Dove House Care Home

Dove House is a residential care home providing accommodation and personal care to up to 42 people in one adapted building. The service provides support to older and younger adults, some of whom are living with mental health conditions and dementia, people with physical disabilities and sensory impairments. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

People were safeguarded from abuse by staff who understood how to report any concerns to the appropriate body. Staff understood how to manage risks to people’s safety and were able to support people to have their medicines as prescribed. There were enough safely recruited staff to ensure people were supported and staff understood how to prevent the spread of infection. When incidents occurred, these were reviewed, and analysis was done to look for any themes.

People had their needs assessed and plans put in place to meet these. There were clear plans to ensure people had a choice of food and drinks and their needs and preferences were met. The building had been adapted to ensure people had effective support. Where needed health professionals were involved in people’s care plans and staff followed any guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s preferences were understood by staff and they had support to do things which were of interest to them. Communication needs were assessed, and staff understood how to communicate with people effectively. Where people were at the end of their life, they had plans in place to guide staff on how they wanted to be supported.

Where people made complaints, these were investigated and responded to. The registered manger had oversight systems in place to ensure the building was maintained and people received the care they needed. The provider worked in partnership with other agencies and applied a learning culture.

Rating at last inspection

The last rating for this service was requires improvement [published 2 June 2021].

Why we inspected

We inspected the service to follow up on concerns from the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dove House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dove House Care Home is a residential care home providing personal care to 22 people at the time of the inspection, some of whom were living with dementia. The service can support up to 42 people in an adapted building.

People's experience of using this service and what we found

Quality assurance checks at the service had previously failed to identify areas of improvement required to the environment. At the inspection we saw that the provider had made improvements to the quality assurance systems, but we could not be assured that these were embedded into their practice.

Areas of the building required decoration and refurbishment. The provider had addressed the urgent issues and had a plan for the rest of the work.

People's care plans were reflective of their current needs.

Effective systems were in place to assess and manage risk to people's safety. Accident and incidents were recorded and reviewed.

People were supported by enough staff who supported them in a timely manner and staff members received training on how to keep people safe from the risk of abuse.

People's medicines were managed effectively.

We found there was a positive culture shared between staff to promote good outcomes for people. Incidents were investigated and improvements were made.

Managers and staff were open and honest. People, their relatives and staff had the opportunity to make changes to the service.

Staff worked in partnership with other healthcare professionals.

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

Rating at last inspection

The last rating for this service was requires improvement (published 8 June 2019).

Why we inspected

We undertook this focussed inspection due to concerns we had received from the local authority that Dove House Care Home was not managing infection control risks at the home effectively and concerns with the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Ratings from the previous comprehensive inspection for those key questions we did not look at were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dove House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Dove House is a care home that provides accommodation and personal care for up to 42 older people, some of whom are living with dementia. At the time of our inspection, there were 32 people living at Dove House.

People’s experience of using this service:

Medicines were not always managed safely.

Care plans were not always personalised, and improvements were required to ensure the information contained within people’s care records was consistent. People were supported to have their end of life wishes met but this information was not always consistently recorded. The service was in the process of developing this practice.

People received enough food and drink to meet their nutritional needs, however improvements were required to make meal times a more positive experience for people. After our inspection, the area manager sent us an action plan of planned improvements. Actions had been taken to address the shortfalls we had found.

Activities for people were provided, however, these were not always meaningful for people and the service was going through the process of recruiting an activities coordinator.

There was no registered manager in place.

Further improvements were required to the systems that measured the quality and safety of the service.

People were protected from the risk of harm and abuse.

People were treated with kindness by a staff group who were caring and knowledgeable about people’s care and support needs.

People knew how to make a complaint and complaints were addressed in line with the service policy.

The senior management were in the process of improving the service to fully imbed the changes that had been and were still being adopted. People, relatives and staff spoke positively about the improvements that had been made.

Rating at last inspection:

At our last inspection in October 2018 (report published 12 January 2019) the service was rated Requires Improvement with the key question of Safe rated as Inadequate.

Why we inspected:

This was a planned inspection based on the date and the overall rating of the last inspection.

Follow up:

We will continue to monitor the service through the information we receive. We will return to re-inspect in line with our inspection programme for Requires Improvement services.

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

Dove 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 42 people in one adapted building. The home is also registered to provide nursing care under some circumstances, however nursing care was not provided at the time of our inspection. We were informed the provider intended to amend their registration to remove nursing care.

