This inspection of Dial House Nursing and Residential Home took place on 14 January 2019 and was unannounced. The service was last inspected in September 2016.

Dial House Nursing and Residential Care Home is a ‘care home.’ Dial house Residential and Nursing Home provides support to older people and younger adults who are living with dementia, mental health, a physical disability or a sensory impairment. The service is a large building split over two floors with communal areas people can use for activities. The service also has four ‘respite beds’ to support people who are transitioning from hospital. On the day of our inspection 41 people were using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

The service was safe. Systems and processes were in place to protect people from harm and abuse. Staff had a good understanding of how to safeguard people from abuse. Risks to people were assessed to mitigate the likelihood of harm. There were enough numbers of staff on shift to support people and staff had necessary pre-employment checks before starting work at the service. People were supported to take their medicines safely. The home was clean and welcoming and systems were in place to promote good infection control.

The service was effective. Thorough assessments of people’s needs were completed before they used the service. Staff had sufficient training and knowledge to support people effectively. People were supported to live healthy lives and had access to health professionals if they needed them. People were supported to eat and drink according to their preferences and support needs. The premises and equipment were designed to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service was caring. People were treated with kindness, respect and compassion. People felt able to, and were supported, to make choices about the care they received. People’s privacy, dignity and independence was promoted. Staff knew people they were supporting well and had built caring relationships with them.

The service was responsive. People received personalised care that met their individual support needs. People’s preferences, likes and dislikes were taken in to account and actioned with regards to their care and support. Complaints were recorded and responded to appropriately. People were supported with privacy and dignity at the end of their lives.

The service was not always well-led. Systems, processes and audits needed further development to monitor the quality of the service. Audits of medication were not effective at finding potential errors. The level of supervision of staff needed to be more frequent to ensure that they remained competent in their job roles. There was a new manager employed by the service who had identified the need to improve governance systems. The manager had started to get feedback from people, relatives and staff to improve the service. The manager and nominated individual were committed to improving the service and had plans in place to achieve this. People and the staff team were positive about the impact the new manager was having on the service.

This inspection took place on 16 August 2016 and was unannounced.

At our previous inspection on 25 and 26 May 2016, we found that people’s medicines were not being managed safely. This was because there were inconsistencies with the recording and administration of medicines.

This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to provide us with an action plan to address this and to inform us when this would be completed. We undertook this focussed inspection to check that the provider had made improvements and to confirm that they now met legal requirements.

This report only covers our findings in relation to the outstanding breach of regulation. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Dial House Nursing and Residential Home’ on our website at www.cqc.org.uk.

Dial House Nursing and Residential Home provides nursing care and support for up to 50 people who are elderly and physically frail; some of whom maybe living with dementia. There were 42 people living at the service on the day 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 and associated Regulations about how the service is run.

During this inspection, we found that the registered manager had put further systems in place to eliminate the inconsistencies with the recording and administration of people’s medicines. Overall there had been an improvement in the recording and administration of medicines.

While an improvement had been made we have not revised the rating for this key question. To improve the rating to 'Good' would require consistent good practice over a longer period of time. We will review our rating for safe at the next comprehensive inspection.

The inspection was unannounced and took place on the 24 and 26 May 2016.

Dial House Nursing and Residential Home provides nursing care and support for up to 50 people, some of whom were living with dementia.

At the time of our inspection 44 people were using the service.

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 and associated Regulations about how the service is run.

Inconsistencies found with the recording and administration of medicines showed that people’s medicines might not be managed safely. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff employed at the service; however, we found that they were not always appropriately deployed. As a result this had an impact on people’s call bells not being answered within a reasonable timescale.

People felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. There were risk management plans in place to protect and promote people’s safety. Effective recruitment procedures were in place. This ensured only staff who were suitable were employed to work at the service.

Staff received appropriate training and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation. People were supported to have food and drink of their choice. If required, staff supported people to access healthcare services.

People and their relatives commented positively about the overall standard of care provided. Staff ensured confidentiality was maintained and people’s privacy and dignity was promoted.

People’s needs were assessed prior to them coming to live at the service. Information gathered at the assessment process was used to develop their care plan, which was reviewed on a monthly basis or as and when needs changed.

People were encouraged to take part in a range of activities of their choice. There was a complaints procedure in place to enable people and their relatives to raise concerns if they wished to.

There was a culture of openness and inclusion at the service amongst staff and people who used the service. Quality monitoring systems were in place, which were used to drive improvements and to identify where action was needed.

We considered all the evidence we had gathered under the outcomes we inspected during our inspection. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We observed that people looked happy living at Dial House Nursing and Residential Home. One person said, “We are really well looked after.” We observed that plans of care included risk assessments to promote people’s safety such as assessments for malnutrition and moving and handling. We also observed staff used safe moving and handling techniques.

We saw that the premises were well maintained with no risks to people’s safety.

