Dorley House Residential Care Home

Dorley House provides care and accommodation for up to 33 older people with care needs associated with older age including dementia. There were 25 people living at the service on the day of our inspection. Dorley House is an adapted building in a residential area of Eastbourne with a passenger lift and access to outside areas.

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

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 received positive feedback from relatives who told us they felt their love ones were well looked after at Dorley House Residential Care Home.

Staff had a good understanding about how to recognise and report any concerns. Staff felt supported by the managers and able to raise any concerns if needed.

There were safe recruitment processes in place. New staff completed a period of induction and all staff had one to one supervision and appraisals. Staff meetings took place regularly to ensure all staff were up to date with any changes or improvements needed.

Medicines systems had recently been reviewed and improvements implemented. People received their medicines safely and in accordance with their prescription.

The home was clean and tidy. There were designated housekeeping staff who completed a daily cleaning schedule.

People were able to spend time in communal areas of in their rooms. Some people had personalised their bedrooms with trinkets and photographs. A programme of redecoration was in progress.

We observed staff interactions with people and activities taking place in communal areas. People responded openly and with a smile when spoken to by staff. Music and activities were taking place throughout the day.

The registered and home manager supported by the provider, carried out regular quality assurance which included all aspects of the day to day running of the home. An improvement plan was also used to facilitate ongoing improvement.

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 good (published 27 May 2022).

Why we inspected

The inspection was prompted in part due to safeguarding concerns raised with the local authority regarding care provision and the environment. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorley House Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dorley House provides care and accommodation for up to 33 older people with care needs associated with older age including dementia. There were 31 people living at the service on the day of our inspection. Dorley House is an adapted building in a residential area of Eastbourne with a passenger lift and access to outside areas.

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

A new manager had recently been recruited and was in the process of registering as manager with CQC. The manager had begun to review systems and processes and was working with staff to develop and improve the service.

Care records included details about people’s individual needs and associated risks. Documentation was reviewed regularly. Improvements to the detail in daily records and documentation had been identified and staff were being supported to implement these improvements.

Staff and relatives told us that the manager was open and approachable. People living at Dorley House responded positively to staff and we observed staff supporting people with kindness and respect.

There was an ongoing programme for staff training. New staff received an induction and worked towards the Care Certificate. Staff received supervision and staff meetings had taken place.

People received their medicines at the right time and medicine policies were in place to support staff.

Quality assurance systems were in place. This included all aspects of care, environment and services. The provider and manager worked together with staff to develop action plans to facilitate learning and improvement.

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.

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 good (published 5 May 2021)

Why we inspected

We received concerns in relation to safeguarding people living at the service. A decision was made to carry out an unannounced inspection to examine these risks. We undertook a focused inspection to review the key questions of Safe and Well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this report.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained as good, based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorley House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We found that improvements had been made following the last inspection. Documentation was stored on an electronic system and included relevant information about people’s care and support needs. Care plans and associated risk assessments provided guidance for staff about people’s individual and environmental risks. People received their medicines safely. Medication records had been audited and reviewed by the manager.

People’s personal preferences had been considered, they, and their relatives (if appropriate) had been involved in decisions about their care. The service worked closely with other healthcare professionals to ensure peoples physical and mental health needs were met.

Staff received training and supervision to ensure they had the skills, knowledge and support to provide people’s care safely. The manager had ensured refresher training had been provided and there was an ongoing training, competency and supervision schedule.

Recruitment procedures ensured only suitable staff worked at the service. New staff completed an induction, training and competency assessment before working unsupervised. Some tasks were delegated to senior care staff. However, the manager had oversight of all staff training, supervision and competency checks completed.

Robust quality assurance checks and had been completed. The manager had implemented a new programme of auditing and observations. This was ongoing and used to identify areas for improvement and learning. Actions had been highlighted and work had taken place to implement improvements. Although some improvements were recent, the positive impact on people and staff of these improvements was evident.

There were systems in place to ensure people were safe. Infection prevention control measures meant people were protected, as far as possible, from the risk of COVID-19. Staff knew what actions to take to protect people from the risks of harm or abuse. Staffing levels were appropriate to meet the needs of people living at the home. We saw staff respond to people promptly offering support and reassurance when needed.

People spoke highly of the meals provided. Nutritional needs had been assessed and reviewed. People were provided with choices and menus were regularly updated to incorporate new meals requested by people. Kitchen staff knew people well and supported care staff to ensure peoples nutritional needs were met.

There was a positive and friendly atmosphere at the home. People engaged in daily activities if they chose. There was a daily activity schedule, however, this was changeable based on people’s wishes on the day. People were seen to interact positively with staff and each other, staff told us there were small friendship groups which had developed. People were able to spend their day how they chose. For those who preferred to spend time in their rooms, one to one support was offered.

Staff told us they felt supported by the manager. People, relative's and staff views had been sought. All feedback gained was used to further improve the service.

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 24 October 2018). There was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced inspection of this service on 19 December 2019. A breach of legal requirement was found in relation to Regulation 17 Good governance. We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

We found the following examples of good practice.

