Daleside Nursing Home

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 assessed 8 quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection which was rated good. Our rating for the key question has changed to inadequate. The service was not safe. We identified 3 breaches of the legal regulations. People were not always protected from the risk of ongoing harm. Systems in place were not consistently followed by the management team to ensure accidents and incidents were appropriately reported to other agencies or reviewed to demonstrate lessons learnt. Concerns raised by family members had not always been appropriately listened to nor acted upon in a robust manner. This placed people at risk of continued harm. People did not always receive safe care as care plans and risk assessments were not always in place or updated when needed. Care was not always planned with people or their family members. People did not receive their medicines as prescribed. Areas of the service were cluttered and unclean. Fire checks had not been completed routinely. Room numbers had been removed from some bedroom doors which meant it was confusing for new and agency staff to know who resided in each bedroom. There was a lack of awareness of the people who were subject to being deprived of their liberty. Care plans did not always reflect when a person was deprived or their liberty or demonstrate how the service was ensuring any conditions were being met. There was a lack of consideration of the Mental Capacity Act when making decisions on behalf of people. Staff had not been safely recruited. Suitable checks had not been undertaken before a person commencing their employment. There were enough staff on duty to keep people safe, however, systems to ensure they were appropriately deployed across the building were unclear. This meant some people on the top floors of the building faced delays when seeking assistance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

In general, people told us they felt safe living at the service however, family members did not always feel concerns they raised were listened to or acted upon. Family members told us they were not always updated about their relative’s care or what actions had been put into place to mitigate risk to a person. One family member told us, “Well we have raised it about mums fall risk. She had a very serious head injury last year and she fell again a few weeks ago but I’m not sure what can be done about it.”

Staff we spoke with were able to describe the process for reporting and recording incidents and accidents. This process was also confirmed by the deputy manager who was able to explain when they would request the support of external professionals following an accident or incident. However, some staff told us that no debriefs took place following incidents and no learning was shared. One staff member commented, “You usually have to ask for feedback, it is not generally given.”

Accidents and incidents were recorded and reported by staff to the registered manager. However, the systems and documentation completed by the registered manager were not robust. Not all accidents and incidents had been reported to other agencies or reviewed by the registered manager at the time they occurred. For example, one person had experienced a series of falls in March 2024. The risks associated with this person had not been reviewed until May 2024 following an audit of records by the regional manager. This had placed the person at risk of continued harm. Systems in place to discuss individual risk included a manager daily walk round, daily flash meetings and monthly clinical governance meetings. These had not been consistently completed which meant there was a lack of opportunity for staff to meet, discuss people’s risk and discuss measures which could be put into place to reduce the risk of further harm.

We received mixed feedback from people and family members about whether there was a joined-up approach to care. Some family members said staff do know about risks and ask for their views. Other family members did not feel this was the case. Family members did not always feel they were involved and informed when their relative moved between the service and hospital. One family member told us, “My [relative] was taken into hospital. [The staff] told us they were calling an ambulance, and he was taken to hospital, but we were not notified that he returned.”

Senior care and nursing staff were able to describe the systems in place to ensure a safe admission to the service.

The local authority told us they and other agencies had significant involvement at the service in recent months to develop a more joined-up approach to working. A social worker also told us as part of a safeguarding enquiry outcome, a family member had very recently been asked to provide some additional information about a person to improve the quality of their care plan. This was something the provider had previously not requested and was seen as a welcome step to improving the quality of care.

We reviewed the admissions processes followed for a person who had recently been admitted to the service. We found the process described by senior staff had been followed however, it was not fully effective. It had not identified confusing information regarding the risk of choking and the need for a specific modified diet. We raised this and clarity was sought after admission from the appropriate medical professional. Despite this however, the persons care plan was not updated with the correct advice until we raised it again.

Most people we spoke with told us they were happy living at Daleside Nursing Home. Comments included, “Yes I feel safe here” and “Yes it’s okay.” Feedback from family members was more varied. Some family members spoke very positively about the staff and the care and described staff as, “Nice” and, “More like friends or family than staff.” However, other family members described concerns about a person not receiving a safe diet or physical support when eating and drinking; another family member told us they had concerns about a person with unexplained bruising. This family member told us, “My relative is not happy here and we are not happy with how [they] are being treated.” They shared they had recently tried to raise their concerns with the registered manager about unexplained bruising, however, was told they were too busy. We raised this straightaway with the regional manager who spoke with the family member and took steps to address the concerns raised.

