Dorrington House (Wells)

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.

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

People were supported by staff who were familiar with their needs, but staff vacancies and poor organisation of staff and their workloads on shift meant people did not always receive care which was timely. We were not assured of people’s safety because of hazards identified at time of the inspection. Staff did not have enough oversight of people’s care which meant people were left unsupervised increasing the risk to people from falls or other avoidable harm.

Standards of cleanliness were not being adequately maintained which was attributed to there being insufficient numbers of staff.

Improvements had been identified by the service but at the time of inspection these had not been fully implemented. There had been concerns about the safe administration of medicines, but this was an area that had recently improved.

Management was not effective because their own quality assurance processes had not identified immediate risks to people’s health and safety or lessons learnt following incidents.

The service provided a range of activities which enhanced people’s wellbeing, but this could be increased further by deploying staff effectively across the day, particularly at lunch time which could be more of a social occasion.

Staff received the training considered mandatory and were sufficiently supported by management. We have made a recommendation about staff supervision.

Care and support plans were up to date and showed consultation in drawing up assessments and care plans and highlighting changing and unmet need. We have made a recommendation about training in end of life care.

People had support to help ensure they had their health care needs identified and met. People were supported to maintain a healthy weight but more supervision around meal time would help promote a positive meal time experience and encourage people to eat.

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. We found however records did not always clearly record people’s consent in the examples given in the report.

The last rating for this service was Good. The last report was published (14 November 2016.)The service is now rated Requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of regulation in relation to safe care, which included cleanliness, staffing at this inspection and recruitment.

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.

Follow up

We will request regular information from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The home has had the current registered manager in post since January 2016. 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.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were usually enough staff available to meet people’s needs although people sometime had to wait when there were sudden shortages. Recruitment checks for new staff members were obtained before new staff members started work.

Although medicines were securely stored, temperature checks of storage areas showed high temperatures, which put the effectiveness of medicines at risk. Medicines were safely administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interest decisions had been made.

Most people enjoyed their meals and were able to choose what they ate and drank. Guidance for staff about how much people should drink each day was not always available and records showed that some people did not drink enough. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. Staff responded well to people’s needs and support was nearly always available. Care plans contained enough information to support people with their needs.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or other staff members could speak with him at any time.

The provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

Below is a summary of what we found.

Is the service safe?

People who we spoke with told us they felt safe and that they liked the staff. One person said, 'I feel safe here.'

People were protected from the risk of abuse as staff had received training and were clear about their responsibilities to recognise and report any concerns. This meant that people were protected from the risk of harm.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had a system in place to demonstrate that they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes have affected the decision and how they were involved in the decision making process.

There were effective recruitment and selection processes in place. appropriate checks were undertaken before staff began work.

Is the service effective?

People we spoke with told us that they were happy with the service which they received. The relatives we spoke with told us that overall, the service met the needs of their family members.

Staff worked closely with professional health staff to ensure that people's needs were met. Care plans were personal to each individual and were reviewed on a regular basis. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

One of the staff we spoke with said, 'I get good support from everyone. It's team work.'

Is the service caring?

We spoke with three people who used the service. Each person said that they liked the staff. We spoke with four relatives. One person's relative said, 'I find all the staff very good. They are kindness itself.' Relatives said that the management team kept them well-informed about the needs of their family members.

Staff told us how they supported people with their personal care and daily living needs. They were able to talk about people's likes and dislikes.

During our inspection, two relatives expressed concerns about the quality of communication from some staff with those people living with dementia. One relative said, "I think communication might be an obstacle, although staff do their best under the circumstances."

Is the service responsive?

People's needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people's likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities of their choice and were encouraged to participate in activities within the local community.

Is the service well led?

Staff told us they felt well supported by the management team. They told us they received guidance from the management team.

The majority of relatives we spoke with told us they felt the service was well-managed. Some relatives we spoke with said they were confident to raise any concerns or complaints they had with the manager and knew they would be resolved. One relative said, "The manager is very approachable.' Some relatives we spoke with were not satisfied with the complaints process.

The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

People's care needs were assessed and from these assessments care plans were drawn up. The care plans reflected people's preferences and rights. For example, one person was supported to take regular walks in the town. Their right to make an informed decision about the risks involved had been respected and plans had been put in place to manage the associated risks.

All the people we spoke with enjoyed the food, however one person found the choices a bit repetitive at times. We observed the lunchtime period in one of the dining areas. Where people needed support to eat this was provided and we found that staff were attentive to people's needs.

We reviewed staff records and found that staff were trained, supervised and appraised on a regular basis. This meant staff were properly supported to provide care and treatment for people living in the home.

There was an effective complaints procedure in place which was publicised to people living in the home and to any visitors.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People reported that they felt respected and involved by staff. The visitors confirmed that they were consulted with about the care that their relatives were receiving and felt able to talk to staff if they had any concerns.

People told us that they were satisfied with the care, attention and kindness shown by staff. For example one person told us that, 'Nothing is too much trouble for the staff'. They confirmed that they were well looked after and that their independence was promoted wherever possible. For example one person told us that, 'The staff are very kind'.

We found that people expressed their views and were involved in making decisions about their care and treatment. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from unsafe or unsuitable equipment because the provider had systems and processes in place to ensure the safety, availability and suitability of equipment. We found that decisions about care and treatment were made by the appropriate staff at the appropriate level.