Archived: Dove Court Care Home

We inspected Dove Court on 14, 15 and 21 June 2017 and rated the service as inadequate. We took urgent enforcement action to place restrictive conditions upon the registration of the location to prevent any new admissions into the home.

Following our inspection in June 2017 local commissioners had been working closely with the home to support improvement however, they had raised concerns that the care people received whilst living at Dove Court continued to place people at risk of harm. We also received an anonymous concern from a whistle-blower that raised further concerns about the care that people received. In response to this information we carried out a focussed inspection to assess how the provider and senior management team at Dove Court were working to improve the care and support that people received and how they were ensuring that people’s safety, health and well-being was maintained.

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.

There was not 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.

The provider had not worked successfully to ensure that improvements had been made within the home since our last inspection so that people consistently received their care and support safely. We found continuing concerns from our previous inspection that highlighted that the action taken by the provider in response to our inspection in June 2017 had not been sufficient.

The provider had dedicated additional resources to the home in the form of ‘Resident Experience Managers’ to oversee people’s care and to support improvement, however, their roles were not clearly defined and the availability of permanent staffing impacted the improvement that they were able to make.

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.

Dove Court Care Home is registered to provide residential and nursing care for up to 58 people, including people with dementia. At the time of this inspection there were 56 people living in the home.

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.

There were not always sufficient staff to meet the needs of people in a timely way and in some areas of the home staff did not have the time to interact with people outside of meeting people's basic care needs. People's experience of care and support differed depending on where they lived within the home. People in some areas of the home were not always able to access suitable levels of social interaction and activity.

Care plans were not always sufficiently person centred and detailed enough to provide staff with the information required to provide individualised care. People were not consistently involved in planning their care.

Appropriate systems or processes were not in place to assess, monitor and improve the quality and safety of the service. Quality assurances processes were not always effective at identifying shortfalls and where shortfalls were identified these were not always addressed in a sufficiently timely manner to minimise the impact on people.

People were supported to take their medicines as prescribed, however staff did not always follow the provider’s policies and procedures when administering medicines. Records showed that medicines were obtained, administered and disposed of safely.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received induction to their role and training in areas that enabled them to understand and meet the care needs of each person.

People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care. Staff supported people to have sufficient amounts to eat and drink to help maintain their health and well-being.

People felt safe in the home and relatives had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. People received care from staff that were friendly, kind and thoughtful and their right to privacy and dignity were respected.

People's consent was sought prior to care and support being delivered by staff. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were many opportunities for people and their families to share their experience of the home and the provider and manager actively sought feedback from people. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

We found that Dove Court is now fully compliant with the regulations we inspected against.

We spoke with one person who was now satisfied that the home was at last going in the right direction. This person stated that the they felt they had not been listened to by the previous management team. They all said the staff do a good job and treat them respectfully.

Visitors we spoke with said that the current manager, deputy manager and other staff are "Making great improvements, things are much better now."

We found the staff were dedicated to the care and welfare of the people who used the service.

We found the home was undergoing a period of change with an interim manager and deputy in place. There is evidence that the management team are empowering the staff and encouraging ownership of the staff team.

There was also evidence that systems have already been put in place to ensure that all staff are aware of residents needs and interventions required.

We listened to people who used the service, relatives and staff who all expressed concerns regarding the number of management changes that had taken place at the home in the past 12 months and would like to see consistency and a settled team.

We found the provider was non compliant in matters of dignity, respect, care and welfare and the recording of complaints in the home on the day of the inspection .

We were told that the food was of a good quality, that people were offered choices before each meal, and that the food was always hot when served. One of the people who used the service commented, 'The food is really good and there is always plenty of it."

People told us that staff were always polite and respectful of their individual needs and that they knew how to support them

We found the home to be a caring and happy home however they failed to regularly seek the views of service users, relatives, advocates or staff by means of formal meetings. The provider also failed to hold clinical governance meetings.

We observed people being supported throughout the day of our visit. Care workers actively assisted people with meals and drinks.

People told us that they felt supported by the care staff and that they had a choice of when to get up in the morning and when they went to bed. They told us and we saw that the staff treated them with respect and dignity particularly when they received personal care.

People who used the service and relatives told us that they received sufficient information about the home and were able to visit prior to becoming resident.

One person who used the service told us the staff were lovely however they sometimes waited for up to an hour to be changed when staff were busy.

Another person who spoke with us said 'they are not just good they are excellent."