Archived: Dovehaven Nursing Home

Dovehaven Nursing Home is a Care Home with nursing and provides accommodation for up to forty elderly people. At the time of the inspection there were 22 people in residence.

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

The management systems needed further embedding to ensure all aspects of care and safety were consistently monitored and improved. Some areas still needed for improvement had not been effectively monitored or actioned in good time. These included updating of the fire risk assessment, medication administration records, care planning for one person and areas signposted around IPC practice.

A routine notification to The Commission regarding a safeguarding incident had not been made at the time.

At our last inspection we found breaches of regulation because sufficient staff were not always deployed to meet people's needs. Enough improvement had been made at this inspection regarding staffing and the provider was no longer in breach of this regulation.

There were concerns with the administration records for medicines. Records did not support safe practice. This meant there was a potential risk some medicines for people might not be monitored effectively and there was a risk some people might not receive their medicines.

The service was not always following best practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control. We signposted the manager to best practice guidance.

People's experience of using the service was positive. People told us they received the care and support they needed when required. Most of the feedback we received showed staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

One person commented. “I’ve had a shower this morning and I can get one when I want. Staff are there and I’ve got by call bell if I need them.” Another person said, “The staff can’t be faulted.”

Standard risks assessments associated with people’s care were carried out and managed to minimise harm. Supporting care records mostly identified risks clearly and there were plans in place to help keep people safe.

The current manager was supported by a senior management team. The provider’s governance systems and organisational structure helped provide monitoring and support for the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 December 2020. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was partly prompted by concerns raised through safeguarding relating to medication documentation and management of pain relief. We also had other information raising concerns around fire safety, personal care for people and training for staff. A decision was made for us to inspect and examine those risks.

We had previously carried out an unannounced focussed inspection of this service on 16 November 2020. A breach of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. As part of this focused inspection we checked they had followed their action plan and confirmed they now met the legal requirement for staffing. A further breach has, however, been identified.

This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dovehaven Nursing Home on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dovehaven is a Care Home with Nursing and provides accommodation for up to forty elderly people. The home is situated in a residential area of Southport, close to the town centre and local amenities.

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

Records did not always consistently record information about people’s care and support. People told us they sometimes had to wait for care and support if they needed help. These shortfalls had been identified by the provider who was taking action to make improvements.

Policies guided on recruitment processes to ensure suitable staff were employed. Risk assessments were completed and reviewed to promote people’s safety. Staff told us they would act to protect people if they believed them to be at risk of avoidable harm. Staff could explain the needs and wishes of people and how they helped them to remain safe.

Medicines were stored securely and administered by staff who had received training and assessment to ensure they were competent.

The service did not have a registered manager. 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 manager in place at the time of the inspection did not have sufficient oversight of the service. The provider arranged alternative manager oversight prior to the inspection concluding.

Quality checks and audits were carried out to enable areas of improvement to be identified and successes celebrated. The service worked with other health professionals to provide identified health services where this was needed. People were also supported to access medical advice when this was required.

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 (15/09/2018).

Why we inspected

We reviewed the information we hold about the service and noted information which indicated risk within the key questions safe and well-led. A decision was made for us to inspect and examine those risks. We carried out this focused inspection to review the key questions of safe and well-led only. The provider had identified where improvements needed to be made and was taking action to improve the service.

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 coronavirus and other infection outbreaks effectively.

Please see the safe and well-led sections of this full report.

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 improvement. Please see the safe and well-led sections of this full 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.

We have identified a breach of regulation as sufficient staff were not effectively deployed.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service had a registered manager. 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 the previous inspection we had some concerns around call bells not being responded to in a timely manner and this had the potential to affect people’s dignity and respect. We recommended the provider review the staffing arrangements which they did. At this inspection we found calls for assistance were being answered in a timely manner. The actions taken by the provider following the previous inspection included robust monitoring of a dependency tool which was used to assess people’s physical needs and well-being to help assess numbers of staff required; care hours had been increased; the deployment of staff across the floors had been changed to reduce the risk of people having to wait for support. Staff told us these measures had proven to be effective. People told us it was a busy home, however, staff did their best to assist them as soon as possible.

