Dalling House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

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.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s feedback was generally positively about staff and management at the home. However, numerous people spoke about lacking solutions to issues they raised at times. For example, the lift being out of order repeatedly and Wi-Fi not working.

Feedback from staff regarding learning culture was mixed. Some told us team meetings and supervisions were now taking place; however, one staff member told us, “We don’t have a de-briefing session. We fill in a form and that’s it.” There was evidence of team meetings however the details regarding lessons learnt was lacking.

Systems and processes to report and address accidents and incidents were not always robustly followed. There was no clear process in place to ensure all learning opportunities were taken following incidents, and the oversight of these was lacking.

People did not have any concerns regarding the systems and care pathways at Dalling House. People were supported to attend appointments or access external services as and when appropriate.

Staff worked well with external agencies to promote good outcomes for people. The registered manager told us that they are supported daily by district nurses to administer and manage people’s diabetes safely. All people at the home were supported by the same GP surgery to enable consistency in care pathways.

The home worked with external agencies to ensure people were supported as needed. However, some feedback we received from professionals highlighted the need for communication to be improved to enable any additional support to be put in place in a timely manner.

Some processes to ensure safe pathways and transitions for people needed improvement. Some people had come to the service initially for respite care. There were good working relationships to promote smooth movement of people across services. However, assessments or care plans were not always updated, and this could lead to unnecessary risks to people.

Generally, people and their relatives felt safe at Dalling House. However, people raised concerns about equipment not being reliable and this causing a feeling of being trapped at times. This was mainly in relation to the lift which was reported to breakdown regularly. This was working at the time of the assessment visit.

Staff demonstrated a good knowledge of safeguarding and were able to tell us the steps they would take if concerning situations arose. They had undertaken training and put this into practice daily.

We observed enough staff available to support people. However, we did note one member of staff trying to achieve three tasks at once. Also, staff were often required to take on different roles throughout the day, for example, the activities worker was seen in the afternoon as a carer. Whilst people were observed to be comfortable in the presence of staff, the deployment of these to keep people safe could be improved.

Systems and processes were in place to support staff to report any safeguarding appropriately and keep people safe. The provider had an up to date and relevant safeguarding policy which staff had a good knowledge of. There was also a whistleblowing policy available should staff need to report any concerns externally.

People and their relatives felt that any risks to them had been assessed, managed and minimised. People were encouraged to be as independent as possible where it was safe to be so. One person told us, “I don’t need any equipment apart from my stick, staff remind me to use it to stop me falling.”

Staff knew people well and supported them in a way which minimised any risks. However, risk assessments to guide staff were lacking details and had not been regularly reviewed. For example, some people who had risks to their skin integrity had not had a Waterlow risk assessment completed. The registered manager told us they were aware of improvements needed and action was being taken to address this.

People were encouraged by staff to be as independent as safely possible. However, we did observe some people who needed support with mobility having to wait until staff were available to support them. A fire door was stuck in an ajar position due to a thick carpet underneath. The most recent hygiene certificate for the kitchen was 3 out of a possible 5. The kitchen staff changed regularly, and some cleaning procedures had not consistently been completed.

Some processes were in place to minimise risks to people. For example, there was clear guidance on the wall in the kitchen as to any allergies people had. However, we found risk assessments within people’s care plans had not been reviewed for months. There were also some risk assessments referred to in care plans, which were then not available to inspectors during the site visit. The provider and registered manager were engaging with the local authority market support team to improve on this.

Most people raised concerns about the lift being out of order regularly and feeling uncomfortable on the stair lift which is tight on a narrow staircase. Although this alternative was available, people told us that they felt trapped in their rooms when the lift wasn’t available. One relative told us, “I do think it’s safe, apart from the lift, that is a constant issue as it never seems to be working.”

Staff told us that when the lift is broken this can impact on their practice as it takes longer to assist people downstairs via the stairlift which is slow. They also need to be more mindful about checking on people who remain in their rooms. Staff were often having to undertake multiple roles, including cleaning the home. The documentation about what tasks had been completed was lacking. The registered manager had not reported the issues with the lift to all appropriate agencies, including CQC.

