Archived: Dovehaven

Dovehaven 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. Dovehaven is a care home providing accommodation and personal care for up to 40 older people. There were 37 people accommodated at the time.

The service had a registered manager in place at the time of the inspection.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The last inspection of Dovehaven took place in December 2017 and was a focused inspection to follow up on two breaches of regulation in relation to fire safety, staffing, and governance. These breaches had been identified at the comprehensive inspection in July 2017. At the focused inspection we found the provider had acted to meet the breaches and the requirements were met. The service was rated good at the inspection in December 2017; the rating remained good at this inspection.

People and their relatives said they received safe care and attention in accordance with their individual needs. They also said the staff were polite and caring and this we observed during the inspection.

People's plan of care considered risks to people’s safety and wellbeing. Plans were in place to minimise these risks. Systems were in place for the recording and monitoring of accidents and incidents to identify any trends or patterns that may occur.

People had a plan of care which was centred around their individual support needs. This included plenty of information about their routines, likes, dislikes, preference and choices to enable staff to deliver this how they wished.

People were supported with their eating and drinking needs and staff were aware of people’s personal likes and dislikes in relation to what they ate.

People were fully involved with decisions about their support. Their consent was sought around day-to-day decisions and they were fully involved in any changes made.

The registered provider worked in accordance with the Mental Capacity Act (MCA) 2005 and staff demonstrated a good knowledge around how this was applied in a care setting.

There was an open culture which people and staff were encouraged to speak up if they had concerns. Staff had received training in the protection of adults and knew what action they should take if they suspected or witnessed abuse.

Staff were knowledgeable regarding people’s care and support. Staff had a good understanding of how people liked to communicate and wished to be treated.

We saw liaison with external professionals to support people with their care needs. Referrals to them were made appropriately. For example, doctors and district nurse teams.

People were supported to follow their chosen interests and maintain relationships with relatives and friends that mattered to them. The registered manager was looking at providing a more varied activities programme as they appreciated more events needed to be organised.

Recruitment practices were robust and this helped ensure that only people suitable to work with vulnerable people were employed by Dovehaven.

The management of medicines was safe and medicines were administered by staff who were trained and deemed competent.

Staff supported people with end of life care. Advice and support was available from the district nurse team and other relevant health professionals when needed.

Policies and procedures provided guidance to staff regarding expectations and performance in accordance with current legislation and best practice.

Staff received training which provided them with the skills and expertise to undertake their work safely. This included more specific training to meet more complex conditions and opportunities for staff development. New staff received a comprehensive induction training programme to support them.

Staff members we spoke with fully understood the importance of acknowledging people’s diversity, treating people equally and ensure that they promoted people’s rights.

The registered provider had a complaints’ policy and procedure. Complaints received were logged and investigation in accordance with home the complaints’ procedure.

Confidential information was stored appropriately to maintain people's privacy.

Systems and audits were in place to regularly check standards and to support the continual development of the home.

Further information is in the detailed findings below.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Dovehaven accommodates up to 40 people in one adapted building. Due to its location there is good access to public transport and many local facilities are a short journey away in Southport town centre.

Dovehaven 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.

There was 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.

Improvements had been made to fire safety and staffing levels. An increase in the staffing numbers had been maintained since the last inspection. The registered manager and other delegated staff conducted a ‘walk around’ of the home twice a day to help ensure it was safe.

The home was well maintained, clean and in good decorative order. Measures were in place to ensure the environment was safe and suitable for the people who lived there. Repairs to the building were reported and attended to in a timely way.

Improvements had been made to care records. People's needs were assessed and care plans now contained the required amount of detail to demonstrate the care and support people required. Charts were in place and were completed to record the care and support people received.

Improvements had been made to quality assurance and governance systems. Regular audits took place to help the registered manager and provider monitor standards of care and drive forward improvements.

People's health care needs were addressed. People saw health care professionals when they needed to.

Risk assessments were in place specific to people's individual needs.

Medicines were managed safely and people received their medicines as prescribed.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. There was sufficient staff on duty to meet people's needs. The staff team provided consistent care and support to people they provided cover for each other for holidays and sick leave. When this was not possible ‘bank staff’ who worked for the provider were used. Agency staff were used in an emergency and the same agency staff were asked to work in the home. This ensured there was a staff team who knew people and were familiar with their care and support needs.