People's needs were assessed and recorded by suitably qualified and experienced staff. Risk assessments, a plan of care and supporting care documents were completed to help ensure people’s needs were met. We found some inconsistencies in the detail of information recorded to support individualised care. The registered manager took action to address this.

Staff knowledge regarding people’s care needs was good and we saw care and support being given in accordance with individual need.

Staff had been appropriately checked when they were recruited to ensure they were suitable to work with vulnerable adults.

Staff understood how to recognise abuse and how to report concerns or allegations.

Medicines were administered safely by staff who were trained and deemed competent. Medicines were subject to auditing to ensure the overall management remained safe.

Policies and procedures provided guidance to staff regarding expectations and performance.

Staff were clear about the need to support people's rights and needs regarding equality and diversity.

We saw clear evidence of staff working effectively to deliver positive outcomes for people. People we reviewed were receiving effective care and support. This included advice from external health and social care professionals.

Menus offered a varied choice of hot and cold meals and people dietary requirements and preferences were taken into account.

People told us that staff treated them with kindness and respect.

People using the service and relatives were asked to share their views. We saw positive responses and suggestions made were acted on by the registered manager.

There was a complaints process. Complaints had been investigated and responded to in a professional and timely manner.

There was clear management structure and people, relatives and staff were positive regarding the registered manager’s leadership of the home.

The registered manager understood their responsibilities in relation to registration. For example, notifications had been submitted in a timely manner and the ratings from the last inspection were displayed as required, including the provider website.

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Further information is in the detailed findings below.

Dovehaven is a Care Home with nursing and provides accommodation for up to 40 elderly people. The home is situated in a residential area of Southport, close to the town centre and local amenities. The home has equipment and aids to assist people and different areas of the home are accessible for people who use a wheelchair or have limited mobility. At the time of the inspection there were 37 people living at the home.

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.

The home had a consistent staff team and there appeared to be sufficient staff on duty. However a number of people told us they felt more staff were needed as calls for assistance were not always responded promptly by the staff. The registered manager said they would look into this with immediate effect and this would include a review of the current staffing levels.

We have made a recommendation about reviewing staff response time to calls for assistance.

Social activities were organised in the home though the registered manager appreciated these needed to be developed further with the provision for more formal activities programme and ‘one to one’ time for people who were at risk of social isolation. The need for this was raised by people during the inspection.

Our observations showed care and support was carried out in a caring, kind, respectful and unhurried manner. People we spoke with and their relatives told us they had confidence in the staff’s ability to care for them.

External contracts were in place and internal health and safety checks and audits were completed to help maintain the safety of the building and its equipment.

Risks to the people living at the home were appropriately assessed and recorded in care records.

Staff were recruited safely subject to the completion of appropriate checks to ensure they could work with vulnerable people. We saw the required checks had been made.

Medicines were administered safely to people and the registered manager completed medicine audits to ensure the safe management of medicines.

The staff we spoke with described how they would recognise abuse and the action they would take to report any actual or potential harm. Training records confirmed staff had undertaken safeguarding training.

People had a plan of care which set out their health and social care needs. Plans of care contained person centred information, which showed that people had been consulted regarding their care. Care reviews took place and people were supported to maintain their health and well-being by accessing a range of external health professionals.

Staff received training and support and had a good understanding of their roles within the service and what was expected of them.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed, in that an assessment of the person’s mental capacity was made.

When necessary, referrals had been made to support people on a Deprivation of Liberty (DoLS) authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the registered manager of the home.

We saw people’s dietary needs were met with reference to individual preferences and choice. People said they liked the meals served.

A complaints’ procedure was in place and people and their relatives felt confident in raising concerns with the registered manager.

The registered manager was able to evidence a range of quality assurance processes and systems to monitor standards within the home and to drive forward improvements. This included a number of audits (checks) for various aspects of the service.

