Dover House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.
 

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity.

People were not treated with dignity or respect. The environment people were living in on floors 1 and 2 at the service displayed a lack of respect, and their dignity was not maintained. The smell of stale urine was overpowering at times due to the lack of hygiene and staff support to enable people to access toilet facilities and support with personal care at regular intervals. People were powerless to have the opportunity to sit and spend their day in pleasant and welcoming surroundings. Some people ate their main meal, which included gravy with their hands. They were not observed to wash their hands before or after the meal. Staff did not appear to have the time to sit with each person for the duration of their meal to provide support and encouragement and to maintain their dignity. Dignity was not respected and maintained. A relative commented, “My loved one is able to drink but is shaky and struggles to eat but the staff seem hesitant to help.”
People living on the ground floor and 3rd floor had better experiences, as the environment was free from odours and more homely with personalised rooms.
A relative said, “The ground floor and 3rd floor is clean and tidy but floor 1 can be a bit pungent.” Another said, “There are people who are incontinent and you can smell it. You can’t pinpoint from where, but you know it’s there.”

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The provider did not always take account of people’s strengths and abilities. We found leaders and staff lacked an understanding of how people should always be treated as individuals. Many people’s care plans and risk assessments used standard statements that were not individual, so did not describe the person and their individual circumstances. A person whose first language was not English was anxious and trying to make themselves understood. They struggled to articulate what they wanted. Staff tried to help but were not sure what they wanted at that time. The person’s care plan did not give clear guidance how best to communicate with the person when they struggled to speak English. There was no record of their relatives being involved in a communication plan. New staff and agency staff may not have the information required to enable individual and respectful care and support.
A relative commented, “I wish they could get themselves sorted and improve how they speak to (loved one) and how they interact and how they look after him, would they look after their loved one like this.”

The mealtime was task orientated with a lack of interactions between staff and people. We saw 1 staff member standing up to assist a person to eat their meal, who was not able to eat their own meal independently. This impersonal interaction avoided an intimate and pleasant mealtime experience. We did observe staff treating people with kindness when they were not focused on getting the tasks done.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and well-being.

People’s care plans had not been completed with them to make sure staff knew how to support them in the way they preferred and how to promote and maintain their choices and independence.
The lack of personal information in people’s care records, including their previous interests and what was important to them, meant staff did not have information to enhance individual interactions. Many people living on floors 1 and 2 were unable to speak about their likes, dislikes and personal history. They were reliant on those who knew them to provide this. However, relatives told us they were not involved in care planning for their loved ones.
Some people became agitated and frustrated as they were losing their memory and sometimes articulating speech, which impacted their ability to make choices, decisions and to maintain their independence. Care plans did not support the prevention of frustrated behaviour and provided limited information for staff how to intervene to limit consequences such as people harming themselves and others. A person’s care plan said to, ‘Talk calmly, redirect away from the trigger and offer a cup of tea’ and that they ‘felt good when in the lounge and in the middle of other residents’. No individual interventions were suggested, and we saw the person shouting in the lounge at staff and people who came near them on more than 1 occasion through the day. Their records showed numerous incidents of them allegedly assaulting other people and allegedly being assaulted by other people. The person had limited choices and ability to be independent due to lack of meaningful occupation and staff understanding of their individual situation.
Staff did not have the ability and skills to provide individual and effective support without clear guidance. The provider had not provided consistent observation and support to staff to ensure their practice was safe whilst treating people as individuals, which had significantly affected the quality of care provided.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Relatives gave examples of their loved ones having urine-soaked clothes on when they visited and had seen other people in this state. They told us about the service smelling of urine and of chairs and floors having urine and faeces on them. We saw people who had not been taken to the bathroom and were wearing urine-stained clothing. We also found the furniture and floors to be smelling of stale urine. People were therefore not having their immediate needs met.
People visibly needed wound dressings changed on their legs and this was not undertaken in a timely manner to meet their health needs. We saw people who needed help but no staff were available, and we needed to seek staff to request their help. For example, a person was trying to walk back to their room with personal belongings in their hands while also using a walking frame. They were at risk of falling but no staff were nearby. Some people were eating with their hands as enough staff were not deployed to make sure all the people who needed assistance received it when their meal was in front of them.
This indicated neglect to meet people’s immediate needs.

Some people, who were able to use a call bell had this available to them. People who had a call bell said they often had to wait for assistance but said they understood that staff were busy. A person said, “Not always answered quickly, but it may be due to others being seen (attended to by staff).” A relative said, “When I press the buzzer they respond but they need 2 staff. The longest we’ve waited is 15 minutes, they usually say if they will be some time as dealing with another resident”.

The provider did not always care about and promote the well-being of their staff. They did not always support or enable staff to deliver person-centred care.

Although staff told us they were well supported and spoke highly of the registered manager, our observations and review of records were that staff well-being was not promoted. There were not enough staff to meet people’s needs overnight, daytime staff struggled to attend to people individually and their day was task orientated. Staff had not received the appropriate training and level of training to meet the highly complex needs of people living in the service, particularly on floors 1 and 2. Some staff had been allegedly assaulted by people. The quality of individual records, the lack of lessons learnt from incidents and the lack of sufficient levels of training left staff, and people, vulnerable.

Staff working on floors 1 and 2 were working in a poor environment, with significant malodours throughout the day and, at times a stressful environment, due to the complexity of people’s needs. There was no evidence of regular staff meetings to share ideas, encourage staff to be proactive and to share concerns in a safe environment.