Staff received a programme of mandatory and optional training relevant to the care and support people needed. Regular supervision and annual appraisals took place. Staff meetings were held to keep staff informed and to support them in their role.

Care plans informed staff of people’s preferences and wishes and they were regularly updated to reflect any changes in people’s need or preference. People’s routines and preferences were supported.

People enjoyed a range of activities, which included chair exercises, board games, musical entertainment, trips out and visits from children from local nurseries.

A complaints policy and procedure was in place and displayed in the home. No complaints had been received since 2016.

There was a person-centred and open culture in the home. Staff reported that the registered manager and regional manager were supportive and made themselves available to support staff when they needed it. Staff worked as a team and supported each other.

Feedback was sought regularly from people living in the home and their relatives to ensure standards were being maintained.

The registered manager and provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications relating to incidents and the rating from the last inspection was clearly displayed both in the home and on the provider’s website.

Further information is in the detailed findings below.

This was an unannounced inspection and it took place on 17 and 18 July 2017.

At the last comprehensive inspection in July 2016 we found breaches of regulations with in respect to, receiving and acting on complaints and good governance; we rated the home as ‘requires improvement’. We completed a ‘focused’ follow up inspection in December 2016 and we found the breaches had been met. The home retained an overall rating of ‘requires improvement’ as we needed to ensure the service would show a record of consistency with meeting regulations.

At this inspection there was a manager in post who had applied to the Commission for 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.

We found on this inspection that there were 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 this report.

There were systems in place to monitor the environment to help ensure it was safe and well maintained. However, these were not robust and we found that fire safety standards had not been monitored effectively which exposed people to potential risk of harm.

Staffing numbers had been increased since our last inspection and were, mostly, satisfactorily during the day. We found, however, the service had not been adequately staffed at night time for a short period which had left people exposed to potential risk of harm in case of an emergency.

We found the services governance [management] arrangements did not ensure effective monitoring of safe standards of care at all times. Some of the local audits and checks had failed to identify the issues we found on the inspection.

Care plans were completed and reviewed so that people’s care needs could be monitored. We found that some of the care plans and charts used for evaluating care could be more detailed and consistent for staff to follow. We made a recommendation regarding this.

Medicines were administered safely. However, supporting protocols and records had not been completed .These were brought up to date at the time of the inspection.

We found the home supported people to provide effective outcomes for their health and wellbeing. We saw people were referred appropriately to health care services and there was liaison with health care professionals when needed in order to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

Care and treatment was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had. .

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice.

People we spoke with said they were happy living at Dovehaven. Staff interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people.

People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care. There was good support in place for staff to receive training and on-going support

People generally felt involved in their care and there was evidence in the care files to show how people had been included.

Social activities were organised in the home. People told us they could take part in a variety of social events which were held; these continued to be developed.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were good records of complaints made and the manager had provided a response to these.

The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 20 December 2016 to check that they had they now met legal requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered two questions we normally asked of services; whether they are 'responsive' and ‘well led.’ The question 'was the service safe’, ‘was the service effective' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dovehaven on our website at www.cqc.org.uk.

Dovehaven is a care home providing personal care. It can accommodate 40 older people. Due to its location there is good access to public transport and many local facilities are a short journey away in Southport town centre.

There was no registered manager in post 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. A new manager had been appointed and they were due to commence their employment at the service in January 2017. The provider was aware of their responsibility to appoint a new registered manager by applying to us, the Care Quality Commission (CQC), for registration. This is because we require care homes to have a registered manager.

At the previous inspection in July 2016 we found the service was not managing complaints effectively. This was because there was a lack of documented evidence regarding complaints received, investigation and response to complainants in accordance with the service’s complaints policy. At this inspection we found improvements had been made in respect of managing complaints. This breach had been met.

At the previous inspection it was difficult to assess how the service was being monitored as audits of the service were not available. We therefore found the service’s overall governance arrangements were not robust to assure a safe, effective service. At this inspection we found the overall management of the service had improved. We saw how changes had been made to ensure a more robust system was now in place to monitor how the service was operating and to drive forward improvements. This included a series of audits completed by the service and also the senior management team. The clinical governance framework was more effective thus ensuring a safer service. Senior management informed us of more extensive auditing that would be taking place in 2017 to help improve the governance and drive forward improvements.

Dovehaven is a residential home in Southport. It is registered to provide accommodation for 32 people who need support with personal needs.