Staff told us they had received information about the whistle blowing procedure with a recent payslip. This indicated that the service encouraged staff to identify any concerns and report appropriately.

Is the service effective?

It was clear from the care plans we looked at that people had stated their preferences, particularly in relation to their food likes and dislikes. These were displayed in the kitchen area of the home. Staff we spoke with had a good understanding of people’s needs and knew how they preferred to be supported.

Is the service caring?

Staff spent time interacting with the people. We observed people being encouraged, and correctly supported, at lunchtime so that their nutritional needs were met.

Is the service responsive?

Duty rotas confirmed there were sufficient staff on duty at all times. The staff we spoke with, including the ancillary staff, confirmed that staffing levels were appropriate. During our inspection we observed that call bells were answered in a timely fashion and any requests from people were responded to.

Is the service well- led?

At the time of our inspection the service was led by a manager who was registered with the Care Quality Commission, however they were on annual leave. The provider was available and they and other senior staff provided us with information we required to make our judgements.

At our last inspection in September 2013, we found concerns about how medications were managed. At the time staff were not recording any stock that remained in the home from one month to the next. It was therefore impossible to reconcile the medications held by the service. We also noted that the staff did not consistently use the same codes to record when a medication had not been given.

When we returned on 16 December 2013, we found that staff had undertaken additional medication training and strengthened the processes to ensure the safe and effective receipt, recording, handling and administration of medication. Staff were now working as a team and supporting each other. One member of staff said, “We have worked hard to get this right.”

At our last inspection we also found that the systems in place to check the quality of the service provided had not been robust enough to identify the medication concerns. At this inspection we saw that the manager had introduced new, and strengthened existing, processes to continually monitor the standard of the service provided.

During our inspection of Dial House Nursing and Residential Home on 4 September 2013, we spoke to eight people using the service and two visitors. As some of the people in this home had difficulty with verbal communication due to dementia, we spent time observing the daily activity. This helped us to understand people's experiences.

We looked at the care files for five of the people living at the home. These were individualised and had been reviewed regularly, but were not well ordered. Some old information had not been removed when new information had been introduced. This could be confusing to the staff team providing care. However the staff we spoke with were very knowledgeable about the care the people who use the service needed.

There were sufficient staff on duty and we noted they were courteous in their approach to people, and competent when they delivered care. We observed positive engagement between the staff and the people who used the service, particularly at lunchtime when staff supported people with their meal. The food served was hot, appeared nutritious and well balanced.

Medications were administered safely. However, because staff did not carry forward the amount of a medication left at the end of one month to the next, a clear audit trial of the medication held in the home was not available.

Staff received appropriate training for them to carry out their role and were supported to attend updates as required.

During our visit on 20 November 2012 we spoke with four people using the service and observed how care and support was provided to four others. We saw that people were treated with dignity and respect, and were encouraged to make choices about the care and support they received. One person said, “We are always being asked if we want this or that or if we would like to do something. We even have choices at mealtimes”. One person told us that they belonged to a resident’s forum and could comment on the service provided during this meeting.

We observed interactions between staff and people using the service were considerate and although people were encouraged to participate in social activities their need for privacy and their choices were respected. A visitor told us that could talk to staff about anything and the manager and the deputy were always available to them.

Some of the people living at the home had formed a resident’s forum. One person said, ”It is the moaning group, if we have anything we don’t like we bring it up at the meeting and it is dealt with.” The person went on to tell us the group had asked the chef to cut the cabbage more before serving and this had been done.

The staff who spoke with us had a good understanding of the needs of the people living in the home and how these should be met. The people using the service told us that the staff cared for them well and were attentive to their needs.

We spoke with several people who use the service when we visited the home. They told us that the care was very good and that staff were kind and knowledgeable.

One person with whom we spoke in their bedroom stated that they were, “Very sick”, but confirmed that they were seen by a GP and had been prescribed different medication that needed time to take full effect. A person confirmed that they had been prescribed strong painkillers and that these had, ‘Helped a bit’. Another person told us that they knew what their medication was for and stated that it did help.

A person with whom we spoke in the communal area stated, “I have been here for a long time. It is a good home, staff are kind and know what they are doing. I don’t need much help, as I am still pretty independent, but they always help me if I ask.”

People confirmed that they had a choice and that they were listened to. One person had just asked for and had been given a cup of tea and added, “We can get a cup of tea anytime.”

People told us that the food was very nice and that they could have drinks and snacks whenever they wanted.

We visited the home on the 16 June 2011 and looked at the care files of three people. Two had high needs and one was a recent admission. We visited these people in their bedrooms and spoke with those we could. We also spoke to a relative who told us, ‘they have done so much for my mother since she has been here, we are really pleased with her care, and she always looks comfortable’.

We observed part of a medication round. One person told us that if they wanted pain relief at any time they could ask for it. Another person said, “I don’t like taking so much medication but the nurses tell me why I have to.”