CQC report explained · a nursing home
What the CQC found at The Dales Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- People felt safe and medicines were managed safely, but recruitment checks were incomplete and inspectors found risks involving windows, garden access, furniture and pressure mattress records. These issues were resolved during the inspection.
- Effective?
- Good
- Staff had suitable training and supervision. People's needs were assessed, food and drink were monitored, healthcare referrals were made promptly, and consent processes followed the relevant legal framework.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People had positive relationships with staff, and relatives were made welcome without time restrictions on visits.
- Responsive?
- Good
- Care was personalised and staff knew people's needs and preferences. Inspectors found particularly strong end of life care, alongside activities, communication support and a complaints process.
- Well-led?
- Good
- The provider and manager were visible and committed to improvement, and staff felt supported. However, quality checks had not covered all the areas where inspectors found problems.
What inspectors found, January 2020
The Dales Nursing Home was rated Good overall, but inspectors found recruitment and some safety checks needed improvement.
Inspectors visited on 15 October and 11 November 2019. The first visit was unannounced and the second was announced. They spoke with people, relatives, staff and professionals, observed care, and checked care, medicine, recruitment and management records.
People were generally positive about the care. Inspectors found kind and respectful staff, good support with food, medicines and healthcare, personalised care plans, and strong end of life care.
The safe rating was Requires Improvement. Recruitment checks were not always complete, and inspectors found several safety risks in the building and garden. These risks were dealt with during the inspection, and the provider sent evidence of new checking systems.
The overall rating was Good. This means the service met the relevant standards overall, but safety was not consistently assured and the provider needed to improve its systems. The well-led rating fell from Outstanding at the previous inspection to Good.
Kind and respectful care
People and relatives described staff as kind and caring. Inspectors observed positive relationships and found that privacy and dignity were respected.
“People were comfortable and settled living at the Dales and spoke fondly of the staff.” from the report
End of life support
Inspectors found good end of life care, with people's wishes considered and staff working with health professionals to provide comfort and dignity.
“There was good end of life care at the service.” from the report
Personalised care
Care plans included people's likes, dislikes and what mattered to them. Staff could describe people's individual care and support needs.
“People's care plans were comprehensive and included information on what was important to the person, their likes and dislikes.” from the report
Training and support
Staff had a structured induction, ongoing training and regular supervision. Staff said they felt trained and supported to do their work.
“There was an ongoing programme of training covering all aspects of health and safety for all staff which was up to date.” from the report
Medicines and healthcare
People received medicines at the right time, and records were clear. Staff responded promptly to changes in people's health and involved other professionals when needed.
“People were supported to eat and drink enough to meet their needs. They received their medicines at the right time and in the correct way.” from the report
Incomplete recruitment checks
seriousThe home did not always record references, employment gaps or interview details clearly enough. This meant it could not be sure every prospective worker was safe to work with vulnerable people.
“A robust recruitment procedure was not always followed which meant people were at risk of not being safe.” from the report
Building and garden safety
seriousInspectors found missing window restrictors, unsafe smoking-area furniture and an unlocked garden door. These problems were dealt with during the inspection, but they showed that safety checks had not identified them beforehand.
“On the first day of inspection, some parts of the home were not completely safe.” from the report
Quality checks and records
needs fixingAudits did not cover every area, and some essential safety records were incomplete. The provider introduced wider monitoring systems after the inspection.
“Some audits of the service took place, but these did not cover all the areas required.” from the report
Pressure mattress records
needs fixingChecks were recorded, but the records did not show what staff had checked or the mattress setting. Inspectors said this could create a risk of skin damage, although no damage was found.
“This meant people could be subject to a risk of skin damage due to incorrect settings.” from the report
- 01How are the new recruitment procedures and checklists being used for every new staff member?
- 02How do you now check window restrictors, garden access, outdoor furniture and other building safety risks?
- 03What records are kept to show that pressure mattresses are set correctly for each person?
