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Inspection carried out on 15 August 2018

During a routine inspection

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. 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. The home is owned by Mrs Wendy J Gilbert and Mr Mark J Gilbert.

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 regist

Inspection carried out on 3 May 2017

During a routine inspection

This inspection took place on 3rd & 4th May 2017 and was unannounced.

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 ma

Inspection carried out on 19 July 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service in March 2016 when two breaches of legal requirements were found. We found a breach in regulation regarding the safe management of medicines and we took enforcement action in respect of this breach. We served the provider with a statutory Warning Notice regarding medicines not being managed safely. We also found a breach of regulation as the service had not followed agreed local authority protocols for reporting an allegation of abuse to ensure people were protected. We asked the provider to take action to address these concerns.

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.

Inspection carried out on 21 March 2016

During a routine inspection

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. 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. The home is owned by Mrs Wendy J Gilbert and Mr Mark J Gilbert.

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.

Inspection carried out on 21 & 22 October 2015

During a routine inspection

This unannounced inspection of Dovehaven Nursing Home took place on 21 & 22 October 2015.

At the time of our inspection there was no registered manager in post. The service had a manager who had applied to CQC (Care Quality Commission) for the position of 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'.

People and relatives we spoke with told us they felt the home was a safe place to live. Our observations and feedback from people who were living at the home and relatives indicated people were not always supported by sufficient numbers of staff to provide care and support in accordance with individual need. At peak times we found staff did not always answer people’s calls for assistance promptly as they were assisting other people. For example, over the lunch time period.

The staff we spoke with were aware of what constituted abuse and how to report an alleged incident.

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

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people.

Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building. We found doors in the home were wedged open which increased the risks to people’s safety in the event of a fire. Following the inspection the manager informed us these had been removed and electronic catches are being fitted to the doors. We referred this concern to the fire service who have since visited the home to provide advice.

Staff told us they were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

We observed staff gaining people’s consent before assisting them with personal care or providing assistance with their meals. People’s consent, or relatives if required, was not always documented in the care files we saw to evidence their inclusion and to ensure the service was working in accordance with the Mental Capacity Act (MCA) (2005). The manager informed us people who lived at the service needed support to make decisions regarding their care. We found staff were not always following the principles of the MCA 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. We observed and spoke with people enjoying lunch. People told us the meals were good and there was plenty of choice.

Staff carried out personal care activities in private. People did however tell us that the home was very busy and at times they had to wait for staff support.

There was a lack of social stimulation for people living at the home. There was nobody organising or co-ordinating a programme of events for people to engage with and enjoy within the home. Following the inspection the manager informed us the home would be recruiting an activities organiser.

People were able to see external health care professionals to maintain their health and welfare. Care files recorded these appointments and people’s plan of care provided information about their care needs and staff support. Risks to people’s safety were also recorded.

The staff interacted well with people and demonstrated a good knowledge of people’s individual care, their needs, choices and preferences. During the course of our visit we saw that staff were caring towards people and they treated people with warmth and respect.

A process was in place for managing complaints and the home’s complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

People living in the home and their relatives told us the manager was approachable and supportive.

Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff said they were able to speak with the manager if they had a concern.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the home.

The manager was able to evidence a series of quality assurance processes and audits carried out internally. These had not picked up the areas of concern we identified during our visit to the home. The provider did not ensure effective systems and processes were in place to consistently assess, monitor and improve the safety and quality of the service.

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

Inspection carried out on 3 February 2014

During a routine inspection

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to two people using the service, a relative and three members of staff. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

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.

Inspection carried out on 28 January 2013

During a routine inspection

We spoke with six people at Dovehaven Nursing Home and they were able to tell us what it was like to live at there and how the staff provided the care and support they needed. All the people we spoke with told us they were happy with the standard of care they received from the staff.

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.

Inspection carried out on 7 January 2011

During a routine inspection

People told us that they were consulted about the care and support they needed and that their wishes were respected by the staff.

People told us they were pleased with the care they were receiving and that the staff gained their consent when planning care and treatment according to individual need. This includes assessments in respect of daily life decisions that affects their welfare. We were also informed that the home seeks advice from external health care professionals and the staff arrange appointments for them promptly. Relatives told us that the staff were good at ‘keeping in touch’ and they had plenty of opportunities to meet with them to discuss the care and support their family member receives.

People said the staff gave medicines out on time and that they were also offered opportunities to look after their own medicines if they wished. No one raised any issues in respect of how medicines are administered at the time of our visit.

Discussions with people confirmed their satisfaction for the choice of meals. They said that the menu was varied, appetising and they were able to choose what they would like to eat.

People told us that they felt ‘at ease’ and ‘safe’ with the staff and that their concerns would be listened to and addressed. No one raised any issues at the time of our visit.

People confirmed that the home was kept clean and tidy, this included bedrooms, communal rooms, shared bathrooms and toilets. They said the home was pleasantly decorated.

People said the staff were kind and helpful and that they were ‘on hand’ to help when needed. They said they felt supported by the staff and confident in their abilities to care for them safely.

People told us the staff involve them with the overall management of the home and that their views are taken into consideration, so that the home is run in their best interests.