Staff and people said the home was well managed and the registered manager approachable and supportive.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

The registered manager had a good understanding of their role and responsibilities in relation to what was expected from them as a registered manager with us, Care Quality Commission (CQC). The registered manager had notified us any notifiable incidents in the home.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 19 July 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This covered one question we normally asked of services; whether they are 'safe’. The question 'was the service effective', 'was the service caring', 'was the service responsive' and 'was the service well led' were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dovehaven Nursing Home on our website at www.cqc.org.uk.

Dovehaven Nursing Home provides nursing care and accommodation for up to forty elderly people. 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 the previous inspection we had concerns regarding the administration of eye drops, the management of people taking warfarin, thickening agents in drinks and checks of controlled medicines. Controlled drugs are prescription medicines that have controls in place under the Misuse of Drugs legislation. At this inspection our findings showed improvements had been made and medicines were now being managed safely. This breach had been met.

At the previous inspection we had concerns that the service had investigated a safeguarding incident (allegation of abuse) and had not followed agreed local authority protocols to ensure people were protected. At this inspection our findings showed staff were aware of the safeguarding procedure to follow and on-going training was provided around the safeguarding of adults (protecting people from abuse). This breach had been met.

This unannounced inspection of Dovehaven Nursing Home took place on 21 & 22 March 2016.

There was a registered manager 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 the previous inspection 21 & 22 October 2015 the provider was found to be in breach of a number of regulations. At this inspection the breach of regulations we identified in October 2015 were now met, apart from the safe management of medicines. We also identified a new breach at this inspection around safeguarding people who use services from abuse.

People living at the home were not always protected against the risks associated with the proper and safe management of medicines.

The safeguarding process to follow in accordance with local authority protocol had not always been followed to protect people from abuse.

People and relatives we spoke with told us they felt the home was a safe place to live.

Staff sought advice and support from external health professionals when needed to help assure people’s health and wellbeing.

Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect them from unnecessary harm.

People were supported by sufficient numbers of staff to provide care and support in accordance with individual need.

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people. All relevant recruitment checks had been undertaken prior to staff starting work at the home.

Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building.

Staff told us they were supported through induction, on-going training, supervision and appraisal.

People’s consent, or relatives’ consent (if legally empowered to do so) was documented in the care files we saw to evidence their inclusion. Staff followed the principles of the Mental Capacity Act (2005) for people who lacked capacity to make their own decisions.

People’s nutritional needs were monitored by the staff. Menus were available and people’s dietary requirements and preferences were taken into account.

Staff carried out personal care activities in private. We found staff support was given in a respectful and caring manner. Staff took time to listen to people and responded in a way that the person they engaged with understood.

A process was in place for managing complaints. People and relatives told us they had confidence in the registered manager to investigate any concerns arising.

We received positive feedback about the management of the home from staff, people who lived at the home and relatives.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the home. This included the provision of satisfaction surveys and ‘one to one’ meetings with people who lived at the home and their relatives.

We found the current system to audit the safe management of medicines was not effective and had the potential to place people at risk. The medicine audits had not picked up on the areas of concern we identified during our inspection.

You can see what action we told the provider to take at the back of the full version of this report.

People said that they were 'well looked after,' and that the staff were, 'very good and led by a good manager.'

People and their relatives told us that they were involved in planning and reviewing their care needs. Relatives said that staff always had time to talk to them and that all knew them well. We saw that staff were attentive and caring, knew the service users' needs and called people by name.

We saw that there were enough, suitably trained staff on duty at all times.

We saw that the provider regularly assessed and monitored the quality of the service provided.

People told us the staff were kind, polite and considerate when caring for them. We found the home's routine relaxed and people and staff were chatting freely during the inspection. People told us they felt at ease and comfortable with the staff when receiving personal care.

People had a plan of care which evidenced the care, treatment and support they needed to ensure their health and welfare. Staff told us the care documents provided the information they needed to care for people safely.

People were protected against the risks associated with medicines because the staff administered medicines safely to people.

Infection control procedures were in place which meant people were cared for in a clean environment.

Staff received training and support, so they had the skills and knowledge to provide safe care and and support to people. Staff were encouraged with their learning, as part of their professional development.

The home's complaints procedure was displayed, so people who used the service had the information they needed should they wish to raise a concern. A relative told us they would not hesitate to speak with the staff if they had a complaint about the home.