Dalling House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

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.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us that care was not always centred around their needs and preferences. Relatives were not always involved in the review of people’s care, when this took place. People told us that staff did know them well, but some elements were not always person-centred, for example, the activities available. One relative told us, “Everyone always looks so bored, just sitting around not doing anything.” Another relative explained that their loved one is not always offered a bath, which would be their preference. This feedback was shared with the provider for improvements to be made.

Staff and the registered manager acknowledged that care plans needed to be more person-centred. However, staff were able to demonstrate a knowledge of people’s needs and wishes. One staff member told us, “‘I do encourage people to be independent, for example at mealtimes, encourage to eat and drink themselves if I know this is what they want.” The registered manager was taking steps to review and improve care plans.

We saw pleasant interactions between people and staff when engaging in activities of their choice. Activities were offered to people who preferred to stay in their rooms. However, care plans were basic and had limited information to guide staff in terms of peoples likes and dislikes.

People were supported to access care provision where needed. Relatives also told us that their loved ones could see external professionals as required. One stated, “[Person] sees the doctor and I know she gets her hair done. I pay for chiropody so that’s regular, every two months or so.”

Staff worked well with other services to ensure good continuity of care for people. The registered manager told us they had a positive relationship with the GP surgery. The home also utilised the hospital passport to support those people who are admitted to hospital. This is a document which summarises people’s needs so care can be continued in a different environment. Staff told us they would feel able to contact other professionals should they have concerns.

The home had a good working relationship with external agencies to promote availability and continuity of care for people. Professionals we spoke with confirmed that appropriate referrals were made to them as and when necessary. Some concerns were raised regarding communication about a recent outbreak of COVID and that this could be improved in future.

Processes were in place to ensure people had access to good care provision, including from external agencies where necessary. Both staff and the registered manager were clear on the processes about when to contact other professionals if needed.

Not everyone had received information in the way they wished. Some people told us that they relied heavily on the internet to access information and stay in touch with loved ones, however reports were that the signal could be very poor in the home. For some, this was an important part of their communication needs and although it had been raised numerous times, had not been resolved at the time of the assessment. We brought this to the provider’s attention as part of our feedback.

The registered manager had contact with relatives to gather feedback. People and their relatives were given newsletters and questionnaires for sharing information. The registered manager told us that they will email or arrange to have meetings with families if required to discuss any concerns or ideas.

Policies were in place to ensure that people received information in a format relevant to them, and aside from the issue with the internet, this was working effectively. People’s care plans considered communication needs, and additional information was available to staff to promote good communication with those living with dementia.

The feedback from people and relatives about being listened to and involved was mixed. One relative told us, “[Registered manager] will give me an update but only if I bump into her.” Another added, “Not many updates. Occasional emails if they need more items for example.” Other people told us that they did receive opportunities to give feedback and commented on staff and the registered manager being helpful and approachable.

Staff told us they felt involved. They also felt that they gave people regular opportunities to feedback on matters they may wish to change. Regular team meetings took place to give staff the opportunity to give their own feedback and ideas around the shaping of the service. The feedback around how effective these meetings were was mixed.

Processes were in place to give people and their relatives chance to give feedback. This was mainly by way of a survey, however the recent participation in this had been limited. The provider used a ‘you said, we did’ tool to monitor people’s feedback and what action was taken.

People told us that they could access additional services should they be required. This was supported by staff, and relatives spoke of this providing them with reassurances that their loved ones where getting the correct care. One relative told us, “They work well between services, the GP comes in regularly and will attend if there’s a problem. [Person] had an infection recently and were examined quickly. I think dentists and nail people also come in regularly.”

Staff had handover meetings to share any information and updates. Staff told us that they regularly updated daily notes on the ‘log my care’ system. Staff were confident to refer people to other services should this be required, for example, requesting GP support.

The provider was engaged with the local authority to begin driving improvements at the home. This contact continued following our site visit. Documentation demonstrated a good working relationship with external professionals, some of whom visited the home frequently.

Processes were in place to support people to have equity in access to external support agencies. Care plans and our conversations with the registered manager demonstrated that positive working provisions with health and social care colleagues had been developed and were utilised to achieve appropriate care for people.

People were supported to access external support systems to ensure good experiences and outcomes in their care. For example, one person had recently developed an infection which was quickly noted by staff and addressed. A relative praised staff on their response to this. Those who experienced difficulties or barriers in accessing treatments were supported by staff to do so.

Staff engaged well with people, and we observed them supporting people in a respectful manner. The home had a dedicated activities coordinator who helped shape what was available to people.

Processes were in place to promote equity across the home to enable good experiences and outcomes for people. Any protected characteristics had been detailed in people’s care plans and staff had positive working arrangements with health and social care partners.

People felt able to express what their wishes would be as they approached the end of their life. People and relatives told us that the home would do all they could to keep people living there, to avoid any unnecessary distress caused by moving to a different service, especially in the latter stages of life.

Staff had undertaken training about understanding end of life care. This was also included in the induction process. Staff told us, “I did end of life training online. A community care matron also came in and gave us a talk;” and, “It’s important to be there, make people comfortable and protect dignity.”

Processes were in place to ensure people’s needs and wishes at the end of their lives were documented. Where appropriate, people had Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms and Do Not Attempt Resuscitation (DNACPR) forms in place. These were not always robustly reviewed and required improving to ensure that the information remained up to date and relevant.