2 February 2022
During an inspection looking at part of the service
People’s experience of using this service and what we found
There was a friendly and relaxed atmosphere at the home. We observed many kind, friendly and thoughtful interactions between people living at the home and staff members. Staff promoted people making choices for themselves. People and their relatives told us they liked the home.
Care planning was person centred and focused on outcomes for people. People’s care plans now identified what was important to them, along with their needs and any risks in their care. This meant that staff had the up to date information they needed to provide safe and appropriate care that met people’s needs and preferences.
The provider had changed the systems in the home in relation to how they assessed, recorded and mitigated risks in people’s accommodation, care and support. These systems were effective in ensuring that staff had the most important and relevant information at hand, to enable them to be effective in supporting people to be safe.
Improvements had been made regarding the governance of the service. However, some of the governance systems had not been consistently maintained or had not always been effectively implemented. In relation to some areas of the providers oversight and governance, the service remained in breach of regulation.
The provider had made significant improvements in other areas of oversight of the service, which had led to improvements in the quality and safety of the service being provided. For example, the safety and effectiveness of people’s care and their care plans were checked upon and audited.
The standard of people’s accommodation and the furnishings and equipment people used had all improved. Areas of the home had been refurbished and the home’s environment was pleasant and clean. There was ongoing maintenance and a series of safety checks taking place at the home. This helped ensure the home’s environment was safe.
The home manager and staff at The Dales worked effectively in partnership with others and were engaging with local systems to support people’s needs. Family members told us that they had good communication with the home manager and staff at The Dales. Staff told us that they felt supported and listened to by the provider and home manager.
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 inadequate (published 14 July 2021).
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 in relation to; Safeguarding service users from abuse and improper treatment (Regulation 13), Safe care and treatment (Regulation 12) and, Fit and proper persons employed (regulation 19). Improvements had been made in relation to Good governance (regulation 17). However, the provider remains in breach of this regulation.
This service has been in Special Measures since 14 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We previously carried out an unannounced inspection of this service on 10 and 16 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Key Questions, “Is the service safe?” and “Is the service well-led?” which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Dales Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified a breach in relation to governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.