CQC report explained · a residential care home
What the CQC found at Dane House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some risks were not consistently assessed or recorded, so staff might not have had all the guidance they needed. Medicines, infection control, safeguarding and staffing systems were otherwise found to be safe.
- Effective?
- Good
- Staff understood people's needs, supported consent and best-interest decisions, and provided appropriate training, food, healthcare and communication support. This improved from Requires Improvement at the last inspection.
- Caring?
- Good
- This question was not inspected during this visit. The rating was carried forward from the previous inspection.
- Responsive?
- Good
- This question was not inspected during this visit. The rating was carried forward from the previous inspection.
- Well-led?
- Requires improvement
- Quality checks had not consistently identified missing risk assessments and care plan information. Incident monitoring did not identify patterns and trends, although the provider said changes were made after the inspection.
What inspectors found, January 2023
Dane House is rated Requires Improvement; inspectors found kind, skilled care, but gaps in risk records and quality checks could affect safety.
This was an announced, focused inspection on 13 October 2022. Inspectors looked at Safe, Effective and Well-led, including infection control. They spoke with people, relatives and staff, observed care, and checked care records, medicines records and management documents.
The home was rated Good for Effective. Staff understood people's needs, supported their choices and used positive behaviour support plans. People were supported with food, healthcare, communication and activities. Inspectors also found kind and caring staff who promoted people's dignity and independence.
Safe and Well-led were rated Requires Improvement. Some risks, including choking and changes in physical or mental health, were not properly assessed or recorded. The systems for checking care plans and identifying patterns in incidents had also missed problems. The manager took immediate action after the inspection to update records and monitoring systems.
The overall rating stayed Requires Improvement. The previous inspection had found a breach about consent. The provider had addressed this, and there was no longer a breach at this inspection.
Kind and respectful staff
People and relatives spoke positively about the staff. Inspectors found that staff promoted dignity, privacy and human rights.
“People were receiving person centred care from staff who were kind and caring.” from the report
Good understanding of individual needs
Staff knew people well and used behaviour support plans to recognise distress and prevent it escalating. Training covered communication, human rights and positive behaviour support.
“Staff knew people well and were skilled at recognising signs of distress or escalating frustration.” from the report
Consent arrangements improved
Staff understood consent and best-interest decisions. Records showed that relevant people had been consulted when someone could not make a specific decision.
“At this inspection the provider had addressed the issue of consent and there was no longer a breach of regulation.” from the report
Safe medicines practice
Staff were trained and assessed as competent to administer medicines. Records and guidance for as-needed medicines were in place.
“People were supported by staff who followed systems and processes to administer, record and store medicines safely.” from the report
Incomplete risk information
seriousSome risks were not fully assessed or documented. This included choking risks and risks linked to physical and mental health, creating an increased risk that people could come to harm.
“Risks to people were not consistently assessed and staff did not always have all the guidance they needed about how to manage risks.” from the report
Quality checks missed problems
needs fixingAudits had not identified missing information in care plans and risk assessments. Incident monitoring also did not look for patterns and trends, so learning opportunities may have been missed.
“The provider's systems for monitoring quality and risks were not consistent in identifying shortfalls.” from the report
Some limits on outings
needs fixingMinimum staffing levels and a lack of a driver on some shifts meant people could not always go out when they wanted. Recruitment was in progress to improve this.
“Sometimes it's difficult for people to just go out, we have to plan in advance and make sure there are enough staff on duty” from the report
- 01Have all choking risks now been assessed, and has advice from a Speech and Language Therapist been included in the care plan?
- 02How are changes in each person's physical and mental health now recorded and communicated to staff?
- 03How does the home check that care plans and risk assessments remain complete and accurate?
- 04How does the home review incidents to identify patterns and prevent them happening again?
- 05Has recruitment improved the availability of drivers and staff for outings?
This was a focused inspection of Safe, Effective and Well-led, including infection control; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 10 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2021
Rated Requires Improvement; inspectors found kind, safe care, but consent practices and management oversight needed improvement.
This was the home’s first inspection. It began as a targeted inspection about bedroom doors being locked at night, then widened into a comprehensive inspection. Inspectors visited on 04 June 2021 and 07 June 2021, spoke with staff and relatives, observed care and checked records.
The home was rated Good for Safe, Caring and Responsive. Inspectors found suitable staffing, safe medicines, detailed risk plans, kind relationships and personalised support. People were supported with activities, communication, healthcare and contact with relatives.
The home was rated Requires Improvement for Effective and Well-led. Bedroom doors had been secured without the required best-interest decisions and legal checks. The provider took immediate action during the inspection, but its own monitoring systems had not found the problem.
The overall rating of Requires Improvement means the home was not consistently meeting the required standard in all areas. CQC said it would ask for an action plan, monitor progress with the local authority and return to check improvements.
Kind and respectful care
Inspectors saw warm relationships between staff and people. Staff understood people’s communication and individual needs.
“We observed interactions between people and staff demonstrated warmth and kindness.” from the report
Personalised support
Care plans included people’s preferences, communication needs, risks and detailed guidance for staff. Staff were observed following this guidance.
“Each person had a care plan specifically designed around their needs.” from the report
Safe medicines and risk management
Medicines were stored and administered safely. Risk assessments and Positive Behaviour Support plans gave staff guidance on keeping people safe.
“People had detailed positive behaviour management plans which included techniques to deescalate potential risks to people and how to manage the behaviours being displayed.” from the report
Support for activities and relationships
People were supported to take part in activities, use community services and keep in touch with relatives during the pandemic.
“Contact with relatives was an important part of people's lives and the service had ensured regular contact was available during the COVID-19 pandemic” from the report
Consent for locked bedroom doors
seriousBedroom doors were secured without proper consideration of people’s capacity, best interests and the least restrictive option. This was a breach of Regulation 11.
“Consent to care and treatment had not always been sought in line with law and guidance.” from the report
Management checks missed the problem
seriousThe provider’s quality checks did not identify that the locked-door practice needed lawful consent and review.
“The provider's quality assurance processes and audits had failed to identify the need to lawfully gain consent for this practice.” from the report
Night-time staffing concerns
needs fixingSome staff said it could be difficult to manage if more than one person got up at night. The manager was reviewing the alert process and considering extra ways to summon support.
“There's not enough staff at night; it can be very difficult if one or two people get up at the same time” from the report
- 01How are decisions about locking bedroom doors assessed, agreed in the person’s best interests and recorded?
- 02How do you make sure any restriction is the least restrictive option and is reviewed regularly?
- 03What changes have been made since the inspection to your consent, Mental Capacity Act and safeguarding checks?
- 04How many staff are on duty overnight, and what happens if two people need support at the same time?
- 05What progress has been made on the action plan requested by CQC?
The inspection began as a targeted review of locked bedroom doors and was widened to a comprehensive inspection covering all five key questions; this was the home’s first inspection. This explanation was written from the published report of 24 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Dane House
2 rated inspections over a year: the service has held its Requires improvement rating throughout.
- January 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2021Requires improvementSafe: GoodEffective: Requires improvementWell-led: Requires improvement
- January 2021Inspected but not ratedSafe: Inspected but not rated
- October 2019
Registered with the Care Quality Commission on 24 October 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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