Archived: Dove Court Care Home

Updated 26 August 2017

We carried out this responsive focussed inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was prompted because of concerns that had been raised about the care people received whilst living at Dove Court since our last inspection in June 2017.

This inspection took place on 13 July 2017 and was unannounced. The inspection was carried out by four Inspectors.

Before our inspection, we reviewed information we held about the provider including, including information that they had submitted to show the action that they had taken to ensure people’s safety since our last inspection in June 2017 where we rated the location as inadequate. We also liaised with health and social care commissioners who place and monitor the care of people using the service.

During the inspection we spoke with seven people who used the service and one person’s relative. We also spoke with 11 members of staff including the acting manager, regional manager and four resident experience managers who were supporting the management of the home. We reviewed the care records of 13 people who used the service. We did this to ensure that care was being delivered safely.

Updated 26 August 2017

This unannounced inspection took place over three days on 14, 15 and 21 June 2017.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Dove Court Care Home is registered to provide residential and nursing care for up to 58 people, including people living with dementia. At the time of this inspection there were 55 people living in the home. Three of these people were in hospital during our inspection. 38 people using the service required nursing care. There were people using the service who could not always express their needs and wishes because they had a mental health condition or because their ability to communicate was impaired. Many of the people using the service were nursed in bed. Many of the people using the service were very frail and had complex needs requiring a high level of support.

There was a registered manager 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 the registered manager left the service due to the concerns raised through our inspection.

At this inspection we found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches we identified posed a significant risk to people who used the service due to the complexity of their care needs. Many of the people using the service were extremely vulnerable, and highly dependent on the care and nursing staff supporting them. Our observations of peoples’ needs during our inspection showed that they were not always receiving the necessary support to ensure risks to their health, safety and wellbeing were being effectively managed. There was a lack of care delivered to meet people’s individual needs and maintain their dignity.

Due to the breaches we identified during our inspection and the risk that these posed to people, some of whom had experience harm as a result, we made a number of safeguarding referrals to the Local Authority as we were concerned about people's safety and well-being.

We found there to be insufficient numbers of staff working at the service to keep people safe. There was a high reliance on agency staff and a lack of clinical leadership within the home. People had experienced and were at risk of experiencing unsafe care and treatment as a result. Staff training and performance was not being effectively monitored and staff lacked knowledge about people who used the service.

We found the premises to be unclean and unsafe. Risks posed by the premises had not been identified and as a result had not been resolved. This put people at risk.

We found that medicines were not always safely stored and managed and that there had been a lack of follow up when medicines had been unavailable.

Care was not always planned and delivered to ensure people's safety. People at nutritional risk and those at risk of developing pressure sores had experienced unsafe care and treatment and there was a lack of monitoring in relation to people's nutritional intake.

People's dignity was not being maintained at the service and their privacy was not always respected. People's personal preferences in relation to their care was not always considered and people lacked stimulation and choices about how they spent their time.

We found some staff to be caring and compassionate towards people, however, due to staffing levels at the service they lacked time to be able to spend with people. Care being delivered was task focussed.

There was a lack of effective monitoring in place at the service and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection.

The principles of the Mental Capacity Act 2005 were followed at the service and people had assessments and best interest decisions documented when needed. However, there was not a clear oversight of who may need a Deprivation of Liberty Safeguard in place. We were told that this would be addressed following our inspection.