Dale park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Dale Park is purpose built and can accommodate 46 people who are living with dementia. It is managed by HC-One Limited. There were 44 people in residence at the time of the inspection.

The home was last inspected in August 2017 and was rated ‘Requires improvement’. All the previous outstanding breaches of regulation had been met. There was fresh leadership in the home which had provided a positive focus for staff, people using the service and visitors. The service remained ‘Requires improvement’ because achieving the rating of ‘Good’ would require good practice being sustainable over a longer period.

On this inspection we found standards and improvements had been maintained. We have rated the service as Good.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found management and overall governance was stable. The registered manager was a consistent and positive lead in the home and had been effective in building a positive staff team and ensuring a consistent approach to care.

Staffing numbers ensured people’s care needs were consistently met. We found this had continued to improve. Feedback from staff, people using the service and visitors was positive in that staffing levels had been consistently maintained to ensure safe standards of care.

People’s nutritional intake was supported appropriately. Meal times were seen to be a relaxed and enjoyable experience for people. People’s nutritional state was very well monitored.

Staff told us there were good systems in place to support them in their work such as training and supervision.

Observations and feedback from people and their relatives evidenced people’s dignity was protected and maintained.

Staff were motivated to provide meaningful activities and a more consistent programme of social activities had been developed.

People’s risks regarding their health care were being adequately assessed and monitored. There was good referral and liaison with community health care professionals who worked with the home to help ensure people’s health care needs were met. We had previously made a recommendation regarding the specific need to ensure best practice around the assessment and monitoring of people who have challenging behaviour; this had improved.

We found medicines were administered safely. We found medication administration records (MARs) were clear and met best practice. People received their medicines consistently.

We looked at how staff were recruited and the processes to ensure staff were suitable to work in the home. We saw checks had been made so that staff employed were suitable to work with vulnerable people.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. Planned development / maintenance was assessed and we were made aware of the refurbishment of the home that had taken place.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

There were people being supported on a Deprivation of Liberty [DoLS] authoris

Dale Park is a purpose built 46 bedded care home offering nursing care for people living with dementia. It is managed by HC-One Limited. There were 41 people in residence at the time of the inspection.

The home was last inspected over a month in December 2016 and January 2017 when we found five breaches of regulations. The home was rated as ‘Requires Improvement’. The ‘Well led’ domain) was rated as ‘inadequate’.

This inspection took place over two days commencing on 23 August 2017. We found the home had improved in its provision of service to people. All of the outstanding breaches of regulation had been met. In particular the home was found to have adequate staffing levels which were being maintained at the time of our inspection. There was fresh leadership in the home which had provided a positive focus for staff, people using the service and visitors.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection we found there had been inconsistent and inadequate leadership in the home. Some key areas of management such as maintaining adequate staffing levels had not been monitored effectively. This had caused instability resulting in fluctuating levels of care which exposed people to risk. On this inspection we found management and overall governance had improved. The registered manager had been in post since the last inspection and was a consistent and positive lead in the home. This had been effective in building a positive staff team and ensuring a more consistent approach to care.

Previously we found there had not been enough staff on duty at all times to help ensure people’s care needs were consistently met. We found this had improved and the breach in regulation had been met. Feedback from staff, people using the service and visitors was now positive in that staffing levels had been consistently maintained. Some staff and visitors voiced anxiety regarding new proposals for staffing and the registered manager was aware of this.

Previously there had been concern with respect to the monitoring of people’s nutritional intake as they were not always supported appropriately at meal times. This had improved. Adequate staffing ensured people were supported at meal times. People’s nutritional state was very well monitored. The breach was now met.

Staff said they were better supported by the new registered manager. Previously there had been a lack of consistency regarding support systems for staff such as training and supervision. We found this was much more consistent. Staff told us they felt supported in their work. The breach was now met.

At our last inspection we found the service in breach of regulations regarding the need to maintain people’s dignity. On this inspection we found improvements. Observations and feedback from people evidenced people’s dignity was protected and maintained. The breach was now met.

Previously, limited activities had been organised in the home and we were told it had been difficult to organise activities due to lack of staff. We found improvements. Staff were motivated to provide meaningful activities and a more consistent programme of social activities had been developed. The breach was now met.

