Dothan House

Dothan House is a residential care home providing personal care to older people some of whom may have dementia, mental health needs or physical disabilities. The service can support up to 19 people and at the time of the inspection, 18 people were living in the home.

Dothan House is a purpose built, two floor building. Each floor or unit has separate adapted facilities.

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

The provider had made improvements to the home following our last inspection in October 2018. Premises and equipment safety was maintained to ensure the environment was safe for people. There were suitable evacuation procedures in place in the event of a fire and there was regular maintenance of gas appliances and the lift service. Arrangements for the ordering, storage and administration of medicines was safe. However, we found some recording errors that had yet to be identified, which could put people at risk. We have made a recommendation to ensure medicine records and audits are more robust to identify errors.

There were procedures to protect people from abuse and staff understood how to report abuse. Staff were recruited safely and their backgrounds checked before they started working in the home. Risks associated with people's needs were assessed and staff understood how to reduce these risks. Staff followed infection control procedures to maintain the hygiene and cleanliness of the home. Accidents and incidents that had taken place in the home were reviewed to identify trends and learn lessons to help prevent them re-occurring. Staffing levels in the home were assessed and the home had suitable numbers of staff available at all times to provide support.

Staff were provided with suitable training to ensure their skills and knowledge were up to date. Staff felt supported by the registered manager and received regular supervision and assessments to monitor their performance and discuss any concerns.

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. People were supported with maintaining their health and nutrition. The service worked in collaboration with health care professionals, such as GPs, nurses and speech and language therapists to ensure their health needs were met. People were encouraged to maintain their independence as much as they could.

Staff were respectful and caring towards people. Staff knew how to communicate with people who had difficulty speaking. Staff understood the importance of promoting equality and diversity.

Activities took place in the home and people were encouraged to participate in them if they wished. Staff interacted and engaged with people throughout the day and were not made to feel isolated.

People and their relatives were supported to make complaints about the home. There were quality assurance systems to monitor the safety of the home through audits, checks and obtaining feedback from people and relatives.

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 6 December 2018) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

Dothan 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.

It is a care home for up to 19 older people, some of whom may have dementia. At the time of our inspection, there were 13 people living in the home.

We last inspected the home on 22 and 23 February 2018 and we rated the service ‘Inadequate’. This was because we found breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2017. These were in relation to providing safe care and treatment, safeguarding people from abuse, providing person centred care, receiving consent to care from people, maintaining clean and safe premises, following safe recruitment processes, supporting staff with training and the overall governance and management of the service. In addition, the provider had also breached conditions of their registration. The provider sent us an action plan to tell us how they intended to improve the service.

We placed the service in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We have now rated the service ‘Requires Improvement’.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

The registered manager demonstrated the work they had carried out since the last inspection. We saw that improvements had been made in ensuring people were safer and they were protected from abuse. Staff were recruited appropriately and the necessary background checks were undertaken to ensure they were fit and proper persons. At our last inspection, we found serious risks to people as the home was not equipped to deal with the event of a fire spreading. The building had undergone a full fire safety inspection since our last inspection and was now compliant with fire safety requirements.

However, despite the improvements, we found there were some on-going issues because the safety of the premises was not always adequately maintained. A professional electrical installation safety check of the premises was judged to be ‘unsatisfactory’ and recommended electrical works to rectify the faults had not been completed. This placed people at potential risk of harm because the building and premises was not fully safe.

Risk assessments had improved but there was some inconsistency in how all risks to all people were assessed. We have made a recommendation in this area.

Medicines were managed more safely and there was a procedure in place for staff to follow. We found that records were accurate and up to date. However, some medicines were not administered in the correct method. We have made a recommendation in this area.

Complaints about the service were responded to appropriately and in a timely manner. However, complaints were not recorded fully and we have made a recommendation about complaints recording.

Staff had received an induction and training to ensure the service they provided to people was effective. Some staff required further training in key areas and we saw that this was scheduled. The provider did not always follow Mental Capacity Act 2005 processes to assess people's capacity and we have made a further recommendation on this.

