Archived: Dovehaven House

Dovehaven House is a residential care home providing personal care to 38 people at the time of the inspection. The service can support up to 40 people and specialises in providing care to people living with dementia.

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

People were not consistently supported in a safe way. We found people had not always been effectively risk assessed for use of moving and handling equipment or bedrails. The provider responded quickly to our inspection findings and made immediate improvements to ensure people’s care plans reflected the safety equipment needed.

People’s medicines were not always managed in a safe way. We found medicine record keeping was not always accurate and this meant people were at risk of not receiving their medicines as prescribed.

On the first day of the inspection we found areas of the environment unclean and furniture was worn making it difficult for domestic staff to efficiently clean. The provider had commenced a full environment refurbishment plan and on day two of the inspection we saw cleanliness standards had improved.

On the first day of the inspection staff did not consistently follow safe Infection Prevention and Control (IPC) standards, on the second day of the inspection standards had improved. The provider had up to date procedures in place for IPC and COVID-19 guidance for staff to follow. Staff received training in best practice standards for the prevention of infectious disease and also had access to a COVID-19 hotline which the provider had set up to allow staff to raise concerns or ask questions.

On the first day of the inspection we found some people’s emotional and personal hygiene needs had not been met. We discussed this with the registered manager who took immediate action to improve standards. On the second day of the inspection we found staff were responsive and acknowledged people’s needs in a timely and effective way. Relatives consistently told us they felt service users were safe, well cared for and respected.

Quality monitoring systems were not always effective to monitor people's safety. Failures highlighted at this inspection in relation to environment hygiene, medicines, bedrail safety and moving and handling assessments had not been identified by the registered manager. We were assured by the providers response to our findings and their actions taken to ensure immediate improvement.

The provider had introduced Person Centred Software, an electronic system to support effective record keeping. However, staff did not always maintain accurate and contemporaneous record keeping.

Staffing levels were planned in line with dependency needs of people who lived at the service. Staff were recruited in a safe way. Staff told us they enjoyed their induction training and felt supported to understand the needs of people who lived at the service

Staff followed safeguarding processes, we found alerts had been made to the Local Safeguarding Authority following allegations of abuse. Staff demonstrated good knowledge of safeguarding processes and told us they felt confident to raise any concerns internally and externally.

Accidents and incidents were recorded, preventative action was taken and lessons learnt at service and provider wide level.

Staff told us they were able to seek support from the manager and deputy manager. Relatives told us they felt involved and communication was good when people’s needs changed.

The registered manager submitted statutory notifications and was aware of their regulatory responsibilities.

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 06 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the care and treatment people received. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, medicines management and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 23 July 2015 we rated the service as ‘Requires Improvements’. This was because breaches of legal requirements were found. The provider did not have adequate systems in place for the safe management of medicines. In addition the provider had failed to ensure care was only provided with consent in accordance with the Mental Capacity act 2005. We found at this inspection on 06 November 2017 the provider had addressed the concerns and met the requirements of the regulations.

Although a number of people had limited verbal communication due to living with dementia we were able to speak with five people who lived at the home. They told us they were happy and supported by staff who cared for them and treated them well. One person who lived at Dovehaven House said, “These are my girls who work here and are truly wonderful caring people.”

We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect.

We found staff had been recruited safely, received ongoing training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at the home.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available around the building for staff to use when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they had choices of meals and there were always alternatives if they didn’t want what was on offer. They expressed positive views on the provision of meals that were purchased by the management team. One person said, “Lovely meals and the right portions.” Also another person said, “You do get plenty and they are really good.”

We found during the inspection visit and observing interactions between staff and people who lived at the home, there was a culture on promoting dignity, respect and independence for people. People told us staff treated them as individuals and delivered person centred care. Care plans seen confirmed the service promoted people’s independence and involved them in delivering person centred care that suited each individual.

The design of the building and facilities provided were appropriate for the care and support provided.

People who lived at the home and their relatives told us they enjoyed a variety of activities which were organised for their stimulation and entertainment. These included games days, sing- a- long afternoons and entertainers.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff, relative and ‘resident’ meetings to seek their views about the service provided.

We found staff to be well supported and appropriately trained and those living at Dovehaven House looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been well established. Systems had been developed, in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

"We have so much fun with the staff, you wouldn't believe it!"

"It is blooming marvellous. I get everything I need and they (the staff) are so helpful."

"The staff genuinely care about us. They go over and above their call of duty."

We found staff to be well supported and appropriately trained and those living at Dovehaven House looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been well established. Systems had been developed, in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

"They (the staff) are very good. They take me to the bathroom in a hoist and usually it is the two people who are looking after me, who bathe me so I know them and trust them."

"The food is good. The home is clean and well kept. The staff are kind. This room (the lounge) was painted last week. I like the Christmas decorations."

"I went to Liverpool in the summer, but the weather hasn't been so good and I would rather be warm inside instead of out in the cold, but if the weather is OK there is usually a trip out."