We saw that people’s risks regarding their health care were being adequately assessed and monitored. There was good referral and liaison with community health care professionals who worked with the home to help ensure people’s health care needs were met. We have made a recommendation regarding the specific need to ensure best practice around the assessment and monitoring of people who have challenging behaviour.

We found medicines were administered saf

Dale Park is a purpose built 46 bedded care home offering nursing care for people living with dementia. It is managed by HC-One Limited.

The service was last inspected in August 2016 when we found three breaches of regulations regarding medicines management, safe recruitment of staff and respect for people’s dignity. The service was rated as ‘Requires Improvement’.

This inspection took place over three days commencing on 5 December 2016 and following up on 11-12 January 2017 in response to concerns that had been raised with us. During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, dignity and respect, support at meal times and good governance. Respect for people’s dignity was a continued breach from the last inspection in August 2016.

Following the first day of the inspection, on 5 December 2016, we found serious concerns and breach of regulations concerning staffing of the home and found this was having an effect on the safety of the care provided. We sent the provider a letter [called a section 64 letter] asking for urgent action to address the concerns. The letter also asked the provider to not admit any more people to the home until the areas of risk we identified had been addressed. We visited again on 11-12 January 2017 to complete a full inspection and check to ensure people were safe.

This report and outcome is based on the evidence we found over the three days of the inspection.

The previous registered manager had not worked in the service since November 2016. A new manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The new manager said they were applying for registration.

There had been a lack of consistent leadership and management since April 2016 when a previous long term registered manager had left. Some key areas of management such as maintaining adequate staffing levels had not been adequately monitored. This had caused some instability resulting in fluctuating levels of care which exposed people to risk in some key areas.

We found the home had not provided enough staff on duty at all times to help ensure people’s care needs were consistently met. This had improved over the past month, following our initial concerns, but consistency of staffing in the longer term remained an issue and we continue to have concerns regarding the sustainability of standards and will therefore continue to monitor the service closely.

We found people were being monitored with respect to their nutritional intake although we saw people were not always supported appropriately at meal times so there was risk that requirements around nutrition and hydration could be compromised. We told the provider to take action.

Staff said they were better supported by the new manager but we found a lack of consistency since the last inspection regarding support systems for staff such as training and supervision.

At our last inspection we found the service in breach of regulations regarding the need to maintain people’s dignity. On this inspection we also made observations which raised concerns that people’s dignity was not always protected and maintained.

Limited activities were organised in the home. We were told it had been difficult to organise activities due to lack of staff. Staff were motivated to provide meaningful activities but the programme needed to be developed further.

You can see what action we took with the provider at the back of the full version of the report.

We found medicines were administered safely. This was an improvement from the last inspection when we found the service in breach of regulation. The breach had now been

Dale Park is a purpose built 46 bedded care home offering care for people living with dementia. It is managed by HC-One Ltd.

This was an unannounced inspection which took place on 2 & 3 August 2016. The service was last inspected in September 2014 and at that time was found to be meeting standards.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was in the process of recruiting a new registered manager. Meanwhile the home had been managed by a stand in ’turnaround’ manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely. We found examples whereby some medicines such as prescribed thickeners for drinks [to help people swallow] and external medicines [creams] were not being recorded appropriately. We told the provider to take action.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found some anomalies with the staff files we checked and some details were missing such as adequate references. We told the provider to take action.

We recorded some negative comments by relatives and made observations that supported the view that aspects of people’s personal care and attention compromised their dignity and could be better monitored. We told the provider to take action.

The manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. We were concerned that, despite fairly well developed systems in place, some areas had not been effectively monitored and issues had been missed. These included the medication issues we highlighted and the lack of thorough recruitment checks for some staff.

We found that the home had undergone major changes in the past six months and this had caused some unrest in response to the changing culture of the home. We found some improvements had been made but there were many planned improvements that still needed to be implemented. The changes around staffing and management approach needed to be further embedded.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed most staff had undertaken safeguarding training and this was ongoing. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The managers had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were completed and were being monitored by the manager.

Activities were organised in the home and these were appreciat

Our inspection was carried out unannounced. The inspection helped answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and well cared for. People enjoyed living at Dale Park and found the staff team supportive. We told about many examples of good care and support that showed people’s safety and wellbeing were being consistently monitored.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents and events that affect people’s clinical care and safety. This reduces the risks to people and helps the service to continually improve.