- 04How often are the new quality audits completed, and who checks that actions have been finished?
- 05What activities are now available for people with different interests, abilities and communication needs?
This was a planned inspection that looked at the care home, premises and care provided across all five key questions. This explanation was written from the published report of 10 January 2020 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, April 2017
Rated Good; inspectors found kind, safe care and Outstanding leadership, with some short-term staffing and activity concerns.
This was an unannounced inspection on 2 and 8 February 2017. Inspectors spoke with people living at the home, visitors, staff, the manager, relatives and health professionals. They observed care, checked medicines and reviewed care plans, staff files, training and quality records.
The home was rated Good overall. It was rated Good for Safe, Effective, Caring and Responsive. Well-led was rated Outstanding. Inspectors found people were protected from harm, received personalised care from trained staff, and were treated with kindness and respect.
There had been high staff sickness in the weeks before the inspection, although shifts were covered by agency staff when needed. Inspectors also found that two people were supported by one staff member between them at lunch, and that activities were being reviewed after the activities organiser had been away for a month. The manager agreed to address these points.
Kind and respectful care
Inspectors saw patient, gentle interactions. Staff respected privacy, dignity, choice and independence.
“Throughout the inspection there were kind and patient interactions between staff and people living in the home.” from the report
End-of-life support
The home worked closely with hospice and palliative care teams. People's end-of-life wishes and medicines were documented and available to staff.
“The nursing team ensures all end of life paperwork (ie Treatment Escalation Plan (TEP) and 'do not attempt resuscitation' (DNAR) forms) and end of life medications are available” from the report
Strong leadership
The manager and provider were accessible and focused on person-centred care, staff development and continual improvement.
“The provider and registered manager had a range of effective monitoring systems in place to assess the quality and safety of the service and plan on-going improvements.” from the report
Personalised support
Care plans included people's health needs, communication, background, relationships, interests and end-of-life wishes. Staff reviewed them regularly.
“Care plans were comprehensive and included detailed information about people's physical and mental health needs, communication and background” from the report
Staff sickness
needs fixingThere had been high sickness levels in the weeks before the inspection. The home used agency staff when permanent staff could not cover shifts.
“There had been some problems with staffing in recent weeks due to high levels of staff sickness.” from the report
Support at lunchtime
needs fixingInspectors saw one staff member helping two people at the same time, although both were attentive to each person. The manager said this would be addressed immediately.
“However, in the dining room we saw two people being assisted by one member of staff between them” from the report
Activities under review
minorThe activities organiser had been away for a month during the inspection. A replacement was due to start, and the programme was being reconsidered to meet people's changing abilities.
“On the week of this inspection the home was without an activities organiser, and had been for a month.” from the report
Explaining care
minorA relative said some staff did not always explain what they were doing during support. The manager planned a workshop and supervision to improve staff confidence and communication.
“However a relative told us some staff did not explain what they were doing when they were supporting people, and felt their interaction could be better.” from the report
- 01How are staffing levels maintained when permanent staff are off sick, and how are agency staff introduced to people's needs?
- 02What changes were made to ensure people receive the individual support they need during meals?
- 03What is the current activities programme, and how is it adapted for people who cannot take part actively?
- 04What training or supervision has been provided to help staff explain care clearly and confidently?
- 05How are care plans reviewed with residents and their relatives when needs or wishes change?
This was an unannounced comprehensive inspection covering all five key questions and was the first inspection since the provider registered on 4 July 2016. This explanation was written from the published report of 12 April 2017 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 The Dales Nursing Home
2 rated inspections over 3 years: the service has held its Good rating throughout.
- January 2020Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Outstanding
- July 2016
Registered with the Care Quality Commission on 4 July 2016.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
17 live-in carers within about an hour of Devon
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,270 a week. 15 can care for a couple. 13 years' experience on average.
“She is such a warm and gentle person while being professional and competent at the same time.”
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.