Dorrington House (Watton)

Dorrington House (Watton) is a purpose-built care home providing personal care and support to up to 52 older people, some of whom were living with dementia. At the time of our inspection 41 people were using the service.

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

Feedback from people who used the service, their relatives and staff was positive about the changes made since the last inspection. Many felt the service was beginning to improve. A typical comment was, “It’s getting better, I think. There are a lot of changes going on, so we will have to see how they pan out.” Although this feedback was positive, we identified some areas which still required significant work to ensure people consistently received safe and high quality care.

Although staff numbers had increased, staff were not provided with all the training and support they needed to carry out their roles safely. Systems to monitor staff development were not robust and some new staff lacked skills and knowledge which placed people at potential risk of harm. We have made a recommendation regarding training for staff.

Although improved from our last inspection, records were not always accurate, and monitoring was not robust. We identified potential concerns with two people’s pressure care and one person who was at risk of dehydration, which the provider’s own monitoring systems had not identified. The provider plans to introduce a new electronic recording system to improve record keeping and ensure people’s health and welfare is safely monitored.

Medicines management had improved from our last inspection and the provider had purchased new safety equipment including pressure sensor mats and weighing scales. Safety systems such as the call bell system had been serviced. The provider had purchased new furniture to enhance the environment and enable more thorough cleaning. The service was clean but further deep cleaning was required in some bathrooms.

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

The provider was open and honest in their response to our findings and promptly put actions in place. They demonstrated a commitment to work in partnership with other key stakeholders and keep CQC informed. A new manager has been appointed and the provider gave us assurances they will support them to continue to improve the service. Their appointment will enable the area support manager to return to their quality oversight role. We do not expect future inspections to be the method by which failings at the service are identified.

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 inadequate (published 8 June 2022) and there were breaches of three regulations. 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 had made improvements but remained in breach of two regulations.

This service has been in Special Measures since 1 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether the provider had followed their action plan relating to a breach of regulation 18 (staffing) and were now meeting legal requirements. Our focused inspection reviewed the key questions of Safe and Well-Led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for this service has changed to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorrington House (Watton) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulation in relation to the training and support of staff, assessing and monitoring the safety and quality of the service at this inspection.

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 from the provider to understand what they will do to further improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will meet with the provider and review this action plan and discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dorrington House (Watton) is a residential care home providing personal care and support to up to 52 older people, most of whom are living with dementia. At the time of our inspection there were 46 people using the service. The accommodation is built over two floors, with a lift. Bedrooms have ensuite toilets, and there are shared bathrooms and living spaces with an enclosed garden.

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

People were not living in a clean, well maintained and comfortable care environment and were not being protected from the risk of harm. This included people living with dementia, having access to unsecured risk items such as denture cleaning tablets. We identified poor infection, prevention and control practices throughout the service.

People were not being supported to have their medicines safely, with lengthy medicine rounds, poor auditing and checks in place, which did not ensure people received their medicines on time. Poor practice had also resulted in one person being given out of date medicine, which placed them at risk of harm.

People at risk of falls, or needing to source additional support from staff, did not all have access to assistive technology that was in working order. People’s care records were not being regularly reviewed following incidents such as falls, to ensure staff provided the required levels of support.

Staff were unfamiliar with people’s needs, particularly in relation to dietary and choking related risks to keep people safe. If people required pureed diets, they were not offered a choice of different meal options, and food was plated up 30 minutes before eating, increasing the likelihood of the food being cold.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

There was not always sufficient staff to safely meet people’s needs. Most people required support and supervision from staff, with tasks including the maintenance of their skin integrity, and the use of equipment to move for example from their bed to a wheelchair. Dependency information provided by the service showed that only one person out of the 46 living at the service was assessed to have low needs and be mainly independent with their own care requirements.

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 Requires Improvement (published 13 July 2021).

Why we inspected

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.

The inspection was prompted in part due to concerns received about staffing levels and standards of care provided. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of Safe and Well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, governance and oversight of the service, and staffing levels at this inspection.

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

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 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.

Special Measures:

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.

Dorrington House (Watton) is residential care home providing personal care to 51 older people, some of whom are living with dementia. The service can support up to 52 people. One person was in hospital at the time of the inspection. The care home accommodates people on two floors in one purpose built building.

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

People who used the service and relatives told us they felt the service was safe. Risks were mostly well managed but some information in care plans was not completely clear which could lead to confusion. The provider had already identified this as an area for improvement and taken action to reduce this potential risk. Some environmental risks would benefit from further review. Risks relating to infection prevention and control, including Covid-19 were mostly well managed, although some areas required further review to ensure best practice was maintained.