At the time of our inspection the home was recovering from an outbreak of Covid-19. Only one person remained in isolation in their room. People who had completed their period of isolation were now able to access communal areas. Dorley House had a large open communal dining/lounge area and separate television area. Staff were supporting people to remain safe, however, due to people’s dementia and memory loss it was not always possible to ensure people remained socially distanced. The manager had made some changes to seating arrangements in the dining room to support this.

The home had designated housekeeping staff to maintain appropriate levels of cleanliness. This included regular and deep cleaning of bedrooms, communal areas, bathrooms and toilets. All staff ensured regular disinfection of frequently touched surfaces of the home for example door handles and keypad entry systems. Any new admissions to the home were tested prior to admission and required to isolate in accordance with government guidance.

Current guidance was being followed in relation to infection prevention and control. Personal Protective equipment (PPE) stations were located around the home and staff were wearing PPE appropriately. Visiting was in line with government guidance, people entering the home were offered Lateral Flow Covid-19 tests, temperatures were taken and PPE provided. The manager had a programme in place to ensure people and staff were tested regularly. This was alongside twice daily temperature testing for everyone and observing people for any signs or symptoms of Covid-19. The manager spoke highly of staff and was proud of the hard work and commitment staff had maintained at the home throughout the Covid-19 outbreak.

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

We have made recommendations about the management of safeguarding processes, dementia support, Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS).

We found concerns relating to documentation. There was an over reliance on verbal information being shared between staff. Staff were aware of peoples care needs, however, people's daily records were not consistently recorded to include all relevant information about people's care.

At the time of the inspection there was no registered manager in position. There had been four managers appointed by the provider since the last inspection. The newly appointed manager had worked at the service for approximately one month and had commenced the process to register with The Care Quality Commission (CQC).

People felt safe living at Dorley House, telling us it was a nice place to live. Staff told us the repeated changes in management had made things difficult, but they found the new manager supportive and were keen to make improvements moving forward.

Care planning and documentation relating to people’s care, support needs and associated risks needed to be improved to ensure people received the appropriate care to meet their needs. Care documentation was difficult to follow and did not demonstrate actions taken in the result of assessments being completed. Nutritional needs were not clearly documented. Specific health care needs did not have appropriate guidance in place for staff to ensure that care was provided safely and consistently.

Improvements were needed to ensure that the environment and the care provided to people met the needs of people with dementia and/or cognitive impairment.

Staff had an understanding around safeguarding people against abuse however, not all incidents had been reported to the local authority or CQC as required.

Care documentation was task orientated and did not demonstrate how decisions had been made in a person’s best interest or who was legally entitled to make decisions on a person’s behalf. Improvements were needed to ensure the service worked within the principles of the Mental Capacity Act.

Records were not person centred and did not demonstrate measures in place to prevent social isolation. Activities needed to be improved to ensure that people had stimulating dementia appropriate activities and sensory stimulation, particularly for people who spent long periods alone in their room.

A schedule for audits was in place, and a variety of checks and audits had been completed by designated persons in September and October 2019. However, when an action was identified no information was recorded to demonstrate whether the issue had been rectified or changes implemented.

Staff knew people and responded promptly when support was needed. Staff spoke to people with kindness. Medicine processes were safe. Peoples nutritional needs were met, and the service worked well with other health care providers and professionals.

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 12/03/2018)

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns about the home employing a number of different managers since the last inspection.

Enforcement

We have identified a breach of regulation. This is in relation to Regulation 17 (Good Governance).

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of governance. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dorley House is a residential care home. The home provides personal and nursing care for up to 24 people aged 65 and over. At the time of the inspection there were 24 people living at the home, some of whom were living with dementia. The rooms are arranged over three floors with a lift to all floors. The home has several lounges including a sun lounge which opens out to the front garden and a large garden at the rear of the home.

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

We undertook a comprehensive inspection on 6 November 2018 which was unannounced. This inspection was in response to information of concern that we received in relation to; people not being treated with dignity and respect, inconsistent care planning and delivery, people’s consent to care and treatment, quality monitoring, restrictive practice and poor management.

The local authority has taken action to work closely with the provider to help them improve their systems and processes to deliver safe care and treatment. The provider has taken proactive steps to introduce action plans to improve key areas of practice. Subsequent to the inspection on 6 November 2018, the provider shared their action plan with us to demonstrate how they intend to address areas of concern, their plan for improvement and their intended timescale for completion. We undertook a second day of inspection on 22 January 2019 to ensure that improvements that the provider had planned had been implemented. Whilst action has been taken to reduce risks to people and improve the level of care people receive, these action plans will need to be fully embedded to show improvements have been made and sustained. This report covers our findings from both days.

People’s experience of using this service:

•Quality assurance processes did not always identify issues in practice to effectively evaluate and monitor care delivery and drive improvements.

•People’s care plans were not always consistently reviewed and updated to ensure changes to people’s health and support needs where recorded.

•People’s consent for the use of CCTV had not been sought. We have made a recommendation about involving people in decisions about the use of CCTV.

•People’s needs had not been assessed to identify if people required specialist equipment such as plates guards to support them to eat independently.

•People were safe from the risk of abuse and staff followed the local authority’s policy and procedure to raise concerns.

