Dolphinlee House Home for Older People

Dolphinlee House Home for Older People is a residential care home providing care for up to 46 people. At the time of this inspection the service was supporting 25 people. The service provides care for older people and people who may be living with dementia and physical disabilities. The accommodation is provided over 2 floors. There are two units on each floor each with their own communal and dining areas.

People’s experience of using this service and what we found

People told us they felt the service was safe. We found improvements had been made since the last inspection to the management of medicines, identifying risks, the training of staff and to the oversight of the quality and safety of the service.

Medicines were being managed safely and people received them as they had been prescribed by staff who had received appropriate training.

Risk assessments were in place to monitor and minimise the potential risk of avoidable harm to people. There were enough staff to adequately support the number of people using the service. Recruitment processes used ensured staff including agency staff were suitable to work with vulnerable people.

Systems were in place to record accidents and incidents. These were consistently monitored to identify any lessons learned, themes or trends. Safeguarding incidents were identified and shared with relevant authorities. People told us they thought the care they received was good and spoke very positively about the staff who supported them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People's care and support had been planned in partnership with them and their relatives where possible.

Documentation used to determine people’s capacity to make certain decisions and establish consent was not consistently completed accurately. We have made a recommendation about this.

Training records demonstrated appropriate and relevant training was completed. Referrals were made to other healthcare services where necessary. People told us they enjoyed the food and their dietary needs were being met.

There were improved, communications, systems and processes used to ensure regular oversight of the safety and quality of the service. The provider, registered manager and staff had worked hard to improve people's experiences and to address shortfalls found at the last inspection driving improvements at the home.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 16 September 2022)

Where there were breaches of regulation and we issued the provider with a notice to improve the safety and quality of the service. The provider also completed an action plan to tell us what they would do and by when to improve the training staff received.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dolphinlee House Home for Older People on our website at www.cqc.org.uk.

Recommendations

We recommend the provider ensures documentation used to establish people’s capacity to make decisions is completed accurately and consistently.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dolphinlee House is a residential care home providing accommodation and personal care for up to 46 adults. Care is provided across four units with two units providing support to people who may be living with dementia and the other two units support people who require a short period of reablement. At the time of the inspection 42 people were living at the home.

People’s experience of using this service and what we found

People told us they felt safe living at the home and were supported by staff who knew how to raise safeguarding concerns. Risks to people were assessed and, in some cases, actions had been taken to reduce the risks. However, this was not always consistent because risk assessments for people’s medical conditions, equipment and the environment were not always carried out or robust. People’s medicines were not always managed safely. Infection prevention protocols were not robustly followed, and we were not assured by measures in place including measures to reduce the risks associated with COVID-19. We made a recommendation about infection prevention practices. The provider had not ensured all staff received training they deemed necessary for the role.

While premises and equipment had been serviced and maintained, improvements were required to ensure professional guidance on fire safety was acted on in a timely manner.

Staff were recruited safely and there were adequate numbers deployed to support people.

The registered provider and their staff used a variety of methods to assess and monitor the quality of the service. However, the systems and processes needed to be robust to ensure shortfalls were identified and acted on in a timely manner; including recommendations from fire services. Medicines audits, environmental and care plan audits were not effective in monitoring quality.

Staff worked in partnership with a variety of agencies to ensure people's health and social needs were met. The provider needed to improve systems for seeking authorisation to protect people from unlawful restriction under Deprivation of Liberties (DoLS). We found people who had been in the service for a while who had no authorisation applications. We received positive feedback from staff regarding management.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 29 March 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dolphinlee House Home for Older People on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to medicines management, risk management, staff training and good governance. Please see the safe and well-led sections of this full report. 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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

Risk assessments were not always documented within people’s care records and care records were not always an accurate reflection of people’s needs.

People told us they sometimes had to wait for help from staff and staff told us there were times they were busy. We have made a recommendation regarding this.

