What life is like for people using this service:

The provider had made essential improvements to the home to become compliant with fire safety and food hygiene regulations. They had improved the décor and cleanliness of the home. People were much happier; they had been involved and kept informed of the changes that were being made.

The provider and registered manager had implemented systems to monitor the safety and quality of the service they provided. The audits informed them of the actions required to improve the service. However, the quality monitoring was not robust enough to identify some areas that continued to require improvement. The provider had not embedded all the systems for health and safety as systems to protect people from accessing the kitchen and stairs were not reliable. We discussed our findings with the registered manager and they responded by implementing further checks and audits to help maintain people’s safety.

The provider had not always implemented all the necessary employment checks, or ensured people were supported to engage in meaningful activities. Following our feedback, the provider took action to improve these areas.

People received care from enough staff that had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

There was a positive culture within the service where staff communicated well and people’s needs were met.

The improvements seen at this inspection were recently implemented; the provider had not had the opportunity to demonstrate these improvements had been embedded into practice or sustained over a period of time. For this reason, we have rated the service as requires improvement.

Rating at last inspection: Inadequate 26 June 2018.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

About the service:

Dallington House Care Home provides accommodation and personal care for up to 16 older people, some of whom were living with dementia or learning disabilities. On the day of our visit, there were 12 people using the service.

Why we inspected:

We carried out this inspection to follow up from our inspection in June 2018 where we found the service to be Inadequate. We had varied the conditions of their registration; this inspection was to assess the progress the provider had made in meeting the regulations.

Follow up:

We will continue to monitor the service in conjunction with other agencies such as the fire service, environ

This inspection took place on 26 June 2018 and was unannounced.

Dallington House Care Home 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. The care home accommodates up to 16 older people, some of whom were living with dementia or learning disabilities. On the day of our visit, there were 13 people using the service.

This was the fifth comprehensive inspection carried out at Dallington House Care Home since they registered with CQC on 9 December 2014. During the previous four inspections since June 2015 the provider had been in continuous breach of two regulations relating to safe care and treatment and governance. The provider had showed repeated lack of improvement. We served requirement notices and took enforcement actions however these did not lever improvements.

The provider has continually failed to demonstrate they have the skills and knowledge to implement governance systems which would assess, monitor and improve the safety and quality of the service. The provider’s reliance on outside agencies to identify risks and areas for improvement demonstrate the provider’s lack of ability to self-govern. Each inspection and assessment by outside agencies have raised recurring themes which indicate the provider’s lack of ability to improve the service.

The provider has failed to provide the financial resources required to make essential and on-going repairs, decoration, upgrading of the home and invest in staffing. The home has deteriorated into disrepair, putting people’s safety at risk in the event of a fire or through poor food hygiene.

The provider did not respond to people’s feedback; they failed to act on people’s request for improvements to their environment.

Although people continue to receive care that meets their basic needs, this was due to their good relationships with staff overseen by the registered manager. The registered manager does not have access to the resources needed to make the necessary improvements. There is a lack of provider oversight of the outcomes of the audits that do take place; issues remain unresolved.

Continued improvement is required with the communication within the home to ensure people’s current needs are known to all staff.

People did not have all the information they required in a format they could use to make a complaint.

People received their medicines safely. Staff treated people with dignity and respect. People had the freedom to practice their own religion as they preferred.

At this inspection we found that Dallington House Care Home was in breach of three regulations relating to the safe care and treatment, premises and equipment and governance. Using our enforcement policy and decision tree, we have taken further enforcement action. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This servi

The inspection visit took place on 20 July 2017 and was unannounced. This meant that staff did not know we would be visiting.

At a previous inspection carried out on 29 September and 3 October 2016 we asked the provider to make improvements. We found that the provider did not ensure that risks associated with people's care were managed safely or that people were always referred to health care professionals in a timely manner. The provider did not ensure that people's medicines were managed safely. We asked them to improve their practices in relation to their arrangements for monitoring the quality of the service and notifying Care Quality Commission (CQC) of significant events at the service. When we inspected the service again on 17 and 19 January 2017 we found that the provider had not made the required improvements to comply with the regulations and the service was rated inadequate. We placed a condition on the provider’s registration to prevent any admissions to the service without the prior written agreement of the Care Quality Commission.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that most of the improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Dallington House provides accommodation and care and support for up to 16 older people. There were 11 people that used the service at the time of our inspection, some of whom were living with dementia or similar conditions.

