About the service:

Daleside Nursing Home is a care home registered to provide residential and nursing care for up to 43 people. This includes accommodating up to 22 people in receipt of transfer to assess care. Transfer to assess care enables people, once medically fit, to be discharged from hospital into a care home setting on a short-term basis prior to them being discharged home or into another community care setting. At the time of our inspection there were 37 people living at the home, 19 of whom were there on a transfer to assess basis.

People’s experience of using this service:

Standards of hygiene and cleanliness had significantly improved at the home since the last inspection. The general environment, including communal bathrooms and toilets, was well-maintained clean and free from unpleasant odours. However, this was an area of ongoing improvement and there were some aspects that the registered provider was continuing to address.

Medicines were managed safely at the home and people received their medicines as prescribed.

There were systems in place to protect people from abuse.

People were supported by staff who had been safely recruited and were well-supported with training and supervision by senior staff.

The atmosphere and appearance of the home was homely and people looked happy and relaxed.

People living at the home were supported by staff to maintain a healthy and balanced diet. Most people and their relatives gave us positive feedback about the food available at the home.

People and their relatives gave us positive feedback about the staff at the home. One person said, “The staff are lovely and really nice people; they are very caring and patient.”

Staff knew the people they were supporting well, including their needs and preferences. We observed many warm, friendly and caring interactions between staff and the people living at the home throughout our inspection.

People and their relatives told us staff respected people’s privacy and treated them with dignity and respect.

People’s care plans were informative, regularly reviewed and reflected their needs.

People and their relatives told us they felt the home was well-led and they would recommend it to others.

Rating at last inspection:

At the last inspection the service was rated requires improvement (22 November 2018).

During the last inspection we found breaches of Regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the home had made sufficient improvements since our last inspection and was no longer in breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out this unannounced inspection on 20 and 21 September 2018.

Daleside Nursing Home is a three-storey building situated in Rock Ferry, Wirral. The home is registered to provide residential and nursing care for up to 43 people. This includes accommodating up to 22 people in receipt of transfer to assess care. Transfer to assess care enables people, once medically fit, to be discharged from hospital into a care home setting on a short-term basis. During this time a multidisciplinary team of health professionals assess people’s ongoing care and support needs prior to them being discharged home or into another community care setting. At the time of our inspection there were 33 people living at the home, two of which were in hospital and an additional two people arrived at the home during our inspection.

The home had a registered manager who is also the registered provider. 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 registered manager was unavailable at the time of our inspection, although we did speak with them over the phone. Therefore, the deputy manager assisted us with our inspection.

During our last inspection in April 2016 we found that the home was performing well and was rated good overall. During this inspection we found that there had been a significant deterioration in standards at the home. We identified breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the home had failed to ensure the premises were safe as the maintenance and cleanliness at the home was poor and the home had failed to adequately monitor, assess and improve the quality and safety of the service provided.

Prior to our inspection we received concerns about hygiene and cleanliness at the home which had been identified by the local infection prevention and control (IPC) team during their visits to the home in August 2018. These concerns included poor basic cleaning standards, stained mattresses and linen and faeces marks on an en-suite bathroom wall. Following the IPC team’s visit they provided some additional training for staff at the home.

We noted that the home had taken some steps to address the concerns raised, such as amending domestic working hours, shift patterns and cleaning schedules and replacing equipment and furniture that was no longer safe to use. However, during our inspection we found that standards of hygiene and cleanliness at the home were poor and had not improved despite input from the IPC team. We saw several examples of this throughout our inspection. However, the most concerning related to the home’s clinical waste room. This room contained a macerator and commode pot washing machine, equipment used to dispose of incontinence pads and cleaning commodes. We found that both of these machines had broken several days before our inspection. During this time staff had continued to stack bags full of used incontinence pads in this room. We saw several used commode pots stacked up, one of which was smeared with faeces. A clinical waste bin in this room was also smeared with faeces and there was an open bag in a bucket containing faecal matter.

Health and safety information and records of environmental checks carried out were not easily accessible. At the time of our inspection the home’s maintenance person was on leave and staff at the home were unable to assist further. The records we were able to review were unspecific and not up-to-date.

We found that parts of the home had not been maintained properly. For example, in the yard area to the rear of the property there was a collection of disused chairs, shower chairs, a sofa and mattresses

This inspection took place on 14 and 19 April 2016 and was unannounced.

Daleside Nursing Home provides people with nursing and personal care. The home can accommodate up to 40 people, at the time of our inspection 37 people were staying at the home. Daleside offered two different types of accommodation, 21 people lived at the home as permanent residents and 16 people were staying on a temporary basis for intermediate care (IMC).

IMC care is provided in conjunction with the local authority and NHS and is designed for people who are expecting to return back to their homes after a period of care and rehabilitation. A high percentage of people who received IMC care at Daleside Nursing Home achieved this and were able to return back to their homes. The manager told us that this figure was typically between 80 to 90%.

The people and their relatives who we spoke with told us they felt safe living at the home. We saw that there were adequate staff available to support people and staff responded quickly when needed. One relative told us they had observed that “The staff are very attentive”. We observed the care, systems and the environment of the home to be safe.