Therefore, the provider's quality assurance systems and processes were not always effective in identifying all shortfalls in the service to assess, monitor and improve the quality and safety of the service.

At our last inspection, the provider had failed ensure the latest CQC ratings of their inspection were displayed on their current website, which is required by law. This was still the case at this inspection, which meant the provider was in breach of their conditions of registration.

People were treated with dignity and respect when personal care was provided to them. People were listened to by staff and were involved in their care and support planning. Care plans were now more person-centred with people's preferences and choices for activities.

People's care and support needs were assessed and reviewed regularly to ensure people received appropriate support based on their current needs.

Staff were supported with regular supervision by their managers. They told us they could approach the registered manager with any concerns.

There were enough staff available to provide care and support to people. The registered manager and staff worked with health professionals if there were concerns about people's health.

People were supported to have their nutritional and hydration requirements met by staff, although their fluid intake was not recorded effectively. Meals and drinks were provided and people could choose them from a menu.

The registered manager was supported by the provider and an external consultant, who carried out regular checks on the home. Feedback was received from people and relatives to check they were satisfied with the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Dothan House is a 'care home' that accommodates up to 19 people some of whom may be living with dementia. On the day of our visit there were 17 people using the service. 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.

On the day of our inspection there was no registered manager. This was a breach of the registration conditions. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service was unsafe. Risks to people and their environment were not always mitigated. Substances hazardous to health were not always stored securely to protect people from harm. We found two radiators without covers or risk assessments in place to mitigate the risk of burns. The premises were not always clean or well-maintained posing a health and trip hazard for people.

Fire equipment was not always easily accessible and personal emergency evacuation plans located by the fire exits were not up to date posing a risk in the event of a fire.

Medicines were not managed safely. Procedures to administer covert medicines, homely remedies and as required medicines were not always followed.

People and staff told us the interim manager was approachable and listened. However we found inadequate governance systems in place. These did not ensure that staff training was up to date and people’s records were not accurate. Policies although signed as reviewed annually, were not up to date or reviewed regularly. The current systems had failed to ensure we were sent all notifications as required by law.

There were ineffective training systems in place. This left staff without up to date training in essential areas such as moving and handling, dementia awareness and behaviours that challenge the service.

Staff had limited understanding of the Mental Capacity Act 2005 (MCA) and how they applied it in practice. This was evidenced by incomplete or out of date capacity assessments and best interest decisions for decisions such as covert medicines authorisation.

Although the premises had murals to stimulate people living with dementia, staff were unaware of how these could be used to engage with people.

People were supported to eat a balanced diet by staff that understood their needs.

People told us they were able to raise any issues. However, we found shortfalls within the current complaints system. The complaints log did not always contain the details of the full investigation, any outcomes or learning from complaints raised. We made a recommendation to ensure the policy is followed and all complaints are dealt with transparently.

People had access to some information. However we made a recommendation about following the accessible information best practice guidelines.

Care plans were not always reviewed to reflect people’s current preferences and support needs. However, they reflected end of life preferences where people and their relatives had outlined their preferences. We made a recommendation for further support for staff in relation to end of life care delivery.

People told us staff were polite and kind. However, we saw instances where peoples dignity was not preserved these included deferring to attend to continence needs and requests for a cup of tea.

Full Information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Dothan House is registered to provide accommodation and support with personal care for up to nineteen people. On the first day of our inspection seventeen people were using the service, most of whom were living with dementia. The service is provided in a detached house with a garden. Some rooms have en-suite facilities and some rooms have hand basins. There are communal bathrooms for people to use. There is a lift for people who have rooms upstairs.

At the time of the inspection there was a registered manager at the service but they had left their post to take up a more strategic role with the provider earlier in the month and were no longer in day to day charge of the service. An interim manager had been in charge of the home since then. The interim manager will make an application to the Care Quality Commission to become the registered manager once the current registered manager cancels their registration. 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.

People were happy with the care and support they received. The relatives we spoke with were complimentary about the service, one relative had recommended the home to three other families.

