Archived: Dorcas House

Updated 18 April 2020

The inspection

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.

Inspection team

The inspection team consisted of one inspector and an inspection manager.

Service and service type

Dorcas 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced and took place on 16 January 2020.

What we did:

We looked at information we held about the service, including notifications they had made to us about important events. We also reviewed all other information sent to us from other stakeholders, for example, the local authority and members of the public.

During the inspection, we spoke with three people using the service to ask about their experience of care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the provider, the registered manager and one member of care staff. We also spoke to one healthcare professional who was visiting the home on the day of the inspection.

We reviewed a range of records. This included three people’s care records and a variety of records relating to the management of the service, including policies and procedures. Details are in the Key Questions below.

After the inspection

We continued to seek clarification from the provider to validate evidence found and actions taken following the inspection.

Updated 18 April 2020

Dorcas House is a ‘care home’ that is registered to provide personal care and accommodates up to 11 people living with dementia or mental health need in one adapted building. There were six people living at the home on the day of the inspection.

People’s experience of using this service:

Since the last inspection in September 2019, improvements had not been made to address the areas we had identified as requiring action, and this inspection found further risks to people’s safety were now present.

There was a continued failure to ensure all peoples risks were identified and managed well and this meant people were not safe and were at risk of avoidable harm. People’s care plans lacked detail on their risks and the de-escalation techniques to be used when one person was distressed. Further guidance was also required on people’s individual risks, including what the risk meant for the person concerned and information, so staff knew how and when to contact professional bodies for advice and guidance.

Staffing rotas show that the registered manager works seven days per week every week and the provider works six nights per week every week. This is not good practice and the provider confirmed there was no contingency plan was in place to ensure continuity of care to support people in the case of emergencies or annual leave.

Overall people were supported to receive their medicines as required however, improvement was required in the reviewing of PRN ‘as required’ medication. The general day to day practice supported infection control, but improvement was required to ensure all equipment is maintained cleanly to promote good infection control.

The provider’s inadequate procedures and processes meant they had failed to ensure that people consented to their care. The Mental Capacity Act (MCA) includes how people are given choices about their care and how they want it delivered. Care records for one person showed they were not allowed out when it was dark, with no record of why this restriction was in place. The provider also had a generic smoking risk assessment and a generic wheelchair risk assessment for all people living at the home, that did not take account of people’s individual capacity, individual risks or consent. The registered manager had a limited understanding of the principles of the MCA and would benefit from additional training.

Staff said training was appropriate to them in their role in supporting people’s daily care. At the last inspection (September 2019) the provider told us training was up-to-date with the exception of two staff which was being addressed. At this inspection we found the training had still not been completed for one member of staff.

Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing. However, at the time of the inspection there was no process in place to record future medical appointments.

Required environmental improvements to the design and decoration of the home to support people’s individual needs had not been completed therefore risks to people’s safety remained.

People gave positive feedback about the choice of food provided. However, we saw one person at risk of choking was not supported with the correct diet to keep them safe. This meant the person was at immediate and ongoing risk of harm to their health, safety and wellbeing.

There was limited opportunity for some people to enjoy activities to avoid social isolation. There was no evidence that activities had developed with people’s past interests and hobbies in mind. People we spoke with told us they were bored because there was a lack of activities.

The service has been rated as requires improvement in the key question ‘well led’ since February 2017 (and inadequate from November 2018). This inspection found the required improvements had not been made and further areas requiring improvement were identified.

The processes in place to monitor, audit and assess the quality of the service being delivered were not effective. The provider had a long history of not being able to improve the quality of the service provided to people or meet legal requirements. Provider audits not been effective in effecting sustained improvement and had not identified some the concerns we raised at this inspection.

At the last inspection (September 2019) we reported, “The provider was unable to demonstrate the systems they had in place to enable them keep themselves up to date with good practice or legal requirements.” At this inspection we found neither the registered manager or the provider had received any further training or taken any action to keep themselves up to date with good practice or legal requirements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published November 2019) and there were multiple breaches of regulation. Following the inspection, the condition on the provider registration requiring a monthly update remained in place.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement

Since the inspection in November 2017 there has been a condition placed on the providers registration. These conditions instructed the provider to send us regular updates on checks that had been carried out at the service to ensure the quality and safety of the service. The provider has submitted updates as per the conditions in place, however the quality of the submissions is not robust, and this has been discussed and shared with the provider.

This inspection found the provider remains in breach of regulation 12 safe care and treatment, this meant we found a failure to ensure all peoples risks were identified and managed well. We also found a breach of regulation 11, consent because people had not consented to some aspects of their care and regulation 9, person centred care. There was also a continued breach of regulation 17, this means insufficient action had been taken to make or sustain improvements in the service provided.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.