We saw that staff were recruited and introduced to the home safely, with the relevant checks in place. New staff received induction training. One staff member told us, “I had an induction over three days, working alongside and shadowing senior staff, showing me the home’s routines.” New staff completed a six month probation period before they became permanent staff. All staff went through a training program and longer serving staff received refresher training as necessary. Staff were supported with periodic team meetings, regular updates and supervisions with a senior member of staff. Staff also had personal development reviews with the manager.

There was a culture of checking and auditing the health and safety and the main functions of the home; audits were assigned to the most appropriate person to undertake and were overseen by the manager. We looked at these audits and checks we saw that they took place regularly and when issues were identified actions had been taken in a timely manner.

We observed people being supported during one lunchtime. The dining room was bright with nicely laid out tables and there was a lively atmosphere during the lunchtime. One person pointed at the others at their table and said they were “All good friends”. There were light hearted conversations with good natured banter between the people living in the home and staff, which added to the atmosphere. People told us they enjoyed the food. We noted that people were well supported during the lunch time period and that people’s preferences and choices were sought and acted upon.

Staff had a positive and caring approach. One staff member told us their job was, “Going good, I love it so much. Different people coming and going, building up new relationships, it keeps it all fresh”. One visiting social worker told us that the staff at Daleside, “Create an environment that allows people to thrive”. Another health professional told us, “Here is a happy home, because carers do care”.

We looked at people’s care files and noted that the care plans were in good order and had a person centred approach. We saw that these contained an assessment of a person’s initial and ongoing care needs. Support needs of individuals were well documented and synchronised between the care home staff and health professionals showing a system that was effective in communicating, planning and documenting people’s care.

We noticed that there was a very positive, respectful and cooperative relationship between the manager and staff at Daleside and external health and social work professionals involved in people’s care. One health professional told us the staff at the home, “Work very closely with us, there is a really positive relationship”.

There was a manager in place at the time of our inspection who was part

A single inspector carried out this inspection. The focus of the inspection was to answer five key 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 describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:

Is the service safe?

We spoke with five care staff who told us that they felt the staffing levels were sufficient to meet people’s needs.

The people who used the service told us they felt safe. The visiting professional we spoke to told us they had no concerns over the welfare of any of the people living at Daleside and felt they were safe.

Is the service effective?

All care files contained a range of risk assessments, for example, skin integrity, bed rails and nutrition. We saw care plans were regularly reviewed. Files contained daily records and records from visiting professionals. We saw evidence and were told that staff liaised with professionals such as, GPs and social workers. Within the home there is an office to accommodate visiting professionals who are responsible for monitoring the transition service. This is a service which supports people once they have been discharged from hospital before they move back to their own home.

The people who used the service and the visiting professional we spoke to confirmed that staff were very knowledgeable about the people. Staff told us that they received regular training, however records were not available in the home to confirm this.

Is the service caring?

We saw that staff supported people in a warm, positive manner and spoke to people pleasantly. Staff assisted promptly and we observed that people were relaxed and comfortable in the company of staff. We heard staff speaking with people to inform and keep them involved with their care and support.

Is the service responsive?

We saw evidence that there was a complaints procedure and people living in the home, their relatives, staff and visiting professionals were surveyed regularly to seek their views on the quality of the service.

Is the service well-led?

We saw the manager conducted monthly audits in order to review the service. This allowed care plans, medication sheets and accidents to be monitored. People living in the home and staff told us that the manager was approachable and available to them to chat or for advice.

We spoke to seven people who used the service and four visitors. Comments from people who lived at the home and their relatives included: "They are very good to me, I have been here for two weeks and they are helping me to get better" and "The staff are very nice indeed. I wouldn't be afraid to ask anything of them".

We also spoke to seven staff and two visiting professionals as well as the owner and home manager. A visiting professional told us "I have a lot of contact with the home. We have a good relationship with the staff and discharge planning is very individualised. Staff are very friendly and approachable, people are involved and care is discussed".

There were 31 people in residence on the day of our inspection and we reviewed five people's care records. An assessment of people's needs was carried out before they came to live at the home and care plans were written from the information received. Risk assessments were undertaken and included information to staff about how those risks should be managed. We saw that people received care and treatment in accordance with their wishes. We observed staff delivering care in a way which explained what they were doing and we saw that people were able to make choice.

We spoke with staff who were able to describe people's care requirements and how they supported them to enhance their well-being. Staff understood people's need for a well-balanced diet and supported and encouraged them to eat and drink.

An extension of the home had been carried out to increase the number of rooms available and offer people more choice. The home was maintained so that risks to people were reduced and repairs were carried out regularly to ensure the safety of people who lived there and their visitors.

We reviewed staff files and found that appropriate documentation was received before a person was offered employment at the home. Staff were trained according to the needs of the people they supported and competency checks were carried out regularly. We saw that there was an effective complaints procedure in place and lessons were learned when incidents occurred. This meant that people were protected because staff understood what had gone wrong and what was required to stop it happening again in the future.

People we spoke with during our inspection told us that they were kept informed and asked their opinion about the services offered by the home. One person told us that the staff were lovely and kept her company at night when she wanted a chat over a cup of tea.

The general feeling of the people living in the home was that they had everything they needed. One person told us that they would much rather live in their own home but accepted that they could not manage.

People we spoke with told us that they felt safe living in the home.