At this inspection we found improvements had been made but further improvement was required before the service could meet the regulations.

There was a registered manager in place who had returned to work following a period of temporary absence. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People felt safe. Staff knew their responsibilities to help people to remain safe. The registered manager took action where there were concerns for people’s well-being.

Risks associated with people’s care were assessed and reviewed to provide guidance for staff. Staff took the appropriate action when an accident or incident occurred.

The provider carried out checks on the environment and people’s equipment to help people to remain safe. However, doors had been wedged open posing a risk to people should a fire occur. The provider planned to make further checks to make sure furniture was secure where it posed a risk to people.

Staffing numbers were sufficient to provide the support people required. The registered manager followed the provider’s recruitment processes. However, on one occasion they did not fully check all of the information available to them before a staff member started to work at the home and records were not kept of the interviews for new staff. We have made a recommendation about this.

People received their medicines when they required them. Staff knew their responsibilities for handling medicines safely.

Staff had the knowledge and skills they required to support people well. There were plans to improve the knowledge of staff where people lacked the mental capacity to make decisions for themselves. People received support from staff members who received training and on-going guidance on their work. New staff received an induction when they started work and they knew their responsibilities. Staff felt supported by the registered manager.

Where there were concerns about people’s ability to make decisions for themselves, the

This was an unannounced comprehensive inspection that took place on 17 and 19 January 2017 and was unannounced on the first day. We returned announced on the second day of inspection.

At the last inspection completed on 29 September and 3 October 2016, we found the provider had not met the regulations for people's safety, good governance and the safe recruitment of staff. At this inspection we found the provider had not made all the required improvements and the regulations were still breeched. We found a further breach of regulation.

The service had a registered manager who had been away on a long term absence. In their absence the service was managed by an interim manager. 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.

Dallington House provides accommodation for older people who require personal care and support. Some people who used the service lived with dementia or similar conditions. There were 11 people that used the service at the time of our inspection.

People did not always feel safe with the staff that support them. They told us that some night staff were not kind and compassionate when they supported them. The provider did not have systems in place to report and investigate incidents that had occurred at the service and did not report incidents to other relevant authorities such as the Care Quality Commission or the local safeguarding authority.

Staff did not consistently follow the provider’s protocols to manage people’s medicines. Medicines audits were not completed in line with the provider’s guidance which meant that the provider could not be assured that people’s medicines were managed safely.

The provider did not always assess the risks associated with people’s care. Where risks had been identified, they did not manage them to ensure that people received safe care. This included where people may behave in a way that may challenge others.

People were not supported in accordance with relevant legislation and guidance. Staff demonstrated a limited understanding of the Mental Capacity Act 2015. Where people were deprived of their liberty, staff did not adhere to the conditions stated on their Deprivation of Liberty authorisation to ensure that any restrictions were lawful.

People were supported to access their doctor when needed. However, we saw that staff did not refer people to other health professionals where there was an identified need for such support.

People were supported with their nutritional needs. They had access to a choice of meals.

People told us that staff who worked the day shift were caring and kind to them. They told us that staff treated them with dignity and respected their privacy. We found the people’s information was not always managed confidentially.

People were socially isolated. They were not supported to engage in meaningful activities. They were not supported to maintain links with their local community.

The provider did not maintain oversight of the service to ensure that people received a high standard of care. The service lacked good leadership to make the required improvements. The provider did not use their own systems to monitor the quality of the service. They did not ensure that they made the improvement to satisfy the relevant regulations.

The provider continued to breach of two regulations of the Health & Social Care Act 2008 Regulated Activities Regulations 2014 and was in breach of one regulation of the Care Quality Commission (Registration) Regulations 2009.

We have taken enforcement action against the provider, the details of our enforcement is at the end of the main report.

The overall rating for this provider is 'Inadequate'. This means that it has been placed i

This was an unannounced comprehensive inspection that took place on 29 September and 3 October 2016 and was unannounced on the first day. We returned announced on the second day of inspection. At the last inspection completed on 24 June 2015, we found the provider had not met the regulations for people’s safety and good governance. At this inspection we found the provider had not made the required improvements and the regulations were still breeched. We also found a breach of the Health & Social Care Act 2008 Regulated Activities Regulations 2014 with regards to safe recruitment of staff.

