Archived: White Doves Ltd

White Doves Ltd is registered to accommodate up to 13 older people and people physical disabilities, and sensory impairment. At the time of our inspection, there were eight people living in the home.

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

At our last inspection the provider had failed to protect people from environmental and infection control risks. At this inspection improvements had been made to the environment and the cleanliness of the home. The provider was no longer in breach of our regulations.

Parts of the home had been refurbished and redecorated, and new carpets and floor coverings fitted. The provider had risk assessed the premises and put measures in place to reduce risk to people. All areas of the home were clean and tidy.

The home has a relaxed, family atmosphere. People were content and settled. A person told us, “It feels like home here. I like everyone and want to stay.” The staff were caring and kind. They knew people well and understood their needs and preferences.

Lunch was served during our inspection. People sat with staff in a family group. People enjoyed their meal and the atmosphere in the dining room was friendly and sociable. People chose the home’s menus in conjunction with the cooks.

People received personalised care and support that met their needs. The home’s assessment and care planning process meant staff had the information they needed to support people in the way people wanted. Staff ensured they saw their GPs and other health care professionals when they needed to.

The provider and staff carried out regular audits and checks on all aspects of the home. People had the opportunity to share their views about the home in meetings, through surveys, and during one-to-one discussions.

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.

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 (report published on 28 July 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in October 2015 we rated the service overall as ‘Good’.

This is the second comprehensive inspection of the service. At this inspection the service had deteriorated to ‘Requires Improvement’.

We found improvements were needed to the premises, décor and cleanliness, despite the regular safety checks and audits carried out on the premises. Although staff had been trained in health and safety, infection control procedures and regular cleaning was carried out improvements were needed to ensure people were protected from avoidable risks to their health and safety.

The registered manager provided leadership and supported staff and people who used the service. The registered manager continued to maintain their knowledge and attended management courses and local health care forums. However, the quality audit tool used to monitor the service referred to the previous regulations and was not reflective of the current Health and Social Care Act 2014 and regulations. There were regular audits and checks carried out on the premises, care records and the management of the service. However, no issues were found by the provider in relation to safety concerns of the premises and infection control risks which contradicted our findings during this inspection visit.

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.

Risk assessments were completed; safety measures were put in place and were monitored and reviewed regularly. People continued to receive good care and support that responded to their individual needs. Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in ways that helped people understand the care and support that had been agreed with them.

People continued to receive safe care. Staff recruitment processes were followed and ensured that people were protected from being cared for by unsuitable staff. There were enough staff to provide care and support to people to meet their needs safely. Staff were trained in procedures and knew how to support and to protect people from abuse.

People’s nutritional and dietary needs were met. People were supported to take their medicines as prescribed. People's health and well-being was monitored by staff. They were supported to have appointments and treatments from health professionals which ensured their health needs were met.

People were able to be involved and make decisions about all aspects of their care. They influenced how the service was run. They were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had developed positive trusting relationships with the staff team. People’s privacy and dignity was respected and independence was promoted. People took part in a range of social activities and events and were supported to go into the wider community.

People knew how to raise a concern or make a complaint. The provider had effective systems to manage any complaints they received.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

White Doves Ltd is a care home that provides residential care for up to 13 people to older people. . The service a detached property with reception area, a lounge, dining room and a kitchen. The bedrooms are seven single occupancy rooms and three shared rooms and close to bathrooms and toilets. At the time of our inspection there were 10 people in residence.

A registered manager was in post. 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.

People told us they felt safe at the service and with the staff that looked after them People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff were trained and understood their responsibility in protecting people from the risk of harm.

People’s care needs were assessed including risks to their health and safety. Care plans were tailored to people’s needs, which included the measures to help promote their safety and independence. Care plans provided staff with clear guidance about people’s needs which were monitored and reviewed regularly.

People lived in an environment that was homely and comfortable. There were ongoing improvements being made to the décor and the secure garden which people could use safely.

People received their medicines at the right time and medicines were stored safely. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health. People were provided with a choice of meals that met their health and dietary needs.

Staff were recruited in accordance with the provider’s recruitment procedures. The provider took account of the needs of people they supported to ensure there were sufficient numbers of staff to promote their safety and wellbeing.

People’s consent had been appropriately obtained and recorded. The management team and staff team understood the principles of the Mental Capacity Act and how they might apply to the people who used the service. When staff had concerns about people’s capacity then they sought advice and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

People were involved and made decisions about their care and support needs and how they wish to spend their day. People had opportunities to pursue their hobbies and interests and their lifestyle choices were respected by staff.

People told us staff were caring and kind and that they had confidence in them to provide the support they needed. There was a warm and relaxed atmosphere where people were comfortable. We saw staff interact with people positively; and treated them with dignity and respect.