There was no registered manager in post; the provider had very recently appointed a new 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.

During the last inspection conducted in March 2015 we found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This was in respect of the service not referring safeguarding incidents to the local safeguarding team and issues requiring the service to notify the Care Quality Commission (CQC) had not been made.

On this inspection we checked to make sure requirements had been met. We found improvements had been made to meet necessary requirements. The breach had been met.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. This included alerting senior managers to an incident and also reporting incidents to the local authority. Staff were aware of the whistle blowing policy and said they would not hesitate to use it.

CQC were also now being notified of incidents that affected the service in accordance with our regulations.

During this inspection (July 2016) we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to the way in which complaints were recorded and the systems and process in place to assess and monitor the service.

There was not an effective system in place to receive, handling and respond to complaints from people who used the service.

Quality assurance systems were in place but did not operate effectively enough to ensure people received a well-managed service.

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

Medicines were safely administered to people. Staff supported people to manage their own medicines. This practice was risk assessed to ensure it was undertaken safely. Staff were trained to administer medicines though staff competencies had not been checked as part of assuring safe medicine practices

People’s views were mixed regarding there being sufficient numbers of staff on duty to care for them. This was subject to on-going monitoring by the service. During the inspection we saw support was given to people in a timely manner.

Risks to people’s health and wellbeing had been assessed in accordance with people’s needs. Not all risk assessments had been updated to reflect current risks though staff were aware of the risks and appropriate support was given.

Staff did not always wear protective aprons when serving meals to assure good standards of food hygiene.

We have made a recommendation about reviewing safe working practices.

People said they felt safe living at the home and were supported in a safe way by staff.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the local authority.

Opportunities were in place to address lessons learnt from the outcome of incidents such as falls.

Care plans provided information to inform staff about people's support needs. The manager was reviewing these to make them more centred on people’s individual needs.

People received care and support from the staff and external professionals to maintain their health and well-being.

People’s individual needs and preferences were known by the staff. People told us staff involved them with decisions about their care; not all were familiar with their plan of care.

People told us staff were kind, caring and respectful in their approach.

We observed positive interaction between the staff and people they supported though some comments raised meant people did not always benefit from care and support that was centred round the individual.

People could take part in a social programme led by an activities organiser. This was being developed to ensure activities and social events were to people’s liking. Consideration was also being given to increasing the time allocated for activities.

Staff were recruited safely. Necessary checks had been undertaken to ensure staff were ‘fit’ to work with vulnerable adults.

People were given a varied menu though not always offered the choices available to them. People spoke positively regarding the meals. They told us the meals were appetising and well presented.

Measures were in place to monitor the safety of the environment and equipment. This included service contracts and health and safety checks.

Staff told us they felt appropriately trained and supported. Staff were being provided with training and support to undertake their job role safely and effectively. Many staff had a formal qualification in care, such as NVQ (National Vocational Qualification) or Diploma.

People told us

"People are very kind, I feel safe"

"They (staff) are so caring and work so hard".

"The staff are so cheerful and kind".

Staff told us "It's brilliant here I love it". A relative told us "She is being looked after well here".

We reviewed a range of records at the home and found that they were comprehensive and ensured that people's health and welfare were supported.

We reviewed how people's nutritional needs were being supported. We found that there were a wide range of food and fluids available for people to access and that individual needs were taken into account. People who lived at the home told us they valued the interaction with the chef in supporting them to make choices.

We reviewed processes that were in place to support people to give feedback on the service they received. We saw that there were regular residents and staff meetings and surveys for people to participate in. We reviewed the complaints procedure in the home and were satisfied that that there was a process in place to ensure that people were able to raise concerns and that they would be listened to.

The information provided meant the provider (owner) had a more robust system for identifying and reporting any allegations of abuse within the home

Those we spoke with said the staff knew what support they required and did everything that was needed for them. One relative told us, 'There is stable staff team and they look after [person] well.'

We spoke with three staff. They told us they had received relevant training and understood how to identify abuse although they were not fully aware of how to report any concerns to the appropriate authorities. They felt supported in their job and received supervision from their manager.

We asked people who used the service about the skills of the support workers. They told us the staff worked very hard and knew how to do their job. They said staff were competent.

We spoke to people about the service they received with regards to their involvement in the quality of the service. They told us they had attended meetings so that their views could be known. They said they were able to contact the manager if they ever had a problem with the service.