Dover House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had implemented a service improvement plan following the last inspection. The plan was a live document that was added to when necessary and action completion recorded and clear. The plan, and the actions already taken demonstrated significant investment in improving the service. Staff, relatives and inspection findings identified substantial improvement since the previous inspection. There was evidence of a culture focused on improvement, and a commitment to addressing concerns to improve the quality and safety of people’s care.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Relatives and staff were positive about the registered manager and described them as approachable, supportive, responsive and committed to improving the home. The provider and registered manager maintained regular communication with CQC and other stakeholders such as health and local authority and had overseen significant service improvements. The registered manager acknowledged they had received the full support of the provider who had been keen to support the changes needed, including financially. Relatives acknowledged the scale of improvements required and generally credited the leadership with driving positive change.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People and relatives told us the registered manager was approachable and willing to listen to concerns, suggestions and complaints. Several relatives described raising issues directly with managers and felt they were taken seriously. The provider maintained regular communication with CQC and demonstrated openness regarding areas requiring improvement. Whilst relatives did not always feel changes occurred as quickly as they would have liked, they generally felt able to raise concerns and be heard.
Staff told us they knew they could speak up if they had concerns about people’s safety. They were confident they would be listened to and action would be taken.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider worked towards creating an inclusive workforce and employed staff from diverse backgrounds. Staff told us they felt supported by managers and described a more positive culture than had previously existed within the service. The provider had invested in staff development and training and worked to improve staff confidence and consistency. We did not identify evidence that staff were disadvantaged or excluded within the workplace and managers promoted an open and supportive culture.
We saw staff who were happy and friendly, pleased to speak with us and sharing their views.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems had improved but remained ineffective in fully identifying and addressing concerns. Medicines discrepancies identified during inspection were similar to the concerns found at the last inspection and had not been recognised through existing audits. Environmental concerns relating to significant odours in some people’s bedrooms had not been identified by the management team. Our reviews of people’s records identified inconsistencies in MCA documentation, consent recording and linkage between assessments and care plans. Whilst governance arrangements had strengthened since the previous inspection, they were not fully effective to ensure the quality and safety of people’s care.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was clear engagement with healthcare providers and commissioners to support people’s access to care and health and social support. Since the last inspection, the provider and registered manager engaged fully with external partners in relation to the measures put in place to ensure people’s safety.
The registered manager was involved in various local community groups and forums to share experiences and gain external support. These included, local authority provider forums, Skills for Care groups and registered manager networks. These partnerships supported an outward focus to benefit the overall care and support of people.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research.

Although the provider demonstrated commitment to learning and continuous improvement, there were still areas to improve, including the ability of staff to effectively put into practice the learning invested in them. Relatives fed back this was an area they felt needed further work. The concerns we found in relation to medicines management, environmental issues and understanding of peoples’ rights in relation to the MCA 2005 evidenced this.
A service improvement plan was being actively progressed and substantial environmental, staffing, safeguarding and care planning improvements had been achieved since the previous inspection. The provider and registered manager were responsive to feedback from CQC and other stakeholders and continued to develop improvement plans for areas requiring further work. The registered manager added medicines management to the service improvement plan after the inspection. They were making decisions how to move forward in improving and sustaining this area, with the full support of the provider.