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 inadequate. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 61 (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 had not always made sure people were at the centre of their care and treatment choices and did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care planning had improved significantly since the last inspection and was person-centred. Records reflected people's life histories, likes, dislikes, communication needs, behaviour support requirements and daily preferences. Positive behaviour support plans clearly identified triggers and guidance for staff around positive interventions. Some relatives were clear their loved one’s care was individually focused; however, not all relatives felt the same way. The comments we received included, “I don’t want to be too critical, because I understand the scale of the problem, but there are still lots of small changes that need to be made”; “I have had a conversation with someone recently and various plans regarding (relative) care were explained. However, when I read these plans on the patient notes system, they were different to what I had been told” and “I don’t always feel that the care is individually person centred and in line with the individual needs.”

Although some relatives felt care could still feel task-focused at times, the evidence demonstrated people were increasingly being placed at the centre of care planning and delivery. These included careful planning in relation to where people were living and supporting a move to a different floor where it was assessed as better meeting their individual needs. This person-centred strategy had proved successful for some people, creating positive outcomes including reduced anxiety and a more pleasant and relaxed life.

The provider did not always have an understanding of the diverse health and care needs of people and their local communities, to ensure care was joined-up, flexible and supported choice and continuity.

The provider engaged with healthcare professionals to support people’s changing health needs. They referred people to healthcare professionals to gain advice in relation to changing physical health as well as community mental health teams to support people’s mental health and well-being. However, some relatives told us, although staff skills had improved, they still did not always recognise a deterioration in people’s health until it was pointed out to them. A relative told us, “I don’t feel that individual communication is good. They are quick to tell you some things like when they have tripped but seem to miss keeping you informed about more serious problems.” Another said, “Identifying changes and people being unwell is a problem.”

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider kept people up to date with information, about the service and the things that affected them. Meetings were held with people and relatives where updates were provided. The registered manager kept in touch by email with those who couldn’t attend and if they needed to provide information in between meeting dates. Relatives described positive communication with managers and some named staff members and told us they were kept informed about significant events. Information could be provided in formats that worked better for people on request, such as large print, or a language other than English.
People and relatives had access to information about care and support. Care plans contained personalised information to help staff understand people's needs, wishes and preferences. Information was available to support staff to deliver care in line with people's individual needs and preferences.
 

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

Information was not always shared effectively with people and those important to them. Relatives repeatedly described occasions where they had not been informed about changes to people's health conditions, appointments or care needs. Some relatives told us they often had to identify concerns themselves and seek clarification from staff. Comments in relation to communication and being listened to were mixed, including, “Communication between staff within the home and relatives is a problem. You often don’t get told things unless you notice for yourself and ask”; “I do think communication within the home and organisation of staff is still lacking and could be improved” and “The staff are very good at communication and will always contact me if there are any concerns”
Language barriers and communication difficulties were also highlighted by several relatives. Although improvements had been made since the previous assessment and the registered manager was described as approachable and listened, information sharing across the staff team was not always consistent.
 

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were able to access healthcare services and professional support when required. Records demonstrated referrals to healthcare specialists, reviews by healthcare professionals and access to additional support when needs had been identified. People requiring enhanced support, including one-to-one staffing arrangements, received this.
People told us they were happy with the care and support they received and they generally had access to help when they needed it, from care staff and from external healthcare professionals.

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

The feedback we had from people’s relatives was mixed. The relatives of people who had one to one care with a staff member throughout the day were very happy with the care their loved one received. A relative told us staff knew their relative very well and the person’s care was now good with the levels of distress previously experienced reducing. A relative said, “The staff who look after him are really kind and patient. They have a good relationship with him and know what sort of things he finds funny.” However, there was an obvious comparison in feedback from relatives whose loved ones did not require this level of support. Their feedback was that staff did not always recognise changes in their loved ones needs and they needed to often advocate for them. A relative told us, “It would appear there are lots of outstanding issues and they have to be prioritised. However, in the meantime people’s personal individual concerns are not always being addressed and this is important to their quality of life and causes a great deal of stress to residents and their relatives.”

People were 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.
Records contained anticipatory care planning, escalation preferences and guidance for responding to changes in people's health and wellbeing. Care plans included information regarding hospital admission, emergency responses and support during periods of deteriorating health. ReSPECT documentation and escalation decisions when people neared the end of their life were recorded where appropriate.