CQC report explained · a nursing home
What the CQC found at The Dales
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2018
Rated Good; inspectors found safe, kind and well-organised care, with some repairs and record updates still needed.
This was an unannounced, comprehensive inspection on 3 December 2018. Inspectors spoke with people living in the home, relatives and staff. They reviewed care plans, medicines records, staff records, audits and building checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were described as safe, well cared for and supported by staff who knew them well.
Inspectors found safe medicines arrangements, suitable staffing, good training, personalised care plans and a range of activities. The home responded to complaints and used audits to monitor improvements.
Some issues were identified. Instructions for some creams needed more detail, the external fire escape needed repair, some furniture needed replacing and records of supervision and appraisals needed updating. These matters were either acted on or had actions planned.
Safe care and medicines
Inspectors found risk assessments, safeguarding systems and safe medicines arrangements. Staff had been trained and their medicines competence had been checked.
“There were safe arrangements in place for managing people's medicines.” from the report
Kind and respectful staff
Staff knew people well and supported their privacy, dignity and independence. Inspectors saw warm and caring interactions.
“We observed caring and warm interactions between staff and people they supported.” from the report
Personalised support
Care plans included people's preferences, needs and communication methods. People were offered choices and supported to remain independent.
“Care plans contained information on people's preferences, likes and dislikes and how they wanted their care and support to be delivered.” from the report
Activities and relationships
The home offered activities across its communities and supported people to maintain important relationships and take part in the wider community.
“A range of activities were available and the activities calendar showed something happening three times a day spread across all communities.” from the report
Quality monitoring
The management team reviewed incidents, complaints and safeguarding matters. Monthly audits and a central action plan were used to track improvements.
“The provider's quality assurance systems were used effectively to monitor quality and drive improvements.” from the report
Fire escape repair
needs fixingThe external fire escape was worn and needed repair. Management had already identified this and said it would be made a priority.
“We noted the external fire escape was worn and in need of repair.” from the report
Some medicines instructions
needs fixingSome instructions for creams did not contain enough detail. The deputy manager and nursing staff acted on this immediately.
“We saw some instructions on TMARs required more detail.” from the report
Furniture condition
minorRelatives said some furniture was dirty and needed replacing. The home was due to be refurbished, including new furniture.
“Two relatives told us some of the furniture needed to be replace as these were dirty.” from the report
Staff records
minorRecords of staff supervision and appraisals needed updating. Management said this would be addressed.
“Although, the overview records of supervision and appraisals required updating.” from the report
- 01Has the external fire escape now been repaired, and how is its condition checked?
- 02Have all topical medicine instructions been made clear and detailed enough for staff?
- 03What has been replaced or refurbished since the inspection, particularly the furniture?
- 04How do you make sure staff supervision and appraisal records are kept up to date?
- 05How would you adapt activities and care for my relative's dementia, communication or end-of-life needs?
This was an unannounced comprehensive inspection covering all five key questions, and the report says the previous overall Good rating continued. This explanation was written from the published report of 18 December 2018 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, January 2017
Rated Good overall, but Safe was still Requires Improvement while inspectors checked whether medicines were being managed safely.
This was an unannounced focused inspection on 20 December 2016. Inspectors checked medicines management only. They reviewed records, policies, audits and care information, observed medicines being given, and spoke with staff and two people living at the home.
Inspectors found that medicines were being administered correctly. Records were clear, medicines were stored securely, and arrangements for covert and as-needed medicines were properly assessed. Staff had received extra training and checks were made on their competence.
The home had previously breached Regulation 12 because its medicines systems did not protect people from risk. Inspectors found that this breach had been met. However, the Safe rating stayed at Requires Improvement because a longer record of consistent good practice was needed. The overall rating remained Good.
Clear medicines records
The medication administration records were complete and clearly showed what medicines people should receive, when and at what dose.
“The MARs we looked at were clearly recorded and listed all medicines separately, including the time of administration and dosage.” from the report
Careful handling of complex medicines
Medicines given covertly or when needed had supporting assessments and instructions. Staff had information about people's needs and how to give these medicines safely.
“Staff had access to clear, factual and explanatory information to make sure they knew exactly how to give the medicine if it was refused when first offered.” from the report
Training and checks
Most staff responsible for medicines had suitable training. The home also used observations and spot checks to check competence.
“The manager explained that, after training, observations and spot checks were carried out to make sure staff were competent.” from the report
Calm administration
Inspectors watched medicines being given and saw staff explain the medicines and make sure the person had enough to drink.
“This was done in a calm manner. The member of staff explained to the person what they were being given and they took time to make sure the person had enough to drink when taking their medicines.” from the report
Safe rating not yet improved
minorAlthough inspectors found the medicines improvements had worked, they kept the Safe rating at Requires Improvement because they wanted to see consistent good practice over a longer period.
“While improvements had been made we have not revised the rating for this key question.” from the report
- 01How have you continued to check medicines administration since this inspection?
- 02How often are medication administration records audited, and how are any mistakes followed up?
- 03How do you make sure new staff are trained and assessed as competent before administering medicines?
- 04How do you check and record changes to medicines after someone returns from hospital?
- 05When medicines are given covertly, how are best-interest decisions and relatives' views recorded?
This was a focused inspection of medicines management and the Safe question only; the report says the other areas and ratings were not covered. This explanation was written from the published report of 10 January 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
3 rated inspections over 2 years: the service has held its Good rating throughout.
- December 2018Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017Goodstayed GoodSafe: Requires improvement
- June 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014Inspected but not rated
- December 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
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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28 live-in carers within about an hour of North Yorkshire
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 £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
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.