The registered manager and the assistant manager collectively provided effective leadership to the service. Staff spoke positively about them in relation to the support and training provided. Staff were confident that any issues raised would be addressed.

People who used the service and relatives told us if they had any concerns or complaints they would tell the registered manager or the staff.

The provider had an effective system in place to assess and monitor the quality of the service. The views and opinions of people who used the service and staff were sought, which included meetings, completion of a range of surveys and internal audits.

Is the service safe?

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. The home was a converted older property for older people and people with disabilities to live in. People we spoke with told us they were satisfied with their rooms and our tour of the building found that people's rooms were personalised, clean and tidy.

One person told us, 'When I came here to visit it felt right it was really homely and I have a nice bedroom'.

We saw people were involved in their care and treatment and were included in decisions about the type of help or support that they needed. We saw other health care professionals were asked to help with assessments when significant changes occurred.

During the day time to ensure people were safe, there was at least one member of staff in the lounge area. When reviewing staffing we found that during the night there was one waking staff member to support people. A sleep-in member of staff was also available to help if required. We found that although most people at the home were independent some people would need assistance in the event of a fire. From looking at a sample of people's care records we noted that on occasions some people were unsettled at night. The provider may find it useful to note that records kept were not clear when the second staff member was asked to help at night. In this way we would be sure that this person's needs or those of others were being suitably managed when the person needed extra support or attention during the night time.

We found that in the event of a person requiring an emergency transfer to hospital, information required to be transferred with the person was not readily available. Staff did not have access to the photocopier hence there had been a recent occasion when staff hand to hand write the information. This had resulted in a delay in the person receiving transfer to hospital for treatment. The provider may wish to review how they can provide a quicker method for ensuring that transfer information is easily accessible in an emergency.

We found that kitchen equipment was not always suitably covered to prevent any risk of contamination and that some room temperatures were not always checked to ensure people's comfort.

Is the service effective?

We saw that people were presented with attractively presented food during a meal time. We found people received help when they needed it and other agencies were asked to visit as appropriate to advise and provide treatment.

We found people were cared for by staff who were trained and received supervision. This meant staff were working to an acceptable standard.

Is the service caring?

Throughout the day we observed staff interacting and supporting people. Staff had a good rapport with people using the service and demonstrated a positive and respectful attitude towards them.

Is the service responsive?

When people needed further support and help staff responded to them in an appropriate way to help them.

Is the service well led?

People we spoke with told us they would discuss any concerns with staff or the manager and felt they could air their views when they wished. We saw the provider had a range of quality assurance procedures that included monthly audits of key records such as medication records, regular meetings with staff, reviews of the support people using the service received, and a clear complaints procedure. Records we saw confirmed that audits of medication records and an infection control audit were up to date.

We found that staff were clear about their responsibilities under the Mental Capacity Act and took action in accordance with the act when necessary.

The provider had put systems in place to ensure that all relevant events are notified to the commission in a timely manner.

We found that the provider had put systems in place to ensure that people's care needs were regularly reviewed and risk assessments in place where necessary. However, we found that the provider did not always ensure peoples rights were protected because mental capacity assesssments were not always completed before decisions were made in people's best interests.

We found that the provider had put systems in place to ensure peoples nutritional needs were met. People we spoke with told us that the food had improved and that they "really enjoyed" the food at the home.

We found that the provider had made improvements in the management of infection control and to the hygiene and cleanliness of the home The provider had also completed all maintenance required on the home and put in place system to identify and deal with maintenance issues as the arise.

We saw evidence that staff were recruited safely and that they were adequately supervised and supported in their roles.

We found that some improvements had been made towards achieving compliance with this outcome. We found that the provider was in the process of developing new menus which would provide a balanced nutritious diet for people living at the home, but that these were not due to be introduced until 19 November 2012.

We found that the provider did not have formal systems in place to maintain good stock control to ensure people were given food which was safe to eat. We saw that the freezers contained food which had passed its 'use by' date. We also found that where people were subject to nutritional monitoring, that inconsistencies in recording nutritional information meant that people who used the service could not be assured they were receiving food in sufficient quantities to ensure they were protected from the risks of inadequate nutrition.

Nine people were living at the home on the day of our inspection. We spoke with six people who used the service and two relatives. People told us they were generally happy with the care they received and felt that their needs were being met. People said that they liked living at the home as it was small and homely and they all got on well. People told us that they liked the staff that supported them and described them as "friendly and helpful".

People told us there was usually a choice of meals. People had mixed views about the food provided. One person told us "the meals were pretty good, you can't please everyone". Another person told us "we get enough to eat but the quality of foods could be better. Some of the food seems cheap and cheerful".

We found that peoples privacy and dignity was generally respected but that the planning and delivery of their care did not ensure their safety and welfare. The provider did not have in place systems to identify, assess and manage risks to the health, safety and welfare of people using the service.