Dover House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to consent to care and treatment.
 

This service scored 29 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Although assessments of people’s needs were carried out prior to them moving into Dover House, consideration was not given to the skills and abilities of staff to fully meet those needs, or whether they had the capacity to meet people’s needs, based on the mix of people already living at the service.
Assessment tools were used to determine the level of people’s individual risks. However, the outcome identified through the assessment tools were not used to develop care plans and risk assessments specific to the individual, to ensure staff had appropriate guidance to provide the care needed and mitigate the risks.

There was limited evidence people and their relatives had been involved in discussing their health and care needs as care plans did not highlight their individuality. The relatives we spoke with told us they had not been involved in discussing their loved one’s care needs. Some relatives were happy with this and said they could see what had happened through the day on the care planning app. Other relatives were concerned with their lack of involvement. A relative commented, “I’ve been involved but some things haven’t been actioned in the care plan.” Another said, “No input to the care plan.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care and support plans and their risk assessments had not been comprehensively reviewed and monitored to ensure information was accurate or contained important information and guidance.
Although staff had used nationally recognised tools to assess risks to people such as malnutrition and skin integrity, these were not referred to in people’s care plans or risk assessments, to enable preventative measures to be put in place. A person’s skin integrity assessment tool showed they were at very high risk of their skin breaking down. There was no specific guidance for staff in relation to the person’s identified risks and what measures to take to prevent deterioration to their skin, following this assessment.

Where people had wounds, although a wound plan was in place for nurses to follow, these were not always dressed at appropriate intervals. A person had significant risks around wound care, and although a wound plan was in place for nurses guidance, their skin integrity care plan, which included guidance for care staff when supporting them with tasks, did not include the wounds and what signs to look out for and report. This was a missed opportunity to ensure care staff were included in taking responsibility to ensure safe and good quality care was provided. The lack of consistency and staff skills to ensure close monitoring of people’s health meant timely measures may not be put in place to support their health and well-being.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

Staff did engage with healthcare professionals and made some referrals for additional advice. However, this proved to be ineffective as some people had received poor care despite advice given, which has been described through this report. For example, wound care plans were in place, and wound regimes had at times been advised by an external healthcare professional. Nurses at Dover house had not used their own professional knowledge to their advantage in order to be able to prioritise people’s individual needs when planning tasks on a daily basis.
The service did not establish effective communication and information sharing within the team. For example, there was no evidence team meetings took place regularly, or that staff handovers between shifts were used effectively.
A relative told us they had asked care staff if they could see the nurse when their loved one’s legs started leaking through their dressings. Care staff told them it could be a while as they were busy. A nurse did not come to speak to the relative. They said there had been other similar incidents when they wished to discuss concerns.

The provider did not support people to manage their health and well-being, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not supported to live a healthier life, and their well-being was not prioritised. Staff had not received training to support important healthcare needs such as catheter care or Parkinsons disease, even though people were living at Dover House with these care and support needs. We found that care plans and risk assessments did not address the important factors and risks in relation to these needs. People and their loved ones could not be assured their needs were being safely or fully met.

People who were living with advanced dementia and unable to verbally articulate their anxiety or frustration, resulting in periods of distress, were not supported by staff who had the skills and abilities to provide positive support to benefit their daily lives and the lives of the people around them. Staff had not received the training to meet the complex mental health needs of people living at the service, resulting in altercations between people where people, and staff, were physically assaulted and at times injured.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans had not been monitored closely to check they included accurate information and there was no process to monitor outcomes for people.
We found limited evidence of records to monitor people’s individual needs such as catheter changes, distressed behaviour, wound management and falls to establish possible trends or patterns. Risks were not identified and mitigated against so there were risks peoples’ needs were not met, leading to complications with their health, and leading to poor outcomes.

Care plans did not include if people had goals, such as to increase their mobility to gain or maintain independence, or to re-commence a hobby or interest. Monitoring processes were not in place to identify this, leading to a risk to people’s health and well-being.

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment.

The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and associated code of practice, or their own MCA policy. The provider and staff’s lack of knowledge and understanding of MCA and what it means in practice meant people’s rights were not maintained and upheld.
Mental capacity assessments were not always completed for the relevant decisions that needed consent and a robust best interest decision making process had not always been followed. Consent forms were often not signed and sometimes had been signed and agreed by a relative without evidence of the appropriate legal authority. When people had been assessed as having capacity to make a decision, they had not always signed consent forms in relation to their care and treatment or agreement to their care plan.
The provider had installed surveillance equipment, CCTV cameras, in communal areas and although consent had been sought, where people lacked capacity to make the decision to consent to this, the best interest decision making process was not robust. For example, people’s relatives had not been asked what the person’s views had been in relation to the use of CCTV prior to losing capacity, such as in the community.
CCTV cameras had been installed in each person’s bedroom. Although the cameras were not yet active, the provider’s intention was that they would be and had been installed and wired in. The registered manager told us information would be provided and consent would be sought before cameras in people's rooms were activated, including the views of relatives where relevant, such as if a person lacked capacity to consent.