Medicines were managed safely. People received their medicines when they needed them.

People were asked to consent to their care. The assistant manager told us they would assess people’s mental capacity if this was required. Any restrictions made to ensure people’s safety were made lawfully.

People told us they were cared for and were supported to see medical professionals if this was needed.

People were involved in their care planning. Records we reviewed reflected this.

People told us they were happy with the food provided and we saw nutritional assessments were carried out to identify if people required extra support.

People were enabled to be involved in the day to day running of the home. Meetings took place to support people in expressing their views.

People were invited to take part in a range of activities. We saw these were enjoyed by people who took part.

Staff were recruited safely. Staff told us they received training and supervision to enable them to fulfil their role.

People told us they were safe and staff told us they would report concerns of abuse or avoidable harm to the registered manager, their line manager and local safeguarding authorities to protect people.

Rating at last inspection: Requires Improvement. The report was published on the 29 June 2018.

Why we inspected: At our last inspection in May 2018 we identified a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). We found care records did not consistently describe the help and support people required. We took regulatory action and served requirement notices for this breach of legal requirements. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by 31 August 2018. We carried out this inspection to check improvements had been made.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breach in regulation and make improvements to the service.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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

Dolphinlee House Home for Older People 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.

Dolphinlee House is situated in a residential area of Lancaster called Ridge Estate. The home is divided into four separate areas. Two providing rehabilitation care, one providing residential care and one providing residential care for people who may be living with dementia. There are a range of aids and adaptations in place to meet the needs of people using the service.

At our last inspection in March 2017 the service was rated as good. At this inspection we found documentation was not consistently reflective of people’s needs. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection concluding we were informed the records had been updated.

We observed medicines being administered and saw this was carried out in a safe way. Access to medicines was restricted to staff who had received training to ensure medicines were administered and managed safely. We found an error had occurred as a medicine was not in its correct packaging and temperature monitoring of a room where medicines were stored was not carried out.

Prior to the inspection concluding we saw monitoring of the room temperature had been started. We also found the medicine error was investigated by the registered provider and registered manager and we were informed staff would receive guidance and instruction to prevent the error reoccurring.

The registered provider had not met the requirements of the regulations inspected. This is reflected in the rating of well-led.

The registered manager completed a series of checks and investigations to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they wanted to enable people to live independently and be happy. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Dolphinlee House Home for Older People.

People told us they could raise their views on the service provided and they felt staff listened to them. We saw minutes of meetings where people at the home were informed of changes and were asked their opinion on the service provided.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. People also told us they were offered more if they wanted this. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they finished their meal. Staff were available to help people if they needed support.

We found the environment was clean and we observed staff wearing protective clothing when required. This minimised the risk and spread of infection.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was displayed in the reception of the home. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

Recruitment checks were carried out to ensure suitable people were employed to work at the service and staff told us they were supported to attend training to maintain and increase their skills.

People and relatives we spoke with told us that overall they were happy with the staffing arrangements at the home. We observed staff spending time with people and the atmosphere was relaxed and unhurried. Staff we spoke with raised no concerns with the staffing arrangements at the home.

People told us there were a range of activities provided to take part in if they wished to do so. We found an activities schedule was displayed at the service and staff told us they reminded people of the activities available.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation. We carried out this unannounced focused inspection on the 20 March 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ Dolphinlee House Home for Older People’ on our website at www.cqc.org.uk'.

Dolphinlee House is situated in a residential area of Lancaster called Ridge Estate and accommodates up to forty-four people with residential care needs. The home consists of four units. Two units providing residential care. One providing dementia care and one dementia rehabilitation.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our focused inspection on the 20 March 2017, we found improvements had been made. We found medicines were managed safely. We saw records related to medicines were accurate and people told us they received their medicines as prescribed.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

From our observations people appeared relaxed and secure. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw that people were treated with respect and dignity by the staff team and their rights protected. People told us that they felt safe.