There was no registered manager at the time of our inspection. 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 had recently left and a new manager had joined the service just over a week before our inspection. The manager told us they intended to support ongoing improvements to the service and to register with the Commission.

Systems were not effective to ensure people would always be safeguarded from abuse. We also found people were not always supported to have their risks safely managed, including some people’s support with their medicines. We also found staff were not effectively deployed to meet all people’s needs safely. The concerns around the safety of the service resulted in three breaches of the regulations related to safeguarding processes, safe care and treatment and the deployment of staff.

Feedback from people, relatives and staff showed they generally felt the service was safe. Routine checks helped promote the health and safety of the home. Recruitment checks were in place but not always carried out robustly. People had access to healthcare support.

People’s needs were not always effectively responded to, including support with people’s meals and drinks. We received positive feedback from most relatives and healthcare professionals about the support provided by staff. Improvements were underway to the support and guidance in place for staff to ensure people’s needs were always effectively responded to. Improvements were also required to ensure people were always supported in line with the requirements of the Mental Capacity Act 2005 (MCA).

People’s privacy was promoted and we often saw friendly and caring interactions towards people from staff, however this was not consistent practice. People were not always well engaged with and involved in their care as far as possible. Improvements were also required to ensure people were consistently supported to have their dignity and respect promoted.

Although we received positive feedback in relation to most people’s care, people’s care and preferences were not always met as far as possible, including around people’s access to activities. The provider told us they were driving improvements to the service to ensure people’s wishes and preferred routines were known and followed. Systems were not robust to ensure complaints would be used and learned from to improve the quality of the service.

The provider recognised improvements were required to the quality and safety of the service and steps to achieve this were underway. Staff felt supported by management and by the new manager who had joined shortly before our inspection. The ratings from our last inspection were displayed as required.

We identified a breach of the regulations because systems and processes were not effective to ensure the quality and safety of the service. Systems had not identified safety concerns including around recruitment processes and staff deployment, and processes were not always robust to ensure incidents and risks were appropriately responded to. We identified a further breach of the regulations because the provider’s processes failed to ensure CQC were notified of all specific events and incidents as required by law.

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

Dove House is registered to provide accommodation and nursing care for up to 42 older people. There were 42 people who used the service at the time of our visit. The manager told us that the home was not currently providing nursing care to anyone.

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.

At our previous inspection visit on the 12 June 2015 the service was meeting the regulations that we checked but we did ask the provider to make some improvements. This was because one area of the home was not independently accessible to people with limited mobility and people needed staff support to ensure their safety was maintained. The dining experience for people required improvement to ensure people were supported to enjoy their meal in a relaxed atmosphere and improvements were needed to enhance people’s social and therapeutic opportunities. At this inspection visit we saw that improvements had been made in all areas.

We observed and were told by people and their visitors that there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to work with people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Where people were unable to make decisions, assessments were in place to demonstrate how decisions were made in their best interests. Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and were involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate how arrangements to seek people’s consent to care, support or treatment had been agreed in the person’s best interests.

The home has recently changed status and was now registered with us to provide nursing care. A new manager had been appointed.

We spoke with three staff, and three people using the service. All the comments received were positive. One member of staff said, “It is so much better, well led, the manager runs a tight ship.” A person using the service said, “I have settled in well, I like it here and the staff are very good.”

The manager had identified a number of concerns with the environment and the equipment in the home; we saw a major refurbishment was underway. This meant the manager had been responsive to people’s needs to ensure they were living in a safe, clean and well equipped home.

Twenty four people were in residence when we undertook our inspection; the home supports people with dementia related conditions. We spoke with three people living in the home, two visitors, seven staff, a visiting healthcare professional and the deputy manager.

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a safe home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw that care was provided by skilled staff who knew the needs of people well. They felt that the management of the home was supportive and encouraging. One staff member told us, “We are well supported and work as a team.”

We checked records were stored safely and correctly and systems were as required. This was to ensure people’s confidential information was stored appropriately.

Some people using the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views we observed interaction between people and the staff. We saw staff provided sensitive support and people using the service were treated with respect.

Medication was recorded correctly to demonstrate the quantity of medicines in the service and how these had been administered. This meant people could not be confident the records matched what had been prescribed to them.

The staff told us they enjoyed working at the home. We saw that all the checks were made to ensure they were fit to do their job.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.