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Inspection report

Date of Inspection: 9 June 2014
Date of Publication: 2 August 2014
Inspection Report published 02 August 2014 PDF

Overview

Inspection carried out on 9 June 2014

During a routine inspection

Although we had planned to inspect Dovetail House, we bought the visit forward after we received concerns about the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. We also spoke with the newly appointed manager and the person responsible for overseeing the management of the home (the nominated individual).

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with four of the people who lived at Dovetail House. They told us that they were, �Ok�. Not everyone was able (or willing) to share their views about the service verbally. We therefore spent time observing staff interactions with people. We saw that people were relaxed in staff�s company although interactions were minimal.

We spoke with staff on duty who told us that there was not enough staff on duty to meet people�s care and support needs effectively or consistently. We saw records that reflected people were entitled to one to one support. The manager could not demonstrate to us that people received these hours. The records we saw showed that, although some one to one activities took place, they were limited. Staff told us that support depended upon staffing levels. We found that staffing levels were inadequate to meet the assessed needs of the people who received a service.

We spoke with staff who told us that they did not always feel well trained to carry out their roles effectively. The manager acknowledged that training was an area where improvements were needed.

Is the service effective?

We found that people who received a service were not getting all of the support that they were assessed as needing. Although we did not observe anything to suggest people�s basic care needs were not met, staff told us that people often had to wait for support. Opportunities to access the local community or take part in in-house activities were limited. We saw that care plans were in place however some staff told us that they did not know what information was contained within them. They told us that in order to know how to support a person they watched other staff. We saw that one person was not getting appropriate support to have their lunch. This showed that this informal approach was ineffective as people were not getting the right support.

We saw that care plans and assessments of risk did not always match. Some areas of risk were identified and there was no record of how to reduce the risk. On other occasions interventions were recorded that staff were unaware of. This confusion could lead to people who received a service (or staff) at risk of being harmed.

Inadequate staff on duty meant that people�s needs could not be met in a timely manner or in ways that people preferred. People were not getting the support that they were entitled to. Opportunities to live full and active lives were restricted.

Is the service caring?

People were supported by staff who were committed to meeting their needs. Staff however were worried that they did not have the time needed to meet people�s needs effectively or in ways that they preferred. Staff told us of concerns that they had had in relation to how some staff spoke to people. They had shared these concerns with the manager who had passed on the information to the local authority safeguarding team. They had then agreed a joint response.

Staff told us about activities that people enjoyed and shared their frustrations that these did not always take place. Staff told us how they worked extra hours and flexibly to try to ensure people got to enjoy planned activities. They acknowledged that there were shortfalls in this area.

Is the service responsive?

We saw that when people�s needs increased the manager made appropriate referrals for them to be seen by health care professionals. This meant that they could maintain people�s good physical health. They also told us how they supported one person with increased support needs.

The manager told us how they had followed up on poor practice by taking the appropriate action. For example they had started disciplinary action against one staff member following an allegation of suspected abuse.

The manager and the person with overall responsibility for the service (the nominated individual) told us how they were actively recruiting staff to address the current shortfalls. We saw that three staff had started working at the home on the day of our visit. Staff were very positive about the increase in staff.

Is the service well-led?

We found that there had been issues with the leadership of the service that had led to staff feeling demotivated and deskilled. Staff told us that they were hopeful the new manager would offer them effective leadership and support.

We found that there had been communication issues between the previous manager, the nominated individual and the owner. This breakdown in communication had negatively affected the quality of the service provided. As a result the nominated individual had taken a more active role within the home. Staff told us that this had had a positive impact on morale.