Archived: Dover House Care Home

Updated 24 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 and 23 November 2017 and was unannounced. The inspection was carried out by one inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law. We contacted the local authority commissioning and safeguarding teams as well as Greater Manchester Fire Brigade and the local Healthwatch board. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services. We used their comments to support our planning of the inspection and details of their feedback is contained within this report.

During the inspection we observed interactions between staff and people who used the service. As some people were not able to tell us about their experiences, we used the Short Observational Framework for Inspection (SOFI) during the lunch period in the lounge areas of the home. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people who used the service, four relatives, the registered manager, six care staff and two visiting professionals. We observed the way people were supported in communal areas and looked at records relating to the service. This included two care records, four staff recruitment files, daily record notes, medication administration records (MAR), maintenance records, quality assurance records, accidents and incidents and policies and procedures.

Updated 24 March 2018

This inspection took place on the 22 and 23 November 2017 and was unannounced. The previous inspection took place in September 2016 where two breaches of the Health and Social Care Act 2008 were identified with regard to medicines management, infection control, the lack of window restrictors and not having a robust auditing system in place. We took enforcement action and issued two warning notices to the provider.

We found window restrictors were now in place and infection control procedures had improved. However we found continued breaches in medicines management and auditing systems were still not robust.

We also identified further breaches with regard to the assessment and mitigation of risks people may face at the home (especially for moving and handling, people using the stairs and guidance for staff when supporting people whose behaviour may challenge the service) and the safe recruitment of staff.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what other action we have told the provider to take at the back of the full version of the report.

Dover House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dover House Care Home provides residential care for up to 11 people in one adapted building, Some of the people at Dover House are living with dementia. At the time of our inspection there were nine people living at the service. The service also operated a ‘day care’ service for one person.

As part of the overall registration of this service, there is no condition that the provider must employ a registered manager at this location. The provider takes on the day to day responsibility for the running of the home along with the sister home, Derby House, next door. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have robust and effective systems in place to monitor, review and assess the quality of the service to help ensure people were protected from the risks of unsafe or inappropriate care.

Care plans were person centred and contained sufficient information about the current needs, wishes and preferences of people. However where risks had been identified assessments and plans to minimise such risk did not provide sufficient guidance for staff. Where people’s needs had changed referrals had not been made to the local authority for a re-assessment of their needs and the risks posed by the person using the stairs instead of the stair lift.

Accidents and incidents were recorded and each was individually reviewed by the owner/ manager to mitigate the risk of further incidents. However there was no overarching analysis of accidents and incidents across all the people living at the home.

Recruitment checks for new staff to ensure their suitability for working with vulnerable people had not been completed.

Medicines management had improved, with medicine administration records (MARs) being completed. However the prescribing instructions for one ‘as required’ medicine had not been accurately transcribed to the MAR produced by the home, resulting in the person being administered the medicine four times a day when they may not have required it.

New chairs had been purchased for the lounge and window restrictors were now in place. The laundry had been moved to the cellar, improving the infection control measures in place at the service. The home was seen to be clean and free from malodours.

Appropriate action had been taken following an enforcement notice issued by the Greater Manchester Fire Service.

There were sufficient staff on duty to meet people’s needs. Staff training had increased and more training was planned. New staff were being enrolled on the care certificate as part of their induction.

Suitable procedures were in place for safeguarding vulnerable people and staff had been trained to recognise and report any concerns they had.

Staff said they enjoyed working at the home and were complimentary about the provider and the deputy manager; saying that they were visible and approachable. Supervisions had not been consistently completed. Team meetings were held each month and included a discussion about each person’s support needs. Staff said they felt well supported by the provider.

The provider had sought the necessary authorisation for those people deprived of their liberty as per the Mental Capacity Act (2005). Best interest decisions had been made with regard to covert medication and wishes at the end of people’s lives. However further, decision specific, best interest decisions were required where people were unable to make an informed decision about the use of the stairs.

Staff sought people’s consent before providing support and supported people in a discrete manner. However we saw one occasion where a staff member did not do this when trying to re-arrange one person’s blanket. A senior care worker intervened and asked the care staff member to re-arrange the blanket again and they did so appropriately.

People had access to healthcare professionals as required. Feedback from the health professionals we spoke with was positive.

People said they enjoyed the food at the home. Staff supported people to eat and drink where required to maintain people’s nutrition and hydration.

There had been an increase in the activities offered at the service, with a senior care member of staff responsible for arranging the activities.

The provider had a system in place for the reporting and responding to any complaints brought to their attention. People told us they could raise any issues with staff or the provider if they needed to.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.