Dalling House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

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.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were mixed views in relation to the culture at the home. Staff supervision had been inconsistent over the past year, with some staff reporting that until recently they had not received supervision for nearly a year. Feedback about action taken following ideas being raised was mixed. Some staff told us that they would be comfortable raising concerns whereas other comments included, “There are opportunities to speak up, but nothing changes” and, “I don’t feel completely supported or appreciated in my role.”

There were processes in place to gather feedback from people and their relatives. However, in the most recent survey only 5 had been completed. It was unclear what action had been taken following the feedback. The provider had developed a ‘You said, we did’ document however this needed time to embed to show effectiveness.

Feedback from staff regarding leadership at the service was mixed. Staff spoke generally of the registered manager being approachable. However, some staff expressed a feeling of being uncomfortable that there were CCTV cameras in some staffing areas and reported feeling ‘watched’ by the management team. There was a newly appointed head of care, to provide additional support to the management team.

The leadership and management cover had been inconsistent over recent months. The registered manager had not been present, and the provider only attended once a week. This had led to some staff not feeling supported in their roles. This situation had stabilised at the point of assessment and improvements were starting to be made, for example, supervisions had started to occur again.

Feedback from staff around whether they would feel confident to speak up was mixed. Some staff told us that they would not have any concerns in raising any issues that they may have. Others reported to us that they don’t feel heard or listened to by the leaders in the home. They reported that approachability was inconsistent across different members of the leadership team, and this would possibly limit their freedom to speak up. All staff knew of the whistleblowing policy.

There was a robust whistleblowing policy in place and staff demonstrated throughout our discussions that they would know how to speak up if needed. Team meetings and supervisions were in place, however, the feedback around the efficiency of these was mixed.

Staff feedback in relation to a fair culture at the home was mixed. Some staff reported that the management team were approachable, and issues could be raised without any worries. However, some staff raised concerns about not feeling able to raise issues and spoke of feeling uncomfortable about the CCTV cameras in the property being used to ‘watch’ practice. Improvements in supervisions had recently been made to give staff more opportunities to discuss any concerns they may have.

Processes to allow staff to express their concerns, needs and wishes had been inconsistent. However, at the time of the assessment, staff had started to receive more supervision. There was a robust equality and diversity policy in place which staff could refer to if they had any concerns.

Some staff reported that they had been advised by management to deviate from the internal policies around infection prevention and control (IPC). There had been some absence of management recently which had caused staff to be unsettled. The provider visited the home once each week to maintain oversight, however, there were shortfalls in some elements of leadership. For example, CQC had not been notified of a significant event when the lift had not been working. Furthermore, a disclosure and barring service (DBS) check for one staff member had been overlooked. This was remedied following the assessment.

The provider had policies and processes in place to promote good delivery of care. However, these were not always followed robustly by the provider, management or staff. For example, in relation to the recent COVID outbreak at the service, this was not immediately reported through the correct avenues despite the threshold for an outbreak being met according to their own infection prevention and control (IPC) policy. Some staff reported to us that they were advised by the provider to not disclose the COVID cases. Audit processes were in place; however, these were not robustly or regularly completed. For example, the IPC audit stated it should have been monthly, but the last one made available to inspectors was completed in April 2024 when our site visit was August 2024. Details in some audits were lacking. People’s care plans had not been regularly reviewed; this had not been picked up by quality assurance processes. The provider had since taken audits to complete however the regularity of these being done needed to be embedded into practice.

People and their relatives were encouraged to engage within the community as they wished. One person told us, “I do have regular appointments with the dentist and a girl does my feet every few months. Staff help me with this.”

Staff described to us positive working relationships with partnership agencies and the community. The registered manager told us that staff worked well with other health and social care professionals, as well as community agencies, to ensure people remained engaged in things which were meaningful to them.

The provider had engaged with the local authority market support team to assist with driving improvement at the service. A professional told us that they had been open to the feedback and were keen to develop systems and processes to aid learning and improvements.

Systems and processes were in place to support people to remain engaged in the local community if they wished. The provider previously produced a local newsletter to keep people updated with what is happening in the community and vice versa.

Staff reported that when accident and incidents happen, they will fill a form in but were not always sure what then happened. There were no debrief sessions in place and until recently, supervisions were not consistent for staff to be able to discuss concerns and take learning from incidents.

The provider had a ‘You said, we did’ document in place to evidence how action and learning had been taken from events or concerns raised by people, relatives or staff. This was a new process and needed time to embed. The provider was requested to provide an action plan after the last inspection detailing how they were going to improve their rating and meet their breaches of regulation. They have remained in breach regarding the governance at the service due to inconsistent quality assurance processes, leading to learning opportunities being missed.