Staff told us they had access to safeguarding policies and knew where they were kept. Staff told us they were confident that appropriate action would be taken by the registered manager if they did raise a concern. Some staff were not confident in describing their understanding of safeguarding and what action to take if abuse was suspected. We shared our findings with the management team. Staff told us they had completed online training on Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, when asked, there was a lack of knowledge about who in the service was currently being deprived of their liberty.

We observed interactions between staff and people who lived in the service. In general, those we observed within communal spaces were positive, and people received appropriate care. However, not all observations were positive. For example, we observed one person leaving the building by a side door. We were told this was to the back garden and that staff would be out there to assist, however this person was unsupported, and the staff member did not check there was another staff member ready to assist if needed.

Systems to ensure safeguarding concerns were promptly identified and addressed were not robust. Safeguarding logs were not completed by the registered manager in a timely manner. This meant there was a delay in reporting events to the local authority, and to the CQC and we were unable to always see what actions had been taken to protect people. For example, we identified occasion where a person experienced repeated unwitnessed falls. Another person had been admitted to hospital following a fall from their wheelchair. Neither of these had been reported until the regional manager had undertaken an audit of documentation during our assessment visits. Several people were being deprived of their liberty following decisions which had been made in their best interests. One person’s care plan stated a DoLS had been applied for. In fact, there was a DoLS which had been approved almost a year earlier, this was only discovered when raised by us as part of the assessment. We reviewed this person DoLS and established there were conditions which the service had to comply with. There was no knowledge of this and no evidence the conditions had been complied with. The registered manager had failed to ensure staff considered the principles of the MCA when a decision had been made for two people to share a bedroom. Neither person had been able to consent to this decision and there were no records staff had explored different ways to encourage the people to make an informed choice. There was also no record of the reason why this decision had been made, who had been involved or if it had been made in their ‘best interests’.

In general, people told us they felt safe living at the service however, not all family members were confident risks to people or changing needs were being promptly identified. One family member told us, “We were telling the nurses for weeks [Name] had a water infection they said they were dealing with it but [Name] was getting worse. So, I ended up going to the GP myself, speaking to GP, explaining [their] symptoms and getting antibiotics and passing it to nurse at the home. They should have been dealing with it, but they weren’t.”

Some staff told us they do not have access to people’s care plans or risk assessments but were made aware of risks associated with people by senior staff members. We discussed this with the regional manager who told us they would address this as the care plans were visible on the recording devices used by staff. Staff understanding of risk management was varied. Not all staff could explain how they would keep people safe and mitigate risks. Senior staff members we spoke with described the care planning process and told us people can have their families involved when they chose to.

We observed several staff practices which demonstrated there was an understanding of how to provide safe care in a way which mitigated risk. For example, we observed safe moving and handling practices and people appropriately supported to eat and drink. We also observed a staff member intervene and encourage a person to change their shoes to a pair which were more appropriate to their environment.

Risk assessments and care plans were not always accurate or sufficiently detailed to mitigate risk. These were not always updated and reviewed in a timely manner following events which occurred; or following updated advice being received by medical professionals. Systems to monitor people following an unwitnessed fall were not completed. This meant staff were not observing people appropriately to ensure they had not suffered a concussion or head injury; or to monitor if further medical assistance was required. This had put people at risk of physical harm.

People told us the service was generally maintained. One family member told us their relative’s bedroom had recently been refurbished. A person told us, “I’ve got lots of stuff and all my magazines.” One family member described the service as very hot. They told us, “The heating is always on full blast, and they don’t open the windows. The windows and doors are being fixed today.”

Staff told us they have access to all the equipment they need to assist people and said everything worked as it should in the service. One staff member described the environment as “a work in progress.”

During our first visit to Daleside Nursing Home we observed the top floor was very hot and at an uncomfortable temperature to spend any length of time. The regional manager had to direct staff to encourage people to the lower floors whilst a contractor resolved this. On the second visit we found the temperature was more tolerable. We identified several environmental improvements were needed. Carpets on one stairway which was used by staff was heavily worn and needed to be replaced. One shower room was missing an emergency pull cord. We identified there was a fault with the call bell system on the upper floors of the service. The service was undergoing a scheme of redecoration which included a new office for the nurses to complete their work. However, we discovered several bedroom door numbers had been removed as they had been painted but had not been replaced. Due to the layout of the building, it was difficult to determine who resided in each bedroom. This was confusing and created a potential risk of inappropriate care due to the number of agency staff working in the service. All these issues were shared with the management team who took immediate action to address.

Routine checks were made on the safety of the environment and equipment. However, we identified improvements were needed in the frequency of fire checks undertaken by the maintenance team. This was raised with the regional manager for immediate action.