The home had supporting policies and information around mental capacity and consent to support people who may not be able to make decisions about their care or treatment. The manager and senior nurses on each unit showed a full understanding of the Mental Capacity Act 2005 which is the legislative framework for the decision making process regarding people who may lack mental capacity.

Currently the home had one person placed on a Deprivation of Liberty [DoLS] authorisation. These are safeguards in law under the Mental Capacity Act 2005 to make sure that any restrictions placed on people’s liberty are assessed and monitored to ensure their rights are maintained and any action is taken in the persons ‘best interest’. Dale Park was acting appropriately in this instance and was continuing to review the person concerned. This ensured the person’s rights were maintained.

Is the service effective?

People’s health and care needs were assessed with appropriate referrals being made to external professionals who were able to assess and support the care of people in the home. Care needs had been identified in care plans and these had been reviewed. Care plans reflected people’s current needs. The home was particularly effective at assessing peoples personal preferences regarding their health and social support and providing a framework where a more individual approach was supported.

Visitors confirmed that they were able to see people at any time as visiting times were flexible. They said that staff kept them informed and they were therefore always up to date with any changes to people’s care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People living at the home and their relatives commented, ‘’The staff do reviews of the care and this keeps us involved and up to date’’, ‘’Staff are very good and they seem to interact with residents well’’ and ‘’ My relative always looks well cared for and is generally very settled here.’’ ‘’There is always enough staff around.’’ ‘’It’s very good here – not institutional at all. My [relative] has improved no end and is very settled.’’ ‘’The care is excellent. The staff can’t do enough and are very friendly and helpful.’’ ‘’My [relative] has had some very difficult times and has been unsettled but the nurses and staff have sorted things out, including reviews with the consultant and community nurses and [relative] has improved in every way.’’ ‘’The care is good. The staff always make sure [relative] is kept clean and comfortable.’’

People using the service and/or their relatives completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed. There were other regular forums where people’s supporters and relatives had input into the running of the home.

People’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities. People were supported as their care needs changed. This was particularly evident with changing medical and nursing care needs.

We spoke with a visiting health care professional. We were told that the home liaised well and referred people appropriately and promptly, so people were assessed in a timely manner and their care needs addressed. We were told the staff in the home were welcoming and took any advice and support positively to ensure people were getting the best care.

Is the service well-led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

The home had a registered manager who is registered with the Care Quality Commission and is able to provide ongoing support and leadership.

People’s privacy, dignity and independence were respected. The interaction we saw between the staff and people they attended was positive. We saw the staff supporting people to mobilise, assisting them to eat and drink and asking after their welfare. When people asked for support this was given by the staff promptly and in a polite manner. Staff were also observed to anticipate people’s needs and respond appropriately.

We looked at how people’s health care needs was organised and saw that people experienced care, treatment and support that met their needs and protected their rights.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People living at Dale Park and their relatives were positive about the staff and the care provided. One relative commented, ‘’Things have improved since the new manager has arrived. Staff are more consistent.’’

We found the provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at the various audits [checks] carried out on a routine basis by the company and found these to be thorough. These audits helped ensure the home was run appropriately and safely.

The staff support we observed was positive and the interactions with people living at Dale Park were patient and delivered at an appropriate pace.

We spoke with five visiting relatives and collected their comments and opinions. People told us they were happy with the care and support they and their relatives received.

We talked to staff about the care and support people received at the home. This along with our observations showed people received care and treatment, which was planned and delivered in a way that ensured people’s safety and welfare. There had been appropriate liaison with health and social care professionals during the many reviews of care to monitor people’s health and well being. For example we found two of the four people we reviewed had been referred to the dietician and a plan of care had been devised to support the people appropriately.

Those people spoken with and their relatives were very relaxed around staff and said they were listened to, so any concerns could be addressed. We saw people were engaged with staff. This helped ensure people had good feelings of wellbeing.

There have been recent concerns by visiting social services officers regarding some care issues as well as overall staffing levels in the home. The home had worked with social services to help address these issues. The service demonstrated they have systems in place to continually monitor the health safety and wellbeing of people in the home.