The Dales Nursing Home is a 31 bed nursing home in Exeter which provides long term, respite or recuperative care for adults over the age of 65. At the time of the inspection there were 29 people living at the service. This is the first inspection of this service since ‘The Dales Nursing Home Limited’ registered as the provider on 4 July 2016.

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.

There was a very high level of confidence in the leadership and management of the service expressed by people, relatives, staff and health and social care professionals. One health professional told us, “I think The Dales nursing home is outstanding. All my patients who have been looked after there have been cared for to the highest level. [Manager’s name] is an outstanding manager and gels the whole team. They care enormously for their patients and their staff. The Dales is a well-run home and I encourage any of my patients to be there for its high level of professional care”.

People told us staff were kind and caring and respected their privacy and dignity. One person said, “I love it here. Even when a new one (staff) comes in they are all very good.” The service placed a strong emphasis on a ‘person centred approach’, and ensured people, and their advocates where appropriate, were fully consulted and involved in all decisions about their lives and support. This meant people’s legal rights were protected. The registered manager played an active role in promoting this ethos of person centred care in their links with other providers and external health professionals. For example through delivering a presentation at a provider engagement meeting, and when student doctors and hospice care workers came to work at The Dales to learn about the service provided. These links also benefitted the people living at The Dales because they also created an opportunity for the staff working there to learn and keep up to date with best practice.

Many people at The Dales were receiving palliative care, and the service worked closely with the hospice and palliative care teams to provide the support they needed. A health professional told us, “In terms of end-of-life care, I feel The Dales far excels any of the other care homes in Exeter. They have a large number of short-stay palliative care patients who are well looked after with dignity and respect”. The home was registered with ‘The Gold Standards Framework’, which is a practical, evidence based approach to providing the best care for people as they approach the end of their lives.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. The service was extremely proactive in supporting people to maintain their fluid and food intake, especially people identified as being at risk of malnutrition.

People were kept safe and free from harm. Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s support plan showing how they should be supported to manage these risks. Systems were in place to ensure people received their prescribed medicines safely.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Where concerns had been bought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected. Staff were recruited carefully and