People told us they liked the staff but did not feel there were always enough staff on duty to meet their needs. Comments included, “You just have to be patient because they are very busy” and, “They are all nice, all very busy though they are always running round rushed off their feet.” We received similar feedback from family members. One commented, “Staff are always very busy but will always take the time for us.” One person told us it took time for staff to answer their call bell when they needed assistance. The provider was using some agency staff to maintain safe numbers. Some family members told us communication could be difficult when English was not the staff members first language. One family member told us they were not confident that agency staff knew their relative very well.

Staff we spoke with told us the main reason for staffing shortages was due to sickness rather than a lack of staff in post. Staff told us it could be difficult to cover all the shifts needed which meant they regularly relied on agency workers and undertake additional duties such as working in the laundry. Staff told us this could often put additional pressures on them. The regional manager confirmed there had been sickness in the service and there were plans in place to monitor and address this. There were ongoing plans to recruit staff to any existing vacancies.

We observed staff always present on the ground floor of the building. This meant people in communal areas were attended to promptly. However, this was not always the experience for people who were located on the top two floors of the building; or those who were cared for in bed. On one occasion we alerted the regional manager as one person needed urgent assistance from a second member of staff for personal care and the staff members requests for support had gone unanswered.

Staff were not safely recruited. Appropriate checks had not been made before being offered employment. We identified staff members who had been recruited without evidence of a completed application and interview. Satisfactory references had not always been sought and some staff did not have a completed DBS check on file. DBS checks are carried out by the Disclosure and Barring Service. A DBS check is a record of a person’s criminal convictions and cautions. We raised our concerns straightaway with the regional manager. Assurances could not be provided about the suitability of some staff members. The regional manager immediately withdrew them from the workplace until satisfactory documentation was obtained. The regional manager confirmed the provider’s human resources team were undertaking a review of all the staff files to ensure they were fully completed and contained all the appropriate documentation to demonstrate safe recruitment process had been followed. Staff did receive training for their role. There were some updates needed which the regional manager was monitoring on a weekly basis. The provider utilised a recognised dependency tool to determine safe staffing levels which were based on the needs of people.

People told us their bedrooms get cleaned. One person said, “Yes, the lady comes in and cleans my room and she does my clothes.” People told us staff wore appropriate personal protective equipment (PPE) when providing care. Family members told us the service was cleaned however described the difficulties of keeping the service and clothes clean due to staffing issues. One family member commented, “The cleaner is doing the laundry as well they are so short staffed. I think the rooms get wiped down, but she is so busy.”

Some staff were able to describe the actions they would take in the event of an infection outbreak. Other staff were less confident. Staff were aware of the need to wear appropriate PPE and told us they had access to adequate supplies. One staff member expressed concern at the amount of work cleaning the service entailed when short staffed and said other staff helped as much as possible. They added, “I do my best.”

We observed there was only 1 domestic staff member on our first visit to the service. The home was not clean. One bedroom had a dirty ensuite bathroom and the toilet seat needed to be replaced. We raised this with the regional manager who told us they would arrange for a deep clean of the area. On our final visit we checked this room. The bathroom had been cleaned however, the toilet seat still needed to be replaced. Another person had heavily stained curtains which needed to be taken down to be washed. The area outside of this room had dirty and stained paintwork and flooring and a stale odour. We observed the laundry area to be very cluttered.

Systems were not effective in preventing the risk of cross infection in the event of an infectious outbreak. Due to clutter in the laundry, there was no visible system of ensuring clean and dirty laundry was kept separate. Records were not consistently completed to evidence staff had completed a robust cleaning schedule for the service.

Most people we spoke with were happy with how their medicines were administered. One person told us, “I have my oxygen tank and my inhalers, and the nurse brings me my tablets.”

Care staff told us they had completed medicines management training online. Nurses and senior care staff were responsible for administering medicines. they confirmed they received additional training and had their competency checked by the registered manager. However, during our assessment, the provider’s regional quality nurse told us they had identified concerns in the competency of some staff members to administer medicines safely and explained they were in the process of reassessing staff competency and updating training.

Medicines processes were not safe. People did not receive their medicines as prescribed. We identified one person had an agreement from their GP to have their medicines administered covertly. This had been agreed as being in the persons best interests over three months prior to our assessment and was clearly stated on the medicine bottles. We raised this with the regional quality nurse, and it was later confirmed the staff had failed to implement these instructions. Another person had recently had several medication changes agreed with the GP. This included changes in medicines to better manage pain. This had not been implemented by the provider and was only identified by the regional quality nurse through a routine audit of medicines. Two people had not received prescribed medicines as they were not in stock. People who had 'as required' medicines prescribed did not always have guidance in place to show staff when this should be administered. This placed people at risk of not receiving these medicines when needed.