•Accidents and incidents were managed and lessons learned to improve people’s care.

•The home was clean and people were protected from infection risks.

•Staffing levels met people’s needs and staff were suitable to work with people.

•People received effective care from skilled and knowledgeable staff.

•One person told us, “It’s very nice here, they look after us well.”

•People were respected as an individual, with their own social and cultural diversity, values and beliefs.

•People received kind and compassionate care.

•One person told us, “I have a good relationship with the staff; they like me and I like them. They have time for a chat If I want.”

•A range of activities were available to people to enhance their lives.

•There was a complaints procedure in place which was accessible to people and relatives.

•People’s wishes for end of life care were recorded where appropriately.

More information is in the detailed findings below.

Rating at last inspection:

Good. (The last report was published on 17 January 2018).

Why we inspected:

This inspection was brought forward due to the information we received from the local authority, health professionals, relatives and a whistleblowing from staff as a collective.

Follow up:

We will monitor the providers action plan following this report being published, to review how they will make changes to ensure they improve the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

Dorley House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Dorley House Residential Care Home provides accommodation for up to 33 people. There were 25 people living at the home at the time of the inspection. People who lived at the home required a range of care and support.. Some people required support for example with personal care and moving and walking safely and some people were living with a dementia type illness. Staff provided end of life care with support from the community health care professionals but usually cared for people who needed prompting and personal care support. There was no-one at the home requiring end of life care at the time of the inspection.

This comprehensive unannounced inspection took place on 21 November 2017. A further day, 27 November 2017 was spent talking with health professionals and relatives. Dorley House was last inspected in March 2016 and was rated good. We brought this inspection forward to follow up on concerns raised and because there had been a number of safeguarding referrals. This inspection found that the service remained ‘Good’ overall

A registered manager was in post. 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 and associated Regulations about how the service is run.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However this inspection found that improvements were needed to ensure that learning from complaints and concerns were taken forward and monitored for improvement within the quality assurance systems. Not all care documentation was up to date and accurate. This included peoples’ resuscitation status and not all ‘as required’ medication was supported by a protocol.

The service continued to provide safe care. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policies to support people in taking their prescribed medicines safely. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. There were enough suitably skilled staff to meet people's needs. Staff had been recruited using safe recruitment practices.

Staff sought people's consent before providing care and people's mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguards (DoLS). A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible). People received care from staff who had received training to meet people's specific needs, and had supervision to assist them to carry out their roles. People were supported to access healthcare professionals and staff were prompt in referring people to health services when required. Staff understood people’s dietary needs and people received a balanced diet which they enjoyed. Staff had a good understanding of Equality, Diversity and Human Rights.

Staff treated people with respect and helped to maintain their dignity. People received care from staff they knew, which helped them to forge positive relationships. Staff supported people emotionally and practically to maintain their independence and well-being.

Care plans were updated regularly and people and their relatives were involved in their care planning where possible. Risks to people’s health and well-being were assessed and staff had followed plans that were centred on the person as an individual. People were supported to pursue their hobbies and interests and continue to celebrate special days.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

There is a registered manager at the home. 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 inspection took place 22 March 2016. It was undertaken by four inspectors.

Staff knew people really well and had a good understanding of people’s individual care and support needs. They supported people to make choices, respected their right to make decisions and promoted their independence. People were looked after by staff who were kind and caring. They were treated with dignity and staff demonstrated an interest in their welfare and views. People and their relatives were involved in the development and review of care plans however these did not always reflect people’s current needs. There was an activities programme in place and people had the opportunity for social interaction with staff on a regular basis throughout each day.

There was an audit system in place which had identified the shortfalls we found throughout the inspection in relation to care plans and record keeping. There was an action plan was in place and work had commenced to address this.

Staff had a good understanding of risks associated with supporting people and what steps they should take to mitigate the risks. Nutritional assessments were in place and people were supported to eat and drink food they enjoyed. People had access to healthcare professionals which included the GP, district nurse, optician and dentist whenever they required it.

There were enough staff with the appropriate experience, skills and character employed to work at the home and to meet people’s individual care needs. Staff received on-going training and supervision to support them in their roles.

Staff communicated clearly with people in a caring and supportive manner. There was an open and relaxed atmosphere within the home, where people were encouraged to express their feelings.

Six people that expressed an opinion told us that they were happy living in the home. Comments included. 'I was not sure before I came in here but I would not want to be anywhere else now.'

Processes were in place to ensure that people were supported to make informed decisions about their care and support wherever possible and families and other professionals were involved.

Each person living in the home had a detailed plan of care that included their individual needs and wishes. The plans also recorded people's physical and emotional healthcare needs.

The home worked with a variety of healthcare professional including district nurses and mental health teams.

The environment was homely and comfortable and people had the specialist equipment they needed to support their health and welfare needs.

Five relatives that spoke with us were positive about the care and support being provided in the home. Comments included. 'The staff are wonderful, so caring and nothing is too much trouble.' Another relative said. ' It's always open house and they are really good at keeping us involved and informed.'

We saw that complaints and concerns are taken seriously and acted upon in a timely manner.