Archived: Dalby Court Residential Care Home

Dalby Court Residential Care Home is a care home which provides care for up to 68 people. The service does not provide nursing care. Care is primarily provided to older people, some of whom are living with a dementia. At the time of the inspection there were 41 people using the service.

The service accommodates people across two floors. There are communal lounges, dining rooms and bathing facilities. There is an enclosed garden for people to use.

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

People and relatives were positive about the caring nature of staff and the service they received. There were enough staff employed and on duty at any one time to meet the needs of people. The provider had an effective recruitment and selection procedure and carried out relevant checks when they employed staff.

Accidents and incidents were recorded and analysed, and most risk assessments were in place. However, we did find some risk assessments for some clinical areas such as diabetes, glaucoma and Parkinson’s disease were not in place. This was pointed out to the registered manager who took immediate action to address this.

Medicines were managed safely. We identified some minor improvements were needed in relation to the recording of medicines. We received confirmation after our inspection that these records had been reviewed and updated.

Ongoing improvements were being made to the decoration and facilities in the building. Careful thought had been given to the redecoration of the unit where people who had dementia were accommodated.

Staff had the skills and knowledge to deliver care and support in a person-centred way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

People told us their privacy and dignity were respected and their independence encouraged. People were able to participate in a range of activities if they chose to do so. Care plans were person centred.

The provider was open and approachable which enabled people to share their views and raise concerns. People and relatives told us if they were worried about anything they would be comfortable to talk with staff or the registered manager.

The provider monitored quality, acted quickly when change was required, sought people's views and planned ongoing improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 June 2018) and there was one breach in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Dalby Court Residential 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 service provides personal care for older people, older people living with dementia and people with learning disabilities. The home is a detached 68 bed purpose built care home in Coulby Newham. Accommodation is provided over two floors. The ground floor of the home accommodates people living with a dementia and people with a learning disability. At time of our inspection there were 45 people using the service.

At our last inspection in December 2015 the service was rated ‘Good’ overall. At this inspection we found the service was now rated 'Requires Improvement' overall. This is the first time the service has been rated as 'Requires Improvement'.

At this inspection we found a breach of Regulation 18 (1) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. This was because we found that staffing levels were not always sufficient to meet people’s needs.

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

The service has 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.

Policies and procedures such as safeguarding and whistleblowing were in place to protect people from harm. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Records showed that maintenance and equipment checks were undertaken to ensure the environment was safe. Emergency contingency plans were in place. Robust infection control practices were in place.

Care plans and risk assessments were in place, these were comprehensive and had been reviewed regularly.

Staff received training that the provider considered mandatory in most key areas. However it was evident that some staff would benefit from further knowledge in the area of learning disabilities. We have made a recommendation that staff training is reviewed to ensure staff are able to apply their learning in their day to day practice. We have made a recommendation that staff training is reviewed to ensure staff are able to apply their learning in their day to day practice.

Staff had regular supervision and annual appraisals. Staff felt they were well supported by the manager.

Medicines were managed safely. People had access to a range of healthcare such as GPs, hospital departments and dentists. People’s nutritional needs were met and people enjoyed a varied, nutritional diet that met their preferences.

The registered manager told us that lessons were learnt when they reviewed accidents and incidents to identify any themes or trends.

The premises were spacious, clean and tidy however they required some redecoration and the Sunflower Unit for people with learning disabilities was not self-contained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The policies and practices of the home helped to ensure that everyone was treated equally.

People’s privacy and dignity was respected by staff when they were supporting people but limited availability of staff meant that people’s dignity was sometimes compromised. Staff members were kind and caring towards those who used the service. Interactions between people and staff showed that staff knew people well however carers were task focused due to staffing levels.

Visitors were made welcome. Staff encouraged people to access to a range of activities and to maintain personal relationships. The service had good links with the local community and its own transport to take people out.

Staff were positive about the registered manager. They confirmed they felt supported and were able to raise concerns. Meetings for staff and people using the service were held regularly. This enabled people to be involved in decisions about how the service was run. The service worked with a range of health and social care professionals. A clear complaints process was in place.

