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Archived: Dovecott Care Home

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Inspection report

Date of Inspection: 3, 13 June 2013
Date of Publication: 2 August 2013
Inspection Report published 02 August 2013 PDF

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 3 June 2013 and 13 June 2013, observed how people were being cared for and talked with carers and / or family members. We talked with staff, took advice from our pharmacist, reviewed information sent to us by other regulators or the Department of Health and talked with commissioners of services. We talked with other regulators or the Department of Health and took advice from our specialist advisors.

Our judgement

The provider had improved systems to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Reasons for our judgement

When we inspected this service in October 2012 we found that the provider was not meeting this standard. This was because the provider did not have a satisfactory system to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. The provider sent us an action plan which set out how they were going to improve and included assurances that the compliance action would be met “Immediately."

We completed a follow up inspection in April 2013 and identified that there were continuing concerns with the systems in place to identify, assess and manage risks. We found that the provider and manager had failed to take into account the findings from the last inspection and implement their action plan. They had also failed to take into account relevant guidance and information from other expert bodies to ensure that people's health, safety and welfare would be protected. We implemented our enforcement procedures which required the provider to become compliant by 31 May 2013.

We completed a follow up inspection in June 2013. We found that most areas had been addressed.

We found that systems to ensure the safe use of bed rails had improved since the last inspection. Appropriate equipment had been provided to ensure the person’s safety, staff had received guidance or training in the use of the equipment and risk assessments for the use of the equipment had been completed by a health care professional. A basic policy and procedure for the use of bedrails had been provided.

We found that appropriate documentation to record accidents had been obtained since our last inspection and these records met the Data Protection Act 1998.

On the first day of our follow up inspection in June we found that there were significant shortfalls in infection control relating to handling laundry and hand washing. We referred our concerns to the infection control nurse who visited the home. We received a report from the infection control nurse prior to the second day of our inspection which indicated that work to address the issues identified had commenced. On the second day of our inspection we found that some work had been completed to improve the laundry room and hand washing practice.

At the previous inspection we had found that fire safety procedures were not adequate. We referred our concerns to the fire officer. We have been informed by the fire officer that they are satisfied that the provider has completed the work they required of them to achieve fire safety standards. At our visit in June 2013 we found evidence that portable electrical appliance testing had been completed, fire training had been arranged, fire risk assessment had been completed and issues relating to signage and storage of fire extinguishers had been addressed.

We spoke with a visitor to the service who was very complimentary about the care provided to their relative. They told us, "They are very well looked after, they keep me well informed."

We spoke with a health professional who told us, "The residents seem happy enough, the staff follow instructions and are knowledgeable."

The provider may find it useful to note that on the first day of our inspection we found four cartons of milk past their sell by date and a number of items past their best before date in the stores. For example, packet soup dated November 2012, a jar of mince meat dated December 2012 and baking powder dated November 2011. We found that the food safety inspector had visited the service in May 2013. The record of their visit showed they had found cooked chicken past the use by date by seven days and one egg past its best before date. We spoke with the manager and staff about the process for stock control. We found there was no set process for monitoring stored food. The food safety policy and procedure stated that daily records of stock control checks should be completed but the manager told us these were no longer in use. This meant that there was a ris