Dovecote Residential Care Home

Updated 10 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 3 inspectors and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Dovecote Residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Dovecote Residential and Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post who was in the process of leaving the home. A new manager was in post and starting their induction when the inspection process ended.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service including information submitted to CQC by the provider about specific incidents. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We sought feedback from the local authority contracts monitoring team, health professionals and safeguarding adults' teams and reviewed the information they provided. We used all this information to plan our inspection.

During the inspection

We reviewed a range of records. This included 7 people's care records, the medicine records for 15 people and the recruitment records for 4 members of staff. We also reviewed the induction information for 7 agency staff members who had recently been employed at the home. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

We carried out observations in the communal areas of the home. We spoke to 16 relatives, 3 people and 18 members of staff. This included the deputy manager, peripatetic manager, regional manager, regional director, 2 team leaders, 8 care staff, 2 registered nurses, the provider’s quality manager, 2 domestic staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also received written feedback from 3 health and social professionals who worked in partnership with the service.

Updated 10 February 2023

About the service

Dovecote Residential and Nursing Home is a residential care home providing personal and nursing care to up to 61 people. The service provides support to people aged 18 and over, some of whom were living with a dementia. At the time of our inspection there were 37 people using the service.

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

People were not always supported in line with their assessed needs and staff did not always follow people’s care plans. Feedback provided by professional visitors to the home, described instances where staff had not acted in a timely way to support people. Care plans were not always person-centred, did not always include all of the necessary information to support people and required a review.

Staffing levels and the high use of agency staff had a negative impact on people. Relatives said that permanent staff were kind and caring with people, but agency staff did not provide support in a timely way or at all. People told us they had to wait long periods of time for support from staff. Relatives commented, “Staff are overworked” and, “They just have too much on.”

People did not have regular access to activities or social interaction. People and relatives told us there was normally no activities to be part of and staff did not have time to engage with them. During the inspection we observed that staff were very busy, and they did not have time to interact with people unless they were carrying out a task.

Medicines were not safely managed. There was an issue with medicine stocks at the home. We could not be assured that people were receiving creams, ointments and patches as prescribed. People did not always receive their medicines. Relatives described instances where people had not received their medicine for several days. Medicine records were not always completed, and medicine care plans did not always contain all the relevant information for staff to follow.

Staff were not always wearing their PPE appropriately or following the provider’s guidance for infection prevention and control.

There was no clear leadership at the home. The registered manager was in the process of leaving the service and a new manager was completing their induction. Staff and relatives commented that they did not know who the responsible manager was. Relatives did not feel that they were communicated with and had to regularly chase staff and management for information.

Since our last inspection, the quality and assurance systems in place had been reviewed and the provider’s quality team were supporting with checks and audits. The systems in place had not been fully imbedded and we found the home manager’s checks had not been completed.

Records relating to people’s care and the quality and assurance systems were not fully completed or completed in a timely way.

We discussed our concerns with the provider and regional management team who had already taken proactive steps to address the issues found during the inspection.

People and their relatives told us they were supported to be independent, but this was affected by staff availability. People were complementary about the permanent staff team and had a good relationship with them.

People were supported to maintain a healthy balanced diet and were very complimentary about the food. Relatives commented that people had re-gained their appetite and were eating lots of varied meals. There was a positive atmosphere at meals times and we observed a very relaxed and happy environment in the dining rooms.

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 requires improvement (published 2 September 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff knowledge, medicines management, skin integrity issues, record keeping, person-centred care and the overall governance of the service. A decision was made for us to inspect and examine those risks.

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.

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.

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

Since the inspection the provider and management team have taken action to address the issues identified. The management team are currently working in partnership with the local authority, health partners and the CQC to improve the service.

Enforcement

We have identified breaches in relation to person-centred care, medicines management, infection prevention and control, management oversight at the home and staffing issues at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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