Whilst we were on site, a staff member slipped and fell on the kitchen floor. It was reported to the inspector on site that this was not the first time this had happened and was due to the flooring material being slippery. We were unable to locate any clear reporting of the previous incident or what action had been taken to prevent reoccurrence. Not all areas of the home we observed were clean and tidy. Surfaces and furniture were sticky to the touch, and we saw some chair covers were not sealed, making them difficult to clean.

The provider had processes in place to maintain some elements of the environment. For example, regular checks were undertaken of water levels, gas and fire safety to ensure these were safe and fit for purpose. However, other concerns had not always been proactively responded on to minimise impact to people. All our findings were reported to the provider for action to be taken.

Feedback from people and their relatives regarding staff levels was mixed. Some people felt there were enough staff and reported that staff regularly check in on them when they are in their room. Other comments included, “The staff are a good bunch, more staff would be helpful because they seem to rush sometimes”, “Not always enough. I go in at different times and they always seem short. Been in on a Sunday and just 2 staff, that’s not enough for 18 people,” and, “They all seem to double up on roles. Some doing cooking one day and out on the floor the next.”

Staff feedback about levels on shift and their deployment at the home was mixed. Comments included, “Staffing is generally fine, but we have short days and are short at the moment,” and, “Staffing is sometimes an issue, especially at weekends. Agency/bank can be cancelled last minute, and we have to fill in anyway.” Supervisions had been inconsistent with some staff telling us that until recently they had not had individual supervisions for almost a year. This had started to improve at the time of the assessment. Staff reported that they do training online however this is in their own time and they do not get additional shift time to do this.

Generally, our observations confirmed that there were enough staff to keep people safe. However, the deployment of staff especially during mealtimes needed to be reviewed. For example, at lunchtime we saw one staff member needing to support someone to the toilet, help another person find their seat who was becoming confused and trying to give people their food. At times, there was 1 staff member present to support 13 residents as others were elsewhere completing tasks.

Processes and systems were in place to monitor staff training to ensure they had the right mix of skills to keep people safe. Supervisions for staff had been sporadic however there was a plan in place to improve upon this and provide more support to staff. Recruitment processes were in place with appropriate checks completed. However, we did identify one staff member did not have a Disclosure and Barring Service (DBS) check in place. This was due to a managerial oversight issue and was rectified following our feedback.

People told us that they were satisfied with the cleanliness at the home. Relatives reported that it was always clean and tidy when they visited. Comments included, “No grumbles, my room is cleaned, and my bed changed. Its clean and I’ve not noticed any odours,” and, “Always seems lovely, clean and tidy.”

The home had a housekeeper for 3 days per week and the rest of the time, the cleaning was done by care staff. A large proportion of the cleaning was expected to be completed by the night staff. There were no records or evidence of what was being completed when, which limited the oversight of this.

People’s rooms appeared clean and tidy, however, there were areas of the home which needed some attention. The inspectors noted that surfaces were sticky. Chairs were not sealed which posed an infection prevention and control (IPC) risk, and some chairs in the dining area had cracks in the vinyl cushions making them harder to keep clean and free from any IPC concerns. Staff were seen to wear aprons when serving food and drinks, but we did not observe good hand hygiene between giving medicines.

Policies and procedures were in place in relation to infection prevention and control. However, these had not always been robustly followed. For example, there had been a recent outbreak of COVID at the home, however this was not immediately acted upon in relation to the provider’s policy. There had been lessons learned following this outbreak to prevent this occurring again.

People and their relatives spoke positively about the management of medicines at the home. Some people were able to manage their own medicines. One relative told us, “[Person] is independent in lots of things, including her medicines, but staff do support if needed.” A person said, “Oh yes, they are safe. I do keep an eye on it and staff discuss any changes with the doctors. I can ask for paracetamol but do not need to often.”

Improvements had been made from the last inspection. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely to people, ensuring that they were offered and given time to take them in the way that they preferred. Medicines were signed for appropriately once they were taken.

Systems and processes were in place to promote safe medicine management. Regular audits were undertaken, and action taken to address any concerns. The risks around certain medicines had been assessed and was documented, for example, risks associated with blood thinning medicines. Electronic medicine administration records (EMARs) had recently been introduced and this was working well.