The registered manager set the staff rotas. The assessed needs of people were taken into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Systems were in place to make sure that any lessons were learned from events such as accidents, incidents, complaints or concerns. This reduced the risks to people and helped the service to improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

Recruitment practices were safe and thorough. This made sure that only appropriate people that had been properly vetted were appointed. Policies and procedures were in place to make sure that any unsafe practice was identified and people protected.

It the service effective?

The people we spoke with and the relative we spoke with told us that they were pleased with the level of care that was being delivered in the home. One person said, “It’s very nice, very good and the food is good. I feel 100% better. The staff do try hard, they are so friendly and caring”. Another person said, “The carers are very, very good here nobody has anything bad to say about them. You have only got to tell them you want to go outside and they take you and will come out and tell you when dinner is ready”. A third person simple said, “They do everything well”.

People’s health and care needs had been assessed and the individual or their family were aware of the care being delivered. Specialist dietary, mobility and equipment needs had been identified in support plans when required.

From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “It is champion living here, it is very good”. A relative said, “I think they are all lovely, they really are and everybody is safe and well looked after without a doubt”.

The visitor we spoke with confirmed that they were able to see their relative in private and that visiting times were flexible. The relative also said that they had good communication with the staff team and they were always informed of any changes or concerns.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience, humour and gave encouragement when supporting people. A relative said, “People always seem really happy here, no complaints at all”.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s preferences. This helped to make sure that people were provided with an individualised service that met their specific requirements.

People living at the home and their relatives had been provided with satisfaction questionnaires annually. We viewed the outcome of the most recent questionnaires, outcomes were positive. Action would be taken to address any concerns expressed.

Is the service responsive?

The registered manager and management team worked alongside staff on a daily basis. This meant that the care and support provided by the staff team was continually monitored so that immediate action could be taken if there was any concern.

People knew who to make a complaint to if they were unhappy. The complaint procedure was robust and understood. However nobody we spoke with expressed any concerns or complaints only positive comments.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. All health care related visits had been recorded including the reason for the visit and the outcome. This provided a clear audit trail. Specialist health care staff were employed in the dementia rehabilitation unit and worked alongside care staff in order to achieve positive outcomes for people.

Staff had a good understanding of the ethos of the home and quality assurance systems that were in place. This helped to ensure that the quality of the service was continually improving. People spoken with told us that they felt listened to and that staff were attentive to their wants and wishes. This helped to ensure that people received a service that met their expectations and requirements.

Staff told us that they were clear about their role and responsibility and that they felt well supported by the management team. Staff confirmed that communication within the staff team was positive and that good supervision arrangements were in place. We were also told that staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including care plans, risk assessments and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

People told us they found the home to be comfortable. They liked the way they could personalise their rooms and felt staff were considerate to meet their needs. They told us, “I love my room. You can see I have everything I need here.” Also, "The girls are very good. They take time with me when I need help.”

We saw some people liked to stay in their rooms and this was respected by staff members.

People we spoke with told us they had access to a range of healthcare services including doctors and district nurses. There was also access to associated health services including opticians, dentists and chiropodists. One person told us, “We often have district nurses in. We also have our own physiotherapist’s and occupational therapists in the rehabilitation unit. We are well supported.”

People were seen to be cared for in ways that suited them. Some of those we spoke with told us that they were involved in the planning of their own care. We saw that people were given opportunities to inform staff of their personal support requirements. This was specifically apparent in the dementia rehabilitation unit.

Dolphinlee House was divided into four units. We looked at them all, but spent time in two communal areas to gain an overview of how the home operated. Some people living at this home had a range of dementia conditions. This affected how they communicated with us. We used this time to observe how staff communicated and helped people.

We received a number of comments from people using this service, they included:

'I like living here, I have everything I need.'

'Staff are very patient, they listen to me and know what I like.'

'There is not a lot going on, but I like to read. That takes up most of my time.'