Dormy House

Dormy House is a care home providing personal and nursing care for up to 88 people. The service provides support to people who have care needs, such as, diabetes and Parkinson’s disease. Some people were living with dementia or had deteriorating mobility. At the time of our inspection there were 60 people using the service.

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

Risks associated with people’s care were not always managed in a safe way. Incidents and accidents were not always recorded in detail or investigated to reduce further risks. Medicines were not being managed safely and there were times people received as and when medicines with no detail as to why this was given.

People were not always protected from the risk of abuse or neglect as staff were not always reporting or investigating allegations. There were some areas of the service that were not clean or well-maintained, however, we saw in other areas staff practiced good infection control. There were not sufficient staff deployed to ensure people received their care when needed.

Staff were not always supervised in relation to their role and training was not always effective in ensuring good practice. The environment was not always suitable to meet the needs of people.

There were mixed response from people about the quality of the meals. The mealtime experience was chaotic, people at times were served with food that had gone cold.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider has taken action to address this.

There were times when people were not treated in a kind and dignified way. However, we did see examples of staff being caring and considerate. Care plans required more detail around people’s life histories and preferences and there was some guidance missing that related to people’s needs. Activities for people were lacking.

Complaints were not always investigated, and actions taken to address the concerns. People and relatives were not always confident in the leadership at the service. There was a lack of robust oversight to ensure the quality of care. There were staff that felt they were not always listened to however, other staff said they were starting to feel more supported. The provider has increased the management presence in the service and were working on making and embedding improvements.

The provider operated effective and safe recruitment practices when employing new staff. People had access to health care when needed and assessments of people’s care were undertaken before they moved in.

Rating at last inspection and update

The last rating for this service was good (published 13 May 2021.)

Why we inspected

The inspection was prompted in part due to concerns received about the safe care and treatment of people, and staff levels. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to the safe management of risks, the deployment and supervision of staff, the management of medicines and people not being protected from abuse. We also identified breaches in relation to complaints not always being responded to, the lack of person-centred care planning and lack of meaningful activities. We identified concerns about people not always being treated in a caring and dignified way and the lack of robust oversight.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Dormy House is a residential care home providing regulated activities personal and nursing care and the treatment of disease disorder and injury to up to 88 people. The service provides support to adults over the age of 65 years and people living with dementia. At the time of our inspection there were 54 people using the service.

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

People were supported to live safely and free from unwarranted restrictions because the service assessed, monitored and managed people’s safety effectively. People’s relatives provided positive feedback about positive outcomes for people. For example, “They have friends here and are talking again, smiling, and their old character is coming back. Staff understand then and piece things together. She is settled and it is homely.”

People’s emotional and physical needs were assessed and captured in care plans. Staff were knowledgeable about how to reduce risk and people’s preferences and wishes.

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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 good (published 13 May 2021).

Why we inspected

This targeted inspection was prompted in part by notification of an incident at the service, following which a person using the service died after they had stopped receiving care from the service. It was also prompted in part due to concerns about poor care in relation to another person’s deterioration in health including dehydration. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of in relation to mobility and falls and nutrition and hydration. This inspection examined those risks.

Follow up

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

Dormy House is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 88 people. The accommodation is across three floors and divided into three units. One of the units specialises in providing care to people living with dementia.

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

Systems such as training and reporting procedures were implemented to protect people from abuse. The manager’s investigation reports did not always identify findings and outcomes; the provider was taking action to improve this. We have made a recommendation in relation to safeguarding training for managers.

People and relatives told us they felt safe and cared for at the service with comments such as, “It’s nice to feel safe here” and “Staff go out of their way to make you happy”.

Risks to people were generally identified and managed. We found a container of powdered thickener was not always kept in locked storage. The manager took immediate action to rectify this and the provider planned to implement a series of audits to monitor compliance. Staff followed robust medicines administration procedures. We found some minor issues in relation to infection control measure, which were addressed by the management team during our inspection. There was evidence of good practice in relation to weekly demonstrations and observations of staff use of personal protective equipment. People and relatives told us they felt the service responded well to the COVID-19 pandemic to keep people safe.

Staff recruitment checks were completed to make sure staff were suitable. Medicines systems competency assessments were not always carried out for regular agency nursing staff. However, agency staff told us they were well supported and had been shown what to do and felt confident in this area. The management team took immediate action to make sure competency assessments were completed to assure themselves all staff authorised to administer medicines knew how to do so safely.

People and their relatives felt the service was well managed. They told us the home was, “Very good, meets [family member’s] needs”, “Kept COVID-19 out of the home, done an excellent job” and “Got a good atmosphere”.

The vast majority of staff were positive about the support they received from the management team and embraced service values of person-centred-care.

The manager and provider had systems to monitor and evaluate all aspect of care and identified areas for development, which were in progress. 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 were being updated by the provider to support 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

The last rating for this service was Good (20 January 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service in relation to a safeguarding concern about medicines administration and management. A decision was made for us to inspect and examine those risks.

We inspected and found management systems for these areas and the atmosphere of some parts of the service, needed to be looked at in more depth. We decided to widen the scope of the inspection to examine potential risks and gain assurances.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

Dormy House is a residential care home providing personal and nursing care to 65 older people at the time of the inspection. The service can support up to 88 people.

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

People living at Dormy House told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Medicines were managed safely, and people received their medicines as prescribed.

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 were supported to maintain good health and to meet their nutritional needs.

People told us staff were caring. This ethos consistency enabled people to receive good care from staff who knew them well. Staff did all they could to promote independency and we saw examples of such practices.

People had access to a wide range of activities and were supported to avoid social isolation. The registered manager successfully maintained an open and transparent culture which contributed to staff work satisfaction and in turn the staff delivering good care for people.

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 26 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At the time of the 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.

