE) appropriately, some hand hygiene practice was lacking. People told us that they felt safe in the care of staff. Staff had completed safeguarding training and demonstrated a good knowledge of what to do should they have concerns. Medicine management was safe, and staff knew people well.

Systems and processes were in place to assess and review people’s needs, however, these were not always effectively followed. For example, one person had been re-admitted to the home without having an up-to-date assessment. Care plans had not been regularly reviewed, and people and their relatives told us they were not always routinely involved in reviews. Whilst we observed staff asking people for their consent before providing care, this was not always robustly documented. People had been supported to access advocacy services where needed. Staff knew people well and delivered care in line with their needs, however improvements were required to the documentation and review of this.

Some care plans were not always person-centred. People told us that staff knew them well however not all care was delivered in line with their needs and preferences. People and relatives were not always involved in reviews of their care. The registered manager and provider were aware that care plans needed improvement and had already started work alongside the local authority market support team to implement this. People were supported to access external agencies as and when necessary. The home had good relationships with other health and social care professionals to ensure good provision of care, and outcomes for people. People’s wishes for the end of their lives had been assessed and documented where necessary.

We identified one breach of the legal regulations. The provider did not have effective governance, including assurance and auditing systems or processes. Whilst some audits had been completed, these were inconsistent and lacked detail into what action had been taken to address any issues. There were no robust systems in place to ensure oversight of accidents, incidents or major events to ensure learning and improvements could be made following these. While people, relatives and staff had been given some opportunity to give feedback, this was not robustly analysed to ensure their views shaped the service. Staff spoke of inconsistency in leadership and a lack of supervisions had resulted in them not always feeling supported. People’s care plans and risk assessments had not been robustly reviewed and the oversight regarding this was lacking. Whilst we did not see any evidence of negative impact to people, the risk that incorrect care could be delivered was possible. The provider did have processes in place for staff to raise concerns should they need to. The feedback in whether staff felt comfortable doing this was mixed. People were supported to remain engaged with the local community and staff had good working relationships with external professionals.