Archived: Dove Court

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We found the following examples of good practice.

Staff adhered to safe visiting procedures and this meant the risk of infections being brought into the service was minimised. Arrangements were in place so people could have the visitors they chose including the essential care giver where this was in people's best interests. The provider followed guidance about visiting and only restricted this if it created additional risks. Alternative arrangements were in place for visits if there was ever a COVID-19 outbreak. Checks and monitoring of standards of hygiene and infection prevention and control helped drive improvements and actions were taken to prevent recurrences or cross contamination.

Testing for COVID-19 was undertaken as required by staff, people and all visitors. Other checks such as, a health declaration and temperature checks were effectively completed before anyone could enter the service. We saw visitors such as, health professionals and staff were competent undertaking these checks and records confirmed this. Additional communication methods, such as telephone calls, video calls, and the use of computer Apps helped increase contact with relatives.

All staff, external health professionals and visitors, evidenced COVID-19 vaccination status, and evidenced a negative rapid COVID-19 test when required, before entering the service. The only exception to this was for emergency workers, to ensure no delay to the care and support people needed.

Personal protective equipment (PPE) was available in the service, and guidance for PPE usage was displayed. Staff wore PPE correctly, and were seen to work safely throughout the inspection visit. Staff understood how to cohort people in different areas of the service to prevent cross contamination. Only staff in each cohort worked in that area of the service. This prevented the risk of any potential cross contamination.

The care home looked and smelt visibly clean and hygienic. Contaminated waste was disposed of safely. Frequently touched areas, such as door handles, switches and handrails, received enhanced cleaning. Staff told us they had access to the required equipment, and cleaning products, to maintain a safe environment.

We found the following examples of good practice.

Staff ensured that any visitors to the service, both social, maintenance contractors and health professional visitors, completed a questionnaire regarding their current health and had their temperature taken.

There was appropriate signage for staff and people about 2-metre social distancing and hand washing techniques as well as regular testing for people and staff. The registered manager had utilised the two main entrances into the building to maintain social distances. Tables, furniture and other touch points were regularly cleaned and disinfected.

The registered manager had identified a ‘clean room’ which was used for people to meet with a visitor. This approach helped reduce any potential risk and promoted good hygiene and infection prevention and control standards. Systems were in place to limit numbers of visitors and to disinfect any area people or visitors may have come into contact with.

The staff promoted good practise in minimising their use of public transport and only caring for the same people. Risk assessments were in place to manage any additional risk such as people at an increased risk due to age or health condition.

People living in the different areas of the home did not mix and remained within their own ‘living’ bubble. Staff were also consistent in supporting these people in a staff 'bubble'. Systems were in place for staff to change their uniform and PPE where required.

The registered manager promoted social distancing as much as practicable, but respected people's choices. There were procedures in place to isolate people for any positive or suspected cases of COVID-19.

The provider had sourced sufficient supplies of PPE and there were enough stocks to cope with any increase in its usage. Regular and effective audits were in place to ensure staff upheld good hygiene and infection prevention and control standards.

Further information is in the detailed findings below.

The service accommodates up to 76 people in a two-storey building which is served by a main lift to the upper floor. Nursing care is not provided.

At our earlier comprehensive inspection in May 2017 we found two breaches of regulations that related to the providers failure to report incidents to the proper authorities and the failure to notify CQC of events they are required to by law. The service was rated as requires improvement. This unannounced inspection took place on 15 and17 May 2018. The service is now rated as good.

The service had a registered manager. 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 felt safe and staff were aware of risks to people’s wellbeing and how to manage them and protect people from harm. There is an open culture from learning from mistakes, concerns, accidents and incidents to improve staff practice and prevent reoccurrence. Medicines were stored and administered safely and medicine administration records were accurate. Regular cleaning of the service ensured that infection control was maintained and action was taken to address any cleaning issues. Staff followed the correct procedures to prevent and control the spread of infection.

There was a robust recruitment process in place that helped to reduce the risk of unsuitable staff being employed. There were sufficient numbers of staff with the right skills and abilities to support people when they needed it.

Assessments of people’s support needs were carried out before the person was offered a place at the service. This ensured the service could provide the right care and support they needed, in the way they preferred. Technology and equipment were used to enhance the support provided to people.

Staff received induction, training and support to enable them to do their job well. People's nutritional needs were met and people were supported to have enough to eat and drink. A range of external health and social care professionals worked with the staff team to support people to maintain their health and well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives were involved in planning their care. Information about independent advocacy services was available for people to assist them with any decisions they wished to make. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible.

Detailed and informative care plans provided guidance to staff about the level and type of care and support each person needed. Staff encouraged people to participate in activities and interests of their choice.

The service had received many compliments from people and their relatives. Staff were happy to be working at the service. A complaints procedure was in place and visible to inform people on how to raise a complaint if they needed.

Meetings and surveys provided people and their relatives opportunities to give their views about the service and how it could be improved.

The provider was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters. The management team worked in partnership with other professionals to ensure people received joined-up care.

This unannounced comprehensive inspection was undertaken by two inspectors and an expert by experience and took place on 24 May 2017. At the previous inspection in 6 October 2014 the service was rated as ‘Good’.

A registered manager was in post at the time of the inspection. 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.

Staff were knowledgeable about safeguarding procedures and keeping people safe from harm. Staff knew how to contact organisations responsible for investigating safeguarding should any such these incident occur. However, these incidents had not always been reported to the relevant authorities. Accidents and incidents were identified and acted upon when required.

Assessments had been completed to reduce the risk of people being exposed to any potential of harm such as choking, falls, malnutrition and skin integrity. Systems were in place to manage these risks effectively.

