Dover House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person centred care.
 

This service scored 32 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

There were no effective systems in place to make sure people, and their relatives were involved in developing their care plans. Care plans did not provide the level of detail to ensure a person-centred approach to people’s care and support.
People did not receive person-centred care. Their interests were not explored and considered to plan their day which led to boredom and frustration. People were often left to sit with limited interaction. For example, some people sat in the lounge all day. Staff did not sit down next to them and have a chat or to hold or massage their hands if they were not able to converse. When not assisting people, staff were focused on their hand-held devices regularly, ticking tasks completed. However, care plans on the devices held limited information about people to enable staff to quickly find a way to engage with people based on their individual circumstances and past life.
The day mainly consisted of music played loudly on the TV in the communal lounge. The music was often changed by staff without any interaction with people about choices. The provider’s weekly compliance audits had picked this up through the auditor’s observations. However, no action had been taken, as we observed the same. No action had been taken to improve people’s quality of life and this was ongoing.
The provider had installed 2 CCTV cameras in every person’s room that were not yet active but with a view to them being used. As the surveillance devices were already installed, prior to individual consultation and consent, a blanket approach had been used rather than a co-ordinated person-centred approach to a potential infringement on people’s choice and rights. If people did not consent to the cameras in their room, they were still there and could make people who hadn’t consented uncomfortable, and they may feel under scrutiny in their private space.
People were wearing clothes that were not clean, their hair not brushed, and some men were unshaven. Many people were walking around without footwear. A relative told us they had raised their concerns with staff about their loved one’s appearance and odour, they were told their loved one refused to take a shower. The relative told us this was unlike their relative and believed staff were not approaching it correctly. This level of personal details was not always included in people’s care plans, and relatives had not been involved, to ensure a person-centred approach was taken to all aspects of people’s care.
The lack of a person-centred approach seriously impacted on the quality of people’s care and experience.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

The provider had not ensured systems and processes had been implemented to enable people to receive appropriate and skilled joined up care in relation to health care and social care needs.

Although staff did liaise with health and social care partners, this did not always lead to improved care and support for people. For example, advice had been sought in relation to wound care, but advice had not always been followed in a timely way to ensure people’s comfort, recovery and to protect from infection and harm.
People who experienced distressed behaviour were not given the support they needed, and care plans had not been developed by staff who had the appropriate training and experience. Professional advice and training had not been sought to make sure people received positive, consistent and co-ordinated support when there were signs or triggers of distress to prevent increased anxiety and escalation of response to this.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider did not always ensure important and critical information was provided to those who needed it. People and relatives did not always know how to make a complaint. Although access to different formats of information could be provided, for example large text or in different languages, this was not advertised to people and relatives to make sure they were aware they had a right to request different formats to aid understanding.

Although relatives had access to their loved one’s care records, some relatives told us they were not always accurate. A relative said, “I use the care record app but some of the details are incorrect as they said I had visited but I hadn’t and some of the data is incorrect, but this might be an admin error.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

People and relatives had raised concerns and complaints. These had not always been captured within the provider’s complaints records. For instance, a relative told us they complained because they had not been kept updated, “There was an unwitnessed fall which happened at midday one day, but I was not informed until 6 pm, they didn’t seem to think it was that important. There is another health concern which I have communicated to them, and it needs looking at but when I raise with the manager they apologise and then the same old cycle begins.”

More serious complaints were not always investigated and the outcome relayed back to the complainant. A relative complained of the alleged poor state of cleanliness they found their loved one’s room in and their loved one did not smell pleasantly but smelled of urine. The record showed staff disputed this and the relative was so upset they said they intended to move their loved one to another care facility. The person was not living at Dover House at the time of the inspection. The complaint was not acknowledged and responded to as per the provider’s complaints policy, as the registered manager told us it was felt the complaint had been dealt with on the day.
A relative commented, “We have been sent evaluation forms to be completed which seem to come out quite regularly and I completed that saying about the difference I had noticed around cleaning but no one has come back to me.”
There was no evidence that lessons had been learnt from the complaints raised to ensure improvements were made to the quality of care as a result. For example, relatives had complained about the smell of urine, the poor cleanliness and the evidence of soiling on floors and chairs. However, complaints were dealt with in isolation, so emerging themes had not been considered and action taken.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

The development and review of people’s care plans did not include people or their relatives. This meant the important information about people, such as the key elements of their life and what they enjoyed and believed in were not available in order to tailor their care. Some people, particularly on the ground floor and 3rd floor, were able to speak with staff and let them know what they needed to support their health and well-being, however, others could not so staff did not have the guidance to advocate on their behalf to enable the right care and treatment when they needed.
As a result, decisions were made for people without always understanding individual needs and wishes. People who could not speak up for themselves were included in a task orientated day where their needs, such as when their significant wounds were dressed, were included in the staff routine rather than when people needed it. People had not been given equal access to receiving care and support when they needed it.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People’s care plans had not always been developed to meet people’s desired outcomes. The importance for people’s well-being to achieve the outcome they wanted was not given sufficient emphasis. Staff did not always work with people’s strengths to develop strategies to reach potential goals such as following an interest they previously had or improving their well-being by reducing anxiety.
People’s care plans did not always contain information about people’s additional needs which may affect their experience and outcomes within care. Care was not taken to ensure people living with dementia had equal access to good quality care in a pleasant environment that supported good individual outcomes. There were not always effective processes in place to make sure action was taken when care inequality was identified and observed.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s wishes at the end of their life were not always considered or recorded. People had a ‘death and dying’ care plan, however, these were not consistently detailed or completed and contained basic and general information. Consideration had not been given to people’s individual beliefs and wishes such as if they had specific religious and spiritual needs that may impact on how their end of life was planned. Staff may not be aware of these details to ensure people were treated appropriately to end their life according to their wishes and beliefs.
Death and dying care plans recorded statements such as, ‘There is currently no information regarding end of life wishes, this is to be discussed with the family nearer the time’. This meant if people had specific wishes for the end of their life, they may not be met if they passed away unexpectedly.