Our last inspection was on 18 August 2016 under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a focused, responsive inspection following information of concern we received. We inspected key question 'Is the service safe?’ which was rated ‘requires improvement’. This was because systems were in place to protect people from harm; however, these had not protected all people at the time. The prior inspection did not change the service’s overall prior rating of good. The latest inspection found the service had sustained their improvements for protecting people, and the subsequent rating for the key question has changed to ‘good’.

People were safeguarded from abuse or neglect. There was a system in place to ensure that people’s safety was maintained. Staff were knowledgeable about abuse and how to deal with any allegations.

Appropriate pre-admission and admission risk assessments were recorded. Care plans and evaluations were completed in association with any risks identified for people.

The safety of the premises, equipment and grounds were assessed and managed which protected people, staff and visitors from risk. We viewed maintenance records which demonstrated most required checks for health and safety were completed. We made a recommendation about keeping appropriate documentation related to maintenance works by contractors.

There were sufficient staff deployed to support people. Our observations showed that the staff were occasionally busy but not task-focussed, which led to positive experiences when they interacted with people. Staff worked well together in their respective teams, were flexible with the service’s requirements and were willing to assist their colleagues.

Medicines were well-managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Registered nurses demonstrated good practice, in line with that set by national standards and guidelines. Regular pharmacist and GP input was sought and obtained for the management of people’s medicines. We made a recommendation about the auditing of controlled drugs.

Staff received appropriate levels of induction, training and supervisions.

The service broadly followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decisions meant the service did not always comply with the MCA codes of practice. We made recommendations about the documentation used for consent and attorneys. We also recommended that policies be reviewed in line with current industry practice. There were records at the service regarding people’s applications, reviews and expiry dates for standard Deprivation of Liberty Safeguards (DoLS) authorisations. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received nutritious, appetising food which they had a positive opinion about. Appropriate hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them. Alternative menus were available. People told us they liked the food and had good choices. The kitchen staff demonstrated excellent presentation of texture-modified food for people with swallowing difficulties.

We found the service was caring. People told us staff were kind and patient. We observed staff were warm and friendly when they interacted with people. Staff smiled and laughed with people, and encouraged them to enjoy their stay.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. The service had a robust complaints procedure.

The service was well-led. People who used the service, relatives, healthcare professionals and staff were satisfied with the management of the service. We found the management team were approachable, involved in the care activities and listened carefully to our feedback. A list of audits were used to check the quality of care. Action plans were used to address any areas that required improvement. We made a recommendation about gaining further feedback about the service to aid continuous improvement for people’s care experience.

At the time of the inspection, there was no 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. The home manager had applied for registration and was awaiting an interview with our registration team to determine they were a fit person to oversee the regulated activities.

The current inspection was a focused inspection in response to concerning information we received. The inspection was prompted in part by notification of an allegation of abuse. This incident was subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. Systems were in place to protect people from harm, however, these had not protected all people. Immediate action was taken to protect people and the service was working with partner agencies.

We looked at one key question: “Is the service safe?” The inspection occurred on 18 August 2016 and was unannounced. The location was last inspected under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on 3 February 2015 and 10 February 2015. At the time we rated the service good overall.

We spoke to people who told us they liked to live at Dormy House. We observed people enjoying themselves and participating in activities. Relatives visited throughout the day of the inspection and were also observed to be actively involved in the lives of people who used the service.

Individual risks to people were assessed and managed. People had risk assessments and care plans in place for a variety of their activities of daily life. For example, we saw assessments related to eating and drinking, mobilising, risk of developing pressure ulcers, and the use of bed rails. These were detailed documents and person-centred. The care documentation protected people, as far as possible, against harm that could occur.

People were protected against abuse and neglect. There were systems in place which staff and managers would use to deal with allegations people might not be safe. The service communicated with us when these kinds of concerns were raised and kept us informed regarding investigations. Staff were required to attend mandatory training to understand how to protect people and what to do if they had concerns.

Sufficient staff were deployed to provide nursing and personal care for people. The service had a system to determine how many staff should work on each unit and shift. We found this was a satisfactory way to determine staffing levels. We observed staff were able to spend time with people and not in a hurry. Busy periods like breakfast and lunch were managed well by the team leaders and workers in each unit.

Robust recruitment checks were carried out before staff commenced work at Dormy House. The service kept evidence of the necessary checks in staff personnel files and was in line with the applicable regulation. Where staff misconduct occurred, we found that the management had acted professionally and ensured people’s continued safety.

Appropriate maintenance of the building occurred. A range of checks and routine repairs were conducted to ensure that people were safe.

Where incidents or accidents occurred, these were formally reported, reviewed by managers and acted upon. Where necessary, other stakeholders like commissioners and safeguarding teams were advised.

However we found that there was a lack of consistent information recorded to allow staff to give medicines safely; this included allergy status and guidance for giving people medicines 'when required'. During the inspection we saw that the storage arrangements for some medicines were not secure.

We found the provider had taken steps to improve the levels and availability of staff. Unit managers had been employed. Lunch times were reorganised to make more staff available when needed. However, the provider's action plan from the previous inspection had not been fully implemented.

Relatives told us they were concerned about staffing levels. They told us about specific examples where people who use the service could have been put at risk due to the unavailability of staff. They said staff worked hard to meet people's needs.

Due to our findings during this inspection we have contacted the provider and requested a meeting to discuss our concerns regarding the location.

We saw staff provided care safely and communicated well when they provided care to people. However we saw staff were not always available when people who use the service required care. Relatives and people who use the service said staff were sometimes unavailable to assist people. Systems for allocating staff were not effective and were not used appropriately.

People who use the service and their relatives were enabled to make complaints about the service. We found complaints were responded to and investigated appropriately. We saw the complaints process was made available for people.