Dorrington House (Wells)

Updated 27 January 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a focused inspection to check whether the provider had met the requirements of the previous inspection and to review concerns raised since the last inspection.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors who were on site for one day.

Service and service type

Dorrington House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager but at the time of inspection they were awaiting their CQC registration decision after completing their CQC interview and were registered shortly afterwards.

Notice of inspection

This inspection was unannounced .

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We spoke to the local authority for their view.

During the inspection

We carried out observations across the day which included lunch time observations and medication administration. We reviewed electronic care plans for three people and sampled a number of care plans in relation to medicines. We did an infection control audit and looked at the environment. We looked at staff recruitment records and a number of records relating to the management of the service. We spoke with the manager, the regional manager and a number of staff including the team leader and domestic.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two healthcare professionals who regularly visit the service. We spoke with four staff and two relatives. We gave immediate feedback following the inspection to the regional manager and manager and arranged verbal feedback to the providers on 4 December 2020 and followed this up with written feedback.

Updated 27 January 2021

About the service

Dorrington House is in Wells-next-the Sea and is a residential care home providing personal and nursing care to people aged 65 and over at the time of the inspection. The service can support up to 38 people predominately living with a diagnosis of dementia. The service accommodates people in one building which has ground floor and first floor rooms and two lifts; one 21-person and one 8-person lift, in-between.

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

People were generally not able to tell us about their experiences as some people were living with cognitive impairment and we only spent a limited amount of time on site. We did observe the care and support people received across the day. We spoke with some people’s families who were happy overall with the standards of care. They said the level of communication between themselves and the service was good although one family member stated that there had not been clear communication in regard to the pandemic in terms of visiting arrangements. Most relatives had not had face to face contact with their family member for some time but received regular updates. A covid visitors policy was in place which was viewed at the time of the inspection.

During this inspection we identified repeated breaches of regulation.

Although the service had some regular, longstanding staff who knew people well there was also some staff who were not as familiar with people’s needs. This was of particular concern for those people unable to make staff aware of their needs. Training records showed that several staff currently showing on the rota and working unsupervised did not have current training in manual handling. Other training gaps were also identfied by the training record. The provider stated some of these gaps were for bank staff or staff off sick. However there were also gaps for staff currently working without the required training.

Staffing levels were determined on people’s assessed needs. Although the service demonstrated that it usually had the agreed number of staff there were times when staff were redeployed into other roles, and this was observed on the day of our visit. Staffing vacancies, staff sickness and shielding staff meant that the service did not always have all roles covered. This had a direct impact on the safety, cleanliness and level of social activity within the service.

Recruitment of new staff was not sufficiently robust for all staff and the provider had not ensured all staff had the necessary skills and abilities for their role. They did complete checks prior to employment such as work history and references and disclosure and barring checks.

The premises were not conducive to people’s wellbeing and we identified a number of risks to people’s safety which had not been identified by the provider. Equipment was checked but not in line with the requirements, and we found some items to be unsafe.

Care plans, risk assessments and an analysis of accidents and incidents did not provide sufficient evidence of how risks were pre-empted and where possible mitigated.

Medicines were managed and administered by trained, competent staff and generally managed safely although we did identify a number of issues. A number of medicines concerns had been identified since the last inspection meant medicines had not always been safely managed.

The provider had not ensured there was effective oversight. The governance and quality systems had not identified shortfalls in the service or ensured improvements were sustained over a period of time.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 16 October 2019) and there were three breaches of regulation. The provider completed an improvement plan after the last inspection to show what they would do and by when. At this inspection we found sufficient improvements had not been made and the provider continued to be in breach of the regulations.

Why we inspected.

The inspection was carried out based on the previous rating and breaches of regulation. There had been a change of manager and a number of safeguarding concerns and whistleblowing concerns received, however from investigation by the local authority, these were not substantiated. A decision was made for us to inspect the service and examine any potential or actual risks to people. 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 Requires Improvement. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively.

We found evidence during this inspection that people were not fully protected from infection, prevention and control risks. Please see the safe and well-led sections of this full report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified ongoing breaches in relation to staffing, fit and proper person checks for staff newly employed, cleanliness and condition of the premises and equipment, and good governance.

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.

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

We always ask the following five questions of services.