Staff understood their responsibilities to safeguard people from abuse but a more robust approach to property going missing would ensure people’s rights were fully protected.

There were enough staff, although the provider plans to further enhance staffing numbers. They plan to make mealtimes protected so that people’s needs can be met promptly. Staff were safely recruited and had appropriate training.

Medicines were managed well, and the provider had promptly taken on board learning from a recent local authority quality inspection.

There were systems in place to monitor the service’s quality and safety. Some monitoring needed to be more robust and the provider gave us assurances that changes were already in hand. The provider was open and transparent and willing to act on feedback immediately. A key relationship with the local surgery was challenging at times and the provider was working with the surgery to try and improve this.

Relatives were happy with the service provided and very supportive of the way the staff had provided care and support during the coronavirus pandemic. They praised the way the service provided person-centred care for their family members.

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 9 October 2019).

Why we inspected

We received concerns in relation to the management of pressure care and people’s care needs relating to food and fluids. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make some improvements. Please see the safe and well-led sections of this report.

The provider had already begun the work to address some of the concerns which prompted this inspection and had a clear plan to complete it.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorrington House (Watton) on our website at www.cqc.org.uk.

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.

Dorrington house (Watton) is a residential care home providing personal care for up to 52 older people. At the time of this inspection there were 52 people living at the service, the majority of whom were living with dementia. The accommodation is purpose built over two floors, with a lift. All bedrooms have accessible ensuite toilets, there are several communal spaces and an enclosed secure garden.

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

People were usually 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; however, the policies and systems in the service did not always support this practice. The provider’s mental capacity assessment records were insufficient, and we have made a recommendation about this.

Staff were generally well trained, although we found that some staff were not skilled in effectively supporting people living with dementia, particularly when agitated or distressed.

People living in the service told us they felt safe and well cared for. We found risks were assessed and managed appropriately. Staff were aware of how to safeguard people from potential abuse. The provider had robust recruitment procedures and had sufficient staff. People received their medicines when they should and were enabled to access healthcare whenever required. People had enough to eat and drink.

All the people we spoke with were complimentary about the kindness of staff. We observed compassionate care which demonstrated staff had an understanding of people's needs and preferences. People's privacy and independence were promoted. People were asked for feedback on the care and support they received although there was sometimes limited involvement from people and their relatives in reviewing their care plans.

People had assessments and care plans in place, detailing their needs and preferences. There was a range of activities which promoted health and well-being. The provider was usually responsive to any concerns or complaints people may have had about the service.

The feedback from both staff and people using the service regarding the registered manager was positive. We found the registered manager open and responsive. There were comprehensive quality assurance systems in place. Staff knew their roles and were provided with support, supervision and career progression opportunities.

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 9 November 2016).

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Dorrington House Watton provides accommodation and personal care for up to 52 older people, some of whom may be living with dementia. There were 50 people living in the home on the day of our inspection.

This inspection took place on 13 and 14 September 2016 and was unannounced on both days.

A registered manager was in post at the time of our inspection. 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.

During our inspection of the home in August 2015, we found that the provider was in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in respect of sufficient staffing, meeting nutritional and hydration needs, dignity and respect and good governance.

Following the inspection in August 2015, the provider sent us a plan to tell us about the actions they were going to take to meet the above regulations.

At this inspection we found that improvements had been made and the provider was no longer in breach of the regulations.

The home had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager knew how to report any safeguarding concerns to the appropriate local authority if necessary.

The home followed safe recruitment practices to ensure only suitable staff were employed to work with people who lived at the home. The home had ensured risks to individuals had been assessed and measures put in place to minimise such risks.

Caring relationships had been built between people and staff. Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. Where people needed support in order to make their own day to day decisions this was provided by staff. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

People were looked after by kind staff that treated them with respect and dignity. They and their relatives were given opportunities to be involved in the setting up and review of people's individual care plans.

Staff were kind and caring and treated people with respect. Staff knew people's likes and dislikes which helped them provide individualised care for people.

People were supported to maintain a balanced diet. Records of support provided with nutrition were not always in place to show that this care had been delivered.

People felt supported by the service manager. Management processes and audits were in place. People and their relatives were involved in their care assessments and care plan reviews. The manager was supported by senior staff, including a deputy manager. People and staff told us the home was well run and that the manager was approachable.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people were well cared for and that staff were very kind and knew how to care for people living with dementia.

Medication was administered, recorded and stored accurately and safely.

People told us that the home was a comfortable place to live and that they liked living there.

Staff members were trained and were supported to provide an appropriate standard of care and support through regular supervision and staff team meetings.

People told us that their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They were provided with a choice of suitable and nutritious food and drink.

People using the service and relatives told us that people received the care and support they needed but that sometimes there were not as many staff available.