The management team completed regular audits and sought feedback to monitor and improve quality however these audits did not identify and address the issues we identified during this inspection in regards to staffing levels.

Dalby Court provides purpose built accommodation for up to 68 older people and / or older people living with a dementia. The service also accommodates (recently) people who have a learning disability. Accommodation is provided over two floors. The ground floor of the home accommodates people living with a dementia and people with a learning disability. The unit on the first floor of the home accommodates people requiring residential care. There are communal lounges and a dining areas on both floors. Bedrooms have en-suite toilet and hand wash basin facilities. There is an enclosed garden.

The home had a registered manager in place. 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. The registered manager was not present for the first day of the inspection; however they were present on the second day of the inspection.

We received mixed comments to determine if there were sufficient staff on duty to meet people’s needs. At times during the inspection and particularly at meal time on the ground floor unit there were insufficient staff to support those people who needed help and interact with others. Call bells were not always answered in a timely way. The registered manager said they would carry out an immediate review on staffing levels.

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.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. However, care records needed improvement to ensure that best interest decisions were clearly recorded.

We saw evidence to inform that people had been involved in developing their plan of care; however some care plans required review and update to ensure peoples changing needs were recorded.

People were involved in activities and outings. However at the time of the inspection these had been limited as the service was in the process of recruiting an activity co-ordinator.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments covered areas such as moving and handling, falls and the use of bed rails. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal performance.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, and patient with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed regularly and nutritional screening took place.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. The registered manager was in the process of developing health action plans and hospital passports for people with a learning disability. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were effective systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the registered manager and senior staff within the organisation. We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.

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?

Care plans and risk assessments were in place and were updated as people's needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

We saw that regular checks were carried out on equipment used at the home to make sure that it was safe for use.

Is the service effective?

People's health and care needs were assessed and where possible people and their relatives were involved in writing their plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends completed satisfaction surveys. Where shortfalls or concerns were raised (however small) these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at the record of complaints and saw that investigations had been completed in line with the complaints policy. Discussion with the manager and deputy manager during the inspection confirmed that any concerns or complaints were taken seriously.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with eight people who used the service and two relatives. We also spoke with the manager, deputy manager, cook and to care staff. People who used the service told us that they were happy with the care and service received. One person said, 'I am very contented. I was at hospital yesterday and couldn't wait to get back home.' Another person said, 'I'm more than happy. I couldn't ask for better.' Relatives we spoke with told us that they were always made to feel welcome and that they were happy with the standard of care provided.

Everyone we spoke with told us that they liked the food that was provided and that there was a plentiful supply of snacks and drinks. We were told that there was a good variety, that food was well presented and that portion sizes were sufficient. One person said, 'All meals are very tasty and if you don't like what's on offer you can have something else.'

People and relatives told us that they felt comfortable in speaking with staff or management should they need to raise a concern. We were told that communication was good, people were listened to and that any concerns / complaints were taken seriously and acted upon. One person said, 'All of the staff and especially the manager are approachable. I can talk to them about anything no matter how small it seems.'

We used a number of different methods to help us understand the experiences of people who used the service, because some people who used the service had complex needs which meant they were not able to tell us their experiences. We spoke with four relatives who said, 'Care staff are pleasant and kind and could not do more.' Another relative said, 'The care here is very good and I would come here if I had to.'

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that support plans were in place.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that staff were supported and trained to provide care to people.

We saw that regular audits were carried out to assess and monitor the quality of the service.

Some people spoken with thought some staff were better than others. We were given the example that some staff were more careful when assisting with moving and handling.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw staff communicate well with people and explanations of care were given in a way that could be easily understood. We saw that people had their needs assessed and that care plans were in place.

We found appropriate recruitment practices to be in place and that staff had received training.

An assessment of dependency was carried out on all people who used the service; however, this information wasn't used as a basis for deciding sufficient staffing levels. This could impact on the quality of care provided and result in unsafe care.