Archived: Dovercourt House Residential Care Home

Dovercourt House Residential Care Home is an adapted building which provides personal and accommodation for up to 27 older people, including those living with dementia. There were 18 people living in the service at the time of our inspection, including people staying on a short break ‘respite’ basis.

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

The quality of the service had improved. Four changes of registered manager in as many years had led to a period of instability in the service, which is only now being addressed.

People, their relatives and visiting professionals spoke about the improvements they had seen following the appointment of their current registered manager. One professional, linked to their previous experience of the service, told us they hoped the leadership, “Manages to maintain it.”

The provider had systems for assessing and monitoring the service to ensure people are consistently supported in a safe, clean and well-maintained. However, they were not robust enough to promptly identify shortfalls and address them, or take effective action when given feedback from health and safety specialists. We have made a recommendation that the service improve in this area.

The registered manager is in charge of the day to day running of the service and supported by the provider through regular telephone contact and visits. However, we continued to receive comments from staff and relatives who felt the provider could be more visible. We have made a recommendation that the service improve in this area.

Despite there being a high turnover of staff, relatives said it had not impacted on people’s care, and were happy with the new staff being appointed. They had confidence in the management and staff to provide safe care and keep them updated on any issues. Describing them as being helpful and friendly, which made people’s visitors feel welcomed.

People were being supported to take their medicines as prescribed and have access to health care professionals when needed. People and their relatives were happy to see the return to ‘home cooked meals’, which offered more flexibility and choice.

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. People’s privacy and dignity were being respected.

People’s care needs were assessed and planned for. Improvements had been made, and further work planned, to support people to access meaningful activities and build/maintain links with the local community.

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 18 February 2019) and there were multiple 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

The service has been rated requires improvement for the last three consecutive inspections. This inspection showed improvements were now being made. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

What life is like for people using this service:

¿ Risks associated with people’s environment, health and wellbeing were not always being identified and acted on.

¿ People did not live in an environment that was well maintained. We have recommended that the environment is made more dementia friendly.

¿ There was not always enough staff on duty to monitor people’s needs and provide personalised care.

¿ People and their relatives were not always involved in making decisions about their care.

¿ Care records did not always provide enough information to support personalised, safe care and show what people had consented to.

¿ People were not sufficiently supported to take part in activities or pursue interests, to enhance their wellbeing.

¿ People said staff were friendly, that they could enjoy exchanging banter and having a laugh. Their visitors felt welcome.

¿ Staff supported people in a compassionate, dignified and engaging way which provided positive experiences for people.

¿ The service was not well led and systems were not in place to ensure that people received care that met their needs.

Rating at last inspection: Requires Improvement (Report published 23 November 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This was the first rating inspection under the service’s new provider who registered with the Commission on the 2 September 2016.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

The quality assurance systems were not robust enough to independently identify and address shortfalls. The leadership team were working to improve systems and develop the service. However this needed further time to be embedded.

Risks to people’s health and well-being were not fully explored and therefore opportunities were missed to reduce the chance of potential harm. This included risks associated with people’s health and welfare deteriorating, environment, fire safety, medicines and evacuation plans.

The service had a process for the safe recruitment of staff and had recognised the need to recruit to activities posts and someone other than care staff to do laundry. In addition they were planning to increase the management structure to help effective oversight.

Although training had improved and more had been made available to staff, further development was needed to ensure staff had the right skills and competency. This included supporting people living with dementia and ageing process.

People were not always treated with dignity and respect due to practices in the service. Care was not always person centred to meet their needs. We have made a recommendation to support the service to improve this area.

People’s care plans did not always provide clear guidance for staff on meeting people’s needs. This included promoting independence and having access to stimulating occupation / actives, linked to latest research.

The quality assurance audits were not sufficiently robust to ensure that people received a service which met their needs and protected their safety.

Although improvements had been made to the service’s medication systems, further development was needed to ensure accurate, person centred records were being completed. This include the use of ‘when required’ medicines, to support staff in monitoring when they should be used, and their effectiveness.

The service worked closely with relevant health care professionals. Generally, people received the support they needed to have a healthy diet that met their individual needs. However improvements were needed in staff’s awareness of how to support people with low appetite, and in promoting fluids to support wellbeing.

Although staff skills and knowledge needed improvement, people were positive about staff and the leadership team. People and their relatives were able to raise concerns and give their views and opinions and these were listened to and acted upon.

We found breaches in the Health and Social care Act. You can see what action we told the provider to take at the back of the full version of the report.