Archived: Dolphin View Care Home

Dolphin View provides care for up to 35 people. There were 34 people living in the home at the time of the inspection, some of whom were living with dementia.

When we completed our previous inspection on 8 August 2017 we found concerns relating to Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. At this inspection we found appropriate action had been taken and we have rated the service as good.

A registered manager was in post. 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.

At our last inspection we found concerns with the safe management of medicines. At this inspection, we found the necessary improvements had been made.

Safeguarding policies were in place and staff were aware of the procedures to follow if they had any concerns of a safeguarding nature. Safe staff recruitment procedures were followed which helped to protect people from the risk of harm.

There were mixed views about the numbers of staff on duty. Some staff and visiting professionals felt staffing could be low at times, but no one had any concerns about the quality of care provided. We found suitable numbers of staff were deployed during our inspection, but we made a recommendation to keep this under close review in light of comments we received.

Infection control procedures were followed. There was some malodour from a faulty sluice during the inspection, we were notified this had been fixed immediately following our inspection.

Risks to people and environmental risks were assessed. A record of accidents and incidents was kept.

The premises needed redecoration and we received numerous comments about this. We were provided with dates of planned redecoration of communal areas following our inspection. We made a recommendation that attention to dementia friendly design features should be taken into account during planned refurbishment.

People’s needs and choices were assessed before they moved into the home.

Staff received regular training, supervision and appraisals. Competency assessments were carried out to ensure staff were competent to carry out specific tasks and nurses felt well supported to maintain their clinical skills.

People were well supported with eating and drinking, and prompt referrals were made where people had problems with swallowing or maintaining a healthy weight.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed numerous kind and caring interactions. Staff supported people to maintain their independence, privacy and dignity.

The needs of people were responded to and visiting professionals told us they received appropriate and timely referrals. End of life care was reported to be good and person-centred care plans were in place to ensure people were supported in the way they preferred.

A variety of activities were available including links with and involvement in community based activities.

A complaints procedure was in place and concerns raised by people or relatives were responded to promptly by the registered manager who was frequently described as approachable and helpful.

At our last inspection we found effective systems to monitor the quality and safety of the service were not in place. At this inspection we found improvements had been made.

People, staff visitors and visiting professionals were complimentary about the way the service was run and told us the registered manager was very committed to people who used the service.

Feedback mechanisms were in place to obtain the views of people and their relatives, and there were close links with the local community.

Dolphin View Care Home provides care and accommodation for up to 42 people, some of whom have nursing care needs and/or dementia. On the day of our inspection there were 33 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Dolphin View Care Home was last inspected by CQC in June 2015 and was rated Good overall.

At this inspection, we identified issues with the management of medicines. For example, we found some gaps in the daily recording of medicines storage temperatures, some medicines that were time specific had not been administered at the appropriate time, advice had not been sought from the pharmacist regarding the crushing of a medicine, important information regarding ‘as required’ medicines had not been documented, medication administration records had not been consistently signed, and no records were kept for one person to show when and where topical medicines were to be applied.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The provider applied the Mental Capacity Act 2005 (MCA), including Deprivation of Liberty Safeguards (DoLS), in line with legal requirements and their responsibilities. However, some mental capacity assessments and specific decisions were not always fully recorded. People and family members told us they were involved in planning their care and had given consent, however, records did not include evidence of this consent being given. We have made a recommendation about this.

People’s dietary needs were catered for and people were offered a choice at meal times.

Care records contained evidence of people being supported during visits to and from external healthcare specialists.

People who used the service and family members were complimentary about the standard of care they received at Dolphin View Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

End of life care plans were in place for people as required, however, some records lacked specific information regarding people’s individual wishes.

Care records showed that people’s needs were assessed before they started using the service and records were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint. There had been not been any formal complaints recorded at the service for over two years.

The provider had a quality assurance process in place, however, this had not identified the issues with medicines and consent highlighted in this report.

Staff said they felt supported by the manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys. Family members told us the management were approachable and accommodating.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 12, entitled Safe care and treatment and Regulation 17, entitled Good governance. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the regulations 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?

This is a summary of what we have found.

Is the service safe?

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place which related to the Mental Capacity Act 2005 (MCA) and DoLS.

We saw there were sufficient members of suitably qualified and experienced staff on duty to meet people's needs.

Is the service effective?

We saw that people's general care needs were addressed and that they had appointments with dentists, chiropodists and opticians. We noted that where people's care needs changed then action was taken and care plans were updated to acknowledge this change.

People who used the service were asked about the support they received and if they understood their rights. People we spoke to were aware of their rights and what to do if there were any problems.

Is the service caring?

People's preferences, interests and needs were recorded in people's care records. Staff were able to give examples of these when we spoke to them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

People's health and care needs were assessed with them and they were involved in this process.

Is the service responsive?

There was a system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined, a referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a registered manager in place at the service. The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service.

We were unable to speak to all of the people using the service because of the nature of their condition. We also spoke to staff and observed their practices to determine how care and support was carried out.

People were complimentary about the care and treatment and we found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. People were complimentary about the range of activities available. One person told us, 'I like to do craft work and the activities lady brings me materials to encourage me.'

We found that there were suitable numbers of skilled, qualified and experienced care staff.

We found that staff received the appropriate support and training for their professional development.

Management systems were in place to identify, assess and manage risks to health, safety and welfare of people using the service and others.

We saw that people's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Relationships between staff and people were good. We found that staff spoke to people in a friendly and respectful manner.

People told us they were happy with the care they received. Comments included, 'It's champion (great), I cannot complain' and 'If I've got to be anywhere, this is as good as it gets.' However, we found that care was not always planned and delivered in a way which met people's individual needs.

We found there were suitable infection control measures in place.

Staff told us they felt supported in their work and we found there were suitable staff induction procedures in place. However, 20 per cent of staff training was overdue and staff were not receiving regular supervisions or appraisals.

People and relatives told us they would feel comfortable approaching the manager if they wished to discuss any concerns. Comments included, 'Any issues have always been sorted' and 'I made a complaint once to the manager, he was very good.' We found there was a complaints system in place and complaints were fully investigated.