Archived: Dover House Care Home

We found window restrictors were now in place and infection control procedures had improved. However we found continued breaches in medicines management and auditing systems were still not robust.

We also identified further breaches with regard to the assessment and mitigation of risks people may face at the home (especially for moving and handling, people using the stairs and guidance for staff when supporting people whose behaviour may challenge the service) and the safe recruitment of staff.

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. You can see what other action we have told the provider to take at the back of the full version of the report.

Dover House 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.

Dover House Care Home provides residential care for up to 11 people in one adapted building, Some of the people at Dover House are living with dementia. At the time of our inspection there were nine people living at the service. The service also operated a ‘day care’ service for one person.

As part of the overall registration of this service, there is no condition that the provider must employ a registered manager at this location. The provider takes on the day to day responsibility for the running of the home along with the sister home, Derby House, next door. 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 provider did not have robust and effective systems in place to monitor, review and assess the quality of the service to help ensure people were protected from the risks of unsafe or inappropriate care.

Care plans were person centred and contained sufficient information about the current needs, wishes and preferences of people. However where risks had been identified assessments and plans to minimise such risk did not provide sufficient guidance for staff. Where people’s needs had changed referrals had not been made to the local authority for a re-assessment of their needs and the risks posed by the person using the stairs instead of the stair lift.

Accidents and incidents were recorded and each was individually reviewed by the owner/ manager to mitigate the risk of further incidents. However there was no overarching analysis of accidents and incidents across all the people living at the home.

Recruitment checks for new staff to ensure their suitability for working with vulnerable people had not been completed.

Medicines management had improved, with medicine administration records (MARs) being completed. However the prescribing instructions for one ‘as required’ medicine had not been accurately transcribed to the MAR produced by the home, resulting in the person being administered the medicine four times a day when they may not have required it.

New chairs had been purchased for the lounge and window restrictors were now in place. The laundry had been moved to the cellar, improving the infection control measures in place at the service. The home was seen to be clean and free from malodours.

Appropriate action had been taken following an enforcement notice issued by the Greater Manchester Fire Service.

There were sufficient staff on duty to meet people’s needs. Staff training had increased and more training was planned. New staff were being enrolled on the care certificate as part of their induction.

Suitable procedures were in place for safeguarding vulnerable people and staff had been trained to recognise and report any concerns they had.

Staff said they enjoyed working at the home and were complimentary about the provider and the deputy manager; saying that they were visible and approachable. Supervisions had not been consistently completed. Team meetings were held each month and included a discussion about each person’s support needs. Staff said they felt well supported by the provider.

The provider had sought the necessary authorisation for those people deprived of their liberty as per the Mental Capacity Act (2005). Best interest decisions had been made with regard to covert medication and wishes at the end of people’s lives. However further, decision specific, best interest decisions were required where people were unable to make an informed decision about the use of the stairs.

Staff sought people’s consent before providing support and supported people in a discrete manner. However we saw one occasion where a staff member did not do this when trying to re-arrange one person’s blanket. A senior care worker intervened and asked the care staff member to re-arrange the blanket again and they did so appropriately.

People had access to healthcare professionals as required. Feedback from the health professionals we spoke with was positive.

People said they enjoyed the food at the home. Staff supported people to eat and drink where required to maintain people’s nutrition and hydration.

There had been an increase in the activities offered at the service, with a senior care member of staff responsible for arranging the activities.

The provider had a system in place for the reporting and responding to any complaints brought to their attention. People told us they could raise any issues with staff or the provider if they needed to.

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.

Dover House Care Home provides residential care for up to 11 people, some of whom are living with dementia. At the time of our inspection there were 10 people living at the service. The service also operated a ‘day care’ service for one person. At the time of the inspection no day care was provided and we were told that it is only used on odd days.

The service had a registered manager in post who was also the owner of the service. 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.

Medicines were not always managed safely, for example, we found one person’s medicines left out for them to take, when staff had already signed to say they had been administered.

Areas of the premises were in need of repair or replacement, including window restrictors and some of the chairs used by people living at the service.

We found concerns with the infection control arrangements in the home and audits held by the infection control lead for care homes in the area had found the same issues both recently and in previous audits which had not been fully addressed.

Governance at the service needed to improve. For example, audits were not robust, as they had not uncovered some of the issues that we had found during our inspection.

People were protected from harm by staff who knew what to do if a safeguarding incident occurred within the service. Although we found that the owner/registered manager had not always reported incidents, as required, to relevant professional bodies when incidents had previously occurred; even though these had been dealt with effectively by staff at the service.

Accidents and incidents, including near misses, were recorded and analysed to ensure that any learning was used to mitigate future incidents. Risk assessments and personal evacuation plans were in place to minimise the risks to people who lived at the service.

There were enough staff in place to support people with their assessed needs. Safe recruitment practices were followed to ensure that staff were safe to work with vulnerable people. Staff had received training, although further refresher training was required and had been booked to take place in the near future. Competency checks were required, particularly in relation to medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. it also ensures unlawful restrictions are not placed on people in care homes and hospitals. We found the service was operating within the framework of the law.

People had access to healthcare professionals as the need arose and staff supported them if required. For example, to GP or hospital appointments.

People enjoyed the food they were prepared and were supported to eat and drink enough to maintain nutrition and hydration levels.

Staff were caring and compassionate and protected people’s privacy and dignity at all times.

Assessments of people's needs had been completed with person centred care plans being developed, although these were under review.

People had choice in their daily lives and knew how to complain. People told us and relatives confirmed, that a range of activities were available for them to participate in if they chose to. Meeting were held for people and their relatives to feedback about the service provided and relatives told us that the owner/registered manager was open to conversation should the need arise.

The provider had not always submitted notifications to us in line with their responsibilities and legal requirements. We have taken this omission into account when deciding upon the rating for the well led domain.

We found breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to Safe care and treatment and Good governance

We have issued two warning notices to the provider and asked them to complete actions within a specific timescale to address our concerns.

One person who used the service told us: 'When staff do anything they always ask whether it is alright. I'm very happy here'.

We found care plans and risk assessments provided clear guidance to inform staff what they needed to do in order to provide care and support according to the personal needs of each person.

People who used the service were able to confirm they found staff respectful of their privacy and independence. One person who used the the service said 'I feel I'm well looked after and the staff are kind. They are very good to me, I don't know what I would do without them.'

During the inspection we found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.

We found the provider had system in place to monitor the quality of the service they provided. We were shown policies and procedures that were available to staff to assist them in the safe care of residents within the home.

The provider was able to demonstrate it had effective systems in place to record, respond and investigate complaint made against the service.