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 inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

At our previous inspection we found assessments and care planning did not always fully reflect people’s needs. During this assessment care records demonstrated substantial improvement. People's health, wellbeing, communication, nutritional, behavioural and mobility needs had been assessed and reviewed. This led to better care planning and guidance for staff to make sure people’s needs were fully met.
Initial assessments were undertaken with people before they moved into the service to make sure their needs could be met by staff.
 

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.
At our previous inspection we found people did not always receive care and treatment that was recognised good practice. During this inspection we found significant improvement. Care plans reflected recognised assessments and approaches to managing falls, skin integrity, nutrition, hydration, continence, distressed behaviour and choking risks. Positive behaviour support plans contained detailed person-centred guidance and specialist recommendations were incorporated into people’s care records.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
Staff worked with a range of healthcare professionals to support people's health and wellbeing. Records demonstrated involvement from GPs, speech and language therapists, dietitians, mental health professionals and other specialist services when required. Recommendations from professionals were followed and incorporated into care plans and risk assessments.

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

Care plans reviewed generally included nutritional monitoring, hydration support, bowel management, skin integrity management, falls prevention and behavioural support interventions. Records demonstrated examples of positive outcomes, including a reduction in distressed behaviour following implementation of positive behaviour support approaches and staff training. Relatives also described people being supported with activities, access to outdoor spaces and opportunities which promoted wellbeing. However, relatives also described occasions when deteriorating health conditions had not been identified promptly. “Most staff don’t seem to understand (relative) very well and do not recognise if there is a problem. They don’t seem to communicate between themselves” and “I do have concerns that anything other than the basic care is missed as carers are not able to assess if someone’s condition is deteriorating.”
As a result, although improved, further improvement was needed so care was delivered consistently to ensure people’s health concerns were identified quickly to ensure good maintenance.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider regularly monitored people's care and treatment and had introduced systems to improve oversight since the previous inspection. Care plans and risk assessments were reviewed, incidents were investigated and signed off by managers, and monthly lessons learned bulletins were used to share learning with staff. We saw evidence of positive outcomes, including reductions in incidents of distressed behaviour following implementation of positive behaviour support plans and staff training. The registered manager had supported some people to move to another part of the service which had a positive impact on their anxiety and distress. Whilst governance processes remained inconsistent in some areas, there was evidence that monitoring systems were increasingly being used to improve people's experiences and outcomes.

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

At our previous inspection we identified concerns relating to the Mental Capacity Act 2005. During this inspection, we found the provider had increased the use of decision-specific mental capacity assessments and supporting documentation. However, records continued to contain inconsistencies regarding how people’s capacity to consent was assessed, and decisions around consent and best-interest decision making. Some assessments did not clearly demonstrate how conclusions around decision making had been reached and recording of consent remained inconsistent. For example, staff assessed the capacity of 1 person to consent to reside at Dover House and they were deemed to lack capacity. The decision-making record contained limited information, with phrases such as ‘no documentation’ used. The person had relatives who may have been able to provide further information in relation to their past life, views and opinions to support the decision taken on their behalf. This opportunity was not evidenced and limited information was available to ensure people's rights under the Mental Capacity Act were evidenced and protected.