People’s care needs had been assessed. These assessed needs were supported by a sufficient number of appropriately recruited and suitably skilled staff.

Staff were trained to achieve the required standard before being deemed competent to safely administer people's prescribed medicines. The recording, management, storage and disposal of medicines was undertaken safely.

Staff had been trained on the subjects they needed to be in order to meet people's care needs such as safeguarding, diabetes and moving and handling. People were enabled, as a result of staff's interventions, to access support from external healthcare professionals in a timely manner.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and to report on what we find. People were supported to have choice and control of their lives. People's ability to make day-to-day and more complex decisions about their care and welfare were assessed by staff. Restrictions on people’s liberty had been determined as being in their best interests or in the least restrictive way possible such as the use of bed rails.

People were cared for with kindness by staff who showed them compassion.

People, their relatives or legal representative were enabled to be involved in identifying, determining and planning the review of their care.

People were supported to be as independent as they wanted to be where this was safe. People were actively encouraged to take part in hobbies, interests and pastimes that provided them with social stimulation. However, for those people cared for in bed there was missed opportunities for social stimulation.

People's concerns were documented and effective actions were taken to help prevent the potential for any recurrence.

The registered manager was supported by a deputy manager, senior care staff, care staff, as well as housekeeping, catering and maintenance staff. Staff were supported in their role with mentoring, supervision and on the job training. This helped staff to fulfil their role effectively.

The registered manager and provider had not always notified the CQC about important events that, by law, they are required to do. This limited organisations responsible for people's safety to take appropriate action if this was required.

People, their relatives or representative and staff were involved and enabled to make suggestions to improve how the service was run. Quality monitoring and audit systems were in place to identify and make changes in the way the service was run.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We also found one breach of the Care Quality Commission Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Is the service caring?

We talked with people who used the service. Not everyone we spoke with was able to communicate verbally with us. We used staff and people's communication records to assist us. People we spoke or communicated with demonstrated to us that they were well cared for and that care staff always treated them with dignity and respect. However, our observations showed us that this was not always reliably provided. Plans of care we looked at showed us that the lack of accurate records meant that we could not be confident that people's support needs would be reliably met. Not everyone's plan of care was up to date. The majority of people we spoke with told us that they had no problems or concerns with the care they were provided with. One relative we spoke with said, "My (relative) has lived at the home for some time and I have always been very happy with the care she has received over the years."

Is the service responsive?

People's care needs had been assessed. However, we could not be confident that this had always been provided based upon people's actual needs. Changes were made to people's care where their health condition had changed. People were provided with individualised care and support. People had made and were supported with their choices on things such as the preferred gender of their carer, the clothing they preferred and the time and place they preferred to eat their meals. People were referred to health care support professionals such as their GP, chiropodist and optician for regular health check-ups where the person required this.

Is the service safe?

We saw that regular reviews of people's assessed health risks, such as their risk of malnutrition; falls, choking or safe mobility around the home had been completed. Checks completed by the provider and other external regulatory inspections such as those for gas and electrical and water safety had completed to ensure that the premises were safe for people who used the service, staff and other visitors. However, people, staff and visitors were not always effectively prevented from entering hazardous areas. Not all staff had adhered to the provider's smoking policy. Accidents and incidents had been recorded and investigated to ensure that the potential for any recurrence was eliminated or significantly reduced.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. People were supported with an advocacy service if they wanted this. This was to ensure that people were not deprived of their liberty. Staff had been trained on the implications of the Mental Capacity Act 2005 DoLS.

Is the service effective?

Our observations of staff supporting people confirmed to us that people did not always have a good experience of using the service. Staff we spoke knew people's care and support needs well and were able to tell us what these needs were. However, we saw that this care was not always provided. The provider used various themed quality assurance reviews to assess the quality of care provided and was in the process of providing these to people and their relatives.

Is the service well led?

The CQC had been provided with information of concern regarding the management of the home. On the day of our inspection we saw that a new manager had just commenced working at the home. This was to ensure consistent and stable management until further improvements were implemented. Following recent safeguarding concerns at the home we saw that the provider had taken appropriate and effective action to ensure that people were safe.

People told us that there were sufficient numbers of staff to meet people's individual support and care needs. Measures had been taken to ensure that unplanned staff absences were covered in a way that made sure people's individual needs were met in a consistent way. There was active recruitment of staff to fill vacant positions, including an additional activities co-ordinator. On the day we visited people's individual support and care needs were met, in an unhurried and calm way, by a sufficient number of staff on duty.

People had positive comments to make about the standard and quality of their support and care. Staff were attentive and responsive in meeting people's physical and mental health needs. People who used the service were supported to access a range of health care services and their well-being was promoted due to how staff interacted with people.

People's individual nutritional needs and preferences were catered for. People had positive comments to make about the quantity and quality of their food and drink and described it as, "Lovely".

Systems were in place to ensure that equipment was safe to use and worked correctly. Equipment was used to promote people's health and comfort.

Members of staff said that they had support and training to do their job, which they said they found rewarding. People who we spoke with had positive comments to make about the suitability and competency of members of staff.

Records were maintained and kept-up-to-date to ensure that Dove Court was a safe place for people to live, work and visit.

People's support and care needs were safely and appropriately met by attentive and knowledgeable staff. Staff had access to an improved standard of information so that they could safely provide people with appropriate support and care.

Improvements had been made to ensure that people were protected against the misuse of medication.

People lived in a safe place which maximised their privacy and dignity.

There were effective recruitment systems which ensured people were protected from unsuitable staff.

Improvements had been made regarding staffing numbers and support, training and morale of staff.

There was a procedure in place for people to make a concern or complaint known and they could be confident that these would be responded to.