Staff knew how to keep people safe from abuse and from other risks to their health and wellbeing. Medicines were managed safety and arrangements were in place to keep people safe in an emergency. Risks had been identified and strategies put in place to address them. Staff knew how to respond when people became upset and how to calmly support them in accordance with their care plans.

There were enough staff to meet the needs of people throughout the day and different activities were planned depending on the type of activity people were best able to enjoy.

Staff were attentive and caring and treated people with dignity and respect.

People’s needs were assessed and reviewed regularly. Care plans were updated as people’s needs changed.

Staff were supported by having supervision and training and we saw that people updated their knowledge to enable them to provide best care and support to people. However, we noted that staff had not had a formal annual appraisal to help them reflect on their achievements and their learning and development needs.

We have made a recommendation about the service setting up regular annual appraisals for staff.

Staff ensured that people had good nutrition and hydration that met their dietary needs. Staff ensured that people had prompt and appropriate access to healthcare professionals as this was needed. Staff followed the advice given to them by the healthcare professionals in order to best meet each person’s individual needs.

There was a clear management structure in place. People and staff told us they found the interim manager approachable.

There were systems in place for people and their relatives to make comments, compliments and complaints about the service and we saw examples of where these had been acted on.

There were regular health and safety checks and audits to ensure the quality of care and the safety of the premises.

As part of this inspection we spoke with nine people who lived at Dothan House. Most people were able to tell us a little about what they thought about their care. We spoke with six relatives of people living at the home, five members of staff and a hospice nurse who was caring for a person on the day of our visit. We reviewed records relating to the management of the home, which included three care plans, three staff files, daily care records and records about how the home monitors its own performance and the quality of care.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed during the visit and what we saw in the records we looked at.

Is the service safe?

People were safe from the risks of abuse because staff were well trained and informed about this area and knew what to do if they had concerns. However, no information about safeguarding was made available for people or their relatives. The care plans we looked at showed that people's risk were assessed and staff knew how to manage these risks.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act and is concerned with people's safety and well-being where they are not always able to make decisions for themselves. Some arrangements had been put in place to care for people under DoLS. Additional arrangements to care for others under DoLS were required.

Is the service effective?

Most of the people we met were cheerful and looked well cared for. People's relatives told us they were very happy with the care provided. One person said 'The care is really good. People are not just sitting round all day doing nothing.' Another said 'Mum was very poorly when she came here. We were really worried about her. She has been here for a while now and is really well. The staff have been brilliant with her.'

The staff took great trouble to ensure the service helped people cope with their dementia by creating a lively and stimulating environment and ensured people could easily find their way around the house. The staff we spoke to understood people's needs and how to care and support each person.

Is the service caring?

People were supported by kind and attentive staff. People were able to do things at their own pace and were not rushed. Staff took time with people who enjoyed being with staff and sharing a joke. All the people we spoke to said that staff were kind, helpful, patient and attentive.

Is the service responsive?

Staff were responsive to the needs and wants of people living at the home. People were encouraged to make decisions about their own care wherever possible and the choices people made were respected by staff. We saw that support offered to people changed in line with their individual needs and in a timely way. The home ensured people's medical needs were met and worked well in partnership with other health professionals to support people living at the home appropriately.

Is the service well lead?

The service was led by an efficient and knowledgeable manager who had specific expertise in dementia care. The emphasis of the leadership was on providing a demonstrable quality service and ensuring staff had the skills, support and training to enable them to deliver bespoke care. Recruitment procedures were thorough and included full checks on suitability, skills and experience of potential employees.

There were systems in place to ensure that people received their prescribed medication appropriately.

We found that staff were competent and received training and support to enable them to provide a service that met people's individual needs. A healthcare professional told us 'it's easy to work with them, they know what they are doing.' A relative said 'they definitely all know what they are doing.'

We saw that people's complaints were fully investigated and resolved, where possible, to their satisfaction. The provider monitored the quality of the service provided to ensure that people were safely receiving the care and support that they needed.