Dallington House provides accommodation for older people who require personal care and support. Some people who used the service lived with dementia or similar conditions. There were 14 people that used the service at the time of our inspection.

The service had a registered manager. 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.

People felt safe at Dallington House. Staff had a good understanding of their responsibilities and knew the provider’s procedure to keep people safe from harm and abuse. There were enough staff on duty to meet people’s needs.

The provider did not always complete relevant pre-employment checks which would have assured them that staff were safe to work with people.

Staff did not consistently assess and manage identified risks associated with people’s care needs to ensure that they received care in a safe manner.

The provider did not have safe practice for the management of people’s medicines. They did not have skills and protocols in place to check the people received their medicines in a safe manner. This meant that they could not be assured that people received their medicines as prescribed by their doctor.

People felt that staff had the relevant skills and experience to support them. Staff told us that the registered manager had ensured that they received the training they required. The registered manager had plans in place to improve the training available to staff. Staff demonstrated they understood the requirement of Mental Capacity Act (MCA) 2005 and how they would apply them in their role.

People had access to a variety of meals, but they did not always enjoy their meals. Staff did not always support people with their health needs. They did not always refer them to health professionals for the support they required.

Staff treated people with kindness and compassion. People felt that staff respected their dignity and privacy and promoted their independence where possible. We observed that staff practice did not always promote people’s dignity and privacy.

People who did not have dementia or similar conditions did not feel that the provider supported them to avoid social isolation. This was because they did not access to meaningful activities. People knew how to raise concerns or complaints and were confident that their concerns would be dealt with.

People complimented the registered manager and were happy with the way the home was managed. Staff felt supported by the registered manager and were confident that they would improve the service.

The provider quality assurance processes included a limited range of audits. We saw that their audits and checks were not completed regularly. We found that the provider had not made the improvement they told us they would at their previous inspection.

You can see what action we have told the provider to take at the back of the full version of this report.

We inspected Dallington House on 19 June 2015. The inspection was unannounced. Dallington House provides accommodation for persons who require personal care and treatment of disease, disorder or injury to people.

This is the first inspection of this service under the new provider, who was registered in December 2014.

On this inspection we found breaches of the Health & Social Care Act 2008 Regulated Activities Regulations 2014 with regard to people’s safety and good governance.

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 and associated Regulations about how the service is run.

People using the service and relatives we spoke with said they thought the home was safe. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Relatives, and some staff, told us that on occasions they thought there weren’t enough staff on duty to meet people’s needs promptly. Some people’s risk assessments were in need of improvement to help ensure staff understood how to support them safely.

People using the service and relatives told us they thought medicines were given safely and on time. Some improvements were needed to the way medicines were ordered to ensure medicines were always available as prescribed to people.

Risk assessments were not detailed enough to be able to keep people safe. Staff were not always safety recruited to help ensure they were appropriate to work with the people who used the service.

People told us they thought staff had skills to be able to provide care to them. Records showed staff had an induction but needed more training to ensure they had the skills and knowledge to be able to fully meet people's needs.

Not all staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had plenty to eat and drink and told us they liked the food served.

Staff understood people’s health care needs and referred them to health care professionals when necessary though they had not always shown what action they took when people had minor injuries.

All the people we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly way. However, there were instances of staff ignoring people when they asked for help.

People were not actively involved in making decisions about their care, treatment and support. People also said staff protected their privacy and dignity and we observed this in practice.

Care plans were not fully individual to the people using the service and did not cover fully cover their health and social care needs.

People said they were generally happy with the activities provided. Records showed that activities requested by people had not been introduced. Planned activities did not always take place.

People and their relatives told us they would tell staff if they had any concerns. Records showed that concerns had been made by relative but had not been responded to.

The manager only worked in the home for a short period every week, which was not enough time to ensure people received a quality service.

People and staff said they were generally happy with how the home was run. People had the opportunity to share their views about the service at meetings, though we could not see that changes were made as a result of peoples input.

Management carried out audits and checks to ensure the home was running smoothly. However, audits did not include all issues needed to provide a quality service, and did not show that prompt action was taken if improvements were needed to the service.

You can see what action we have told the provider to take at the back of the full version of this report.