Archived: Dormie House Residential Care Home

As the provider is an individual, the service is not required to have a separate registered manager. The provider is the ‘registered person’ and manages the day to day running of the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection in August 2016, we found the provider was in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found sufficient improvements had been made and the provider was no longer in breach of these regulations.

People were assured of their safety in the home now because the provider and care staff were able to demonstrate a full understanding of safeguarding and what constituted abuse.

There were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. The premises were well maintained and any safety issues were rectified promptly.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work and all new members of staff completed an induction. Staff were supported well by the provider.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The provider understood the requirements of the MCA, although everybody living in Dormie House was deemed to have capacity and nobody was subject to DoLS. 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 had enough to eat and drink and enjoyed their meals. If needed, people’s intake of food and drinks would be monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Relatives were welcome to visit as and when they wished and people were encouraged and supported to be as independent as possible. People were also able to follow pastimes or hobbies of their choice.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise any identified risks.

The service was being well run and people’s needs were being met appropriately. The provider and care staff were ensuring that a good quality service was provided and were promoting values that included involvement, compassion, dignity, independence, respect, equality and safety.

There were a number of systems in place to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the provider in order to identify any areas that needed improvement.

This focused inspection took place on 18 August 2016 and was unannounced.

Dormie House provides residential care and support for up to eight older people. At the time of our inspection, six people were living in the home.

As the provider is an individual, the service is not required to have a separate registered manager. The provider is the ‘registered person’ and manages the day to day running of the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People could not be assured of their safety in the home because neither the provider nor staff working in the home demonstrated a full understanding of safeguarding or what constituted abuse. This was because they did not recognise the signs of abuse, including emotional and psychological abuse, or report any issues of concern appropriately.

The provider did not respect people’s individual preferences or choices with regard to what they were able to eat and drink or how, where and when they spent their time. People were unhappy with the way they were treated and spoken to and the strict house rules. People were also afraid of ‘upsetting’ the provider.

The provider did not demonstrate good governance because people living in the home, their relatives and staff were not empowered to make decisions nor be involved in the development or improvement of the service. Concerns or complaints were not responded to appropriately and steps were not taken to ensure sufficient improvements were made for people’s quality of life.

Our findings from this focused inspection were that the provider was in breach of two regulations 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.

As the provider is an individual, the service is not required to have a separate registered manager. The provider is the ‘registered person’ and manages the day to day running of the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were safe and lived in a safe environment because staff knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. In addition, there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. The premises were well maintained and any safety issues were rectified promptly.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work and all new members of staff completed an induction. Staff were supported well by the provider.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The provider understood the requirements of the MCA, although everybody living in Dormie House was deemed to have capacity and nobody was subject to DoLS.

People had enough to eat and drink and enjoyed their meals. If needed, people’s intake of food and drinks would be monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Relatives were welcome to visit as and when they wished and people were encouraged and supported to be as independent as possible. People were also able to follow pastimes or hobbies of their choice.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise any identified risks.

People and their families were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

The service was well run and people’s needs were being met appropriately. Communication between the provider, staff, people living in the home and visitors was frequent and effective.

There were a number of systems in place in order to ensure the quality of the service provided was regularly monitored and regular audits were carried out by the provider in order to identify any areas that needed improvement.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with five people who used the service and two staff members. In addition, we looked at three people's care and support plans.

Is the service safe?

Risk assessments were in place to ensure that, as far as was reasonably practicable, people were safe in the home and that staff were safe in their working environment. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with on-going support, training and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked at staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs throughout the day and night.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people living in care homes. At the time of the inspection no applications to restrict people's freedom had needed to be submitted. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one.

Is the service caring?

People we spoke with said that staff treated them with respect, consideration and dignity. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received.

One person told us, "It's fabulous here. I feel so at home." Another person said,"[The provider] is very approachable. They listen and spend a lot of time with us. It's appreciated."

People's needs were assessed by staff and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing the care.

During the inspection we observed that staff were kind and caring in their interactions with people. We saw that staff made every effort to ensure people were comfortable and engaged.

Is the service responsive?

The provider had a system of dealing with complaints although at the time of the inspection no complaints had been received. People knew how to make a complaint if they were unhappy about the service they received. The complaints process was displayed in the entrance hall, making it easily available to people and visitors to the home. Where shortfalls or concerns were raised these were addressed by the provider immediately

People told us that the provider responded to their changing needs in a timely manner. This meant that personal needs were assessed and reviewed on a monthly basis or as and when needed. Where changes occurred, the service referred to health professionals for advice and guidance if required. All changes were accurately documented and recorded.

People who used the service and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

People using the service that we spoke with told us that the care and support provided was of good or very good quality. From our observations we saw that care and support was effective and consistent.

Where practicable people were supported to be as independent as possible.

We saw that staff knew the people they were supporting and that the people receiving the care and support were happy. We noted that if something was not right that staff responded quickly to resolve matters.

People told us, or indicated to us, that they liked living at Dormie House and that staff were kind and caring.

Is the service well led?

Views of people using the services and, where possible, of their families were obtained and opportunities were in place for social gatherings where further views and opinions of the services, and staff, could be gained by the provider.

Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training, or support, that they were confident this would be arranged by the provider.

There were quality monitoring systems in place and regular audits and spot checks took place to ensure that people received a good service.

Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.

Needs assessments, care plans and risk assessments had been revised and were now informative and personalised. The service was planning and delivering care and support so that people were safe and their needs were being met.

Medicines were being recorded and managed appropriately and an audit system was now in place to help identify any errors or omissions. Medicines were handled and monitored appropriately.

The development of staff was supported through a system of supervision and appraisal which was now in place.

We found that people's care plans had been redesigned. Care plans were person specific and had been reviewed on a monthly basis. We also found that risk assessments had now been completed and were comprehensive and appropriate.

When we checked records for medicines administration we found they were complete and up to date.

Records we reviewed showed gaps in recent medicines administration however people told us they had been receiving medicines as usual. Care records and people's medical information were in need of updating and risk assessments were uncompleted or considerably out of date.

Staff felt well supported by the manager, who lived on the premises, however there was no system in place for staff appraisals.