Dolphin View Care Home

Dolphin View Care Home is registered to provide accommodation, nursing and personal care to a maximum of 35 older people, including people who live with dementia. The service was across two floors, with a range of communal and outdoor space. At the time of the inspection, there were 27 people living at the home.

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

People were not always kept safe because not all risk assessments were in place or up to date. Some observations, key to ensuring people remained safe, had not always been recorded. Staff demonstrated a good understanding of the risks people faced and how to reduce them.

Governance and audit systems and processes were not always effective in identified areas for improvement. When actions were identified they had not always been completed.

Lessons learned and updates to staff were not always shared effectively or consistently. Opportunities for practice improvement had therefore been missed. Delegation of responsibilities to staff and empowering them through specific responsibilities, such as champion roles, had not yet happened. We have made a recommendation about this.

Medicines administration and the storage of medicines had improved.

The culture had not always been open, with multiple staff experiencing a lack of support under the previous registered manager. At the time of inspection the new home manager had made a positive impact on the culture. They were more open, accessible and supportive. People, relatives, staff and external professionals all commented on this improvement in the culture. The provider planned to move the manager’s office from the entrance to the building into a room inside the care setting. They committed to continuing these cultural improvements by supporting the new manager with sufficient supernumerary time to gain oversight of the service and make the necessary improvements.

Staffing levels had improved since our last inspection. The provider was less reliant on agency staff and sickness levels had reduced. Staff morale had improved in the time the home manager had been at the service. Staff needed more support and upskilling from the provider. We have made a recommendation about this.

Staff worked well with a range of external health and social care professionals to ensure people got the right care and treatment. Clinicians had confidence in the ability and knowledge of staff, although recognised communication was an area to improve.

Care planning was not as person-centred as it needed to be and information was at times difficult to locate and to read. The provider recognised this and was prioritising a review of care planning information, as well as bringing forward the rollout of an electronic care records system. We have made a recommendation about this.

Activities had improved recently and there was a range of positive feedback in this area. The service had made some positive initial links with local organisations and groups.

People were supported to have maximum choice and control of their lives and to live in the least restrictive way possible and in their best interests; policies and systems in the service supported this practice. Where improvements were required to practice, the home manager and supporting manager were responsive.

People felt safe and supported. Staff regularly checked on people’s wellbeing and call bells were answered promptly. Relatives had confidence in the ability of staff to safely look after their loved ones.

The environment was clean and well maintained. There was a refurbishment plan in place to ensure the dining room and other areas were improved in early 2024.

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 6 April 2023).

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 some improvements had been made, however further issues found, meant the provider was still in breach of regulation 17 good governance. They were also found to be in breach of regulation 12 regarding risk assessments.

At our last inspection we recommended that staffing levels be kept under review, that systems were in place to provide activities and that people were promoted to be involved in daily decision making. At this inspection we found recommendations had been addressed and there were improvements in staffing and activities.

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, responsive 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 remains requires improvement based on the findings of this inspection. This service has been rated requires improvement for the last three consecutive inspections. We have met with the provider to discuss this and to encourage improvement at the next inspection.

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

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

Enforcement and Recommendations

We have identified a breach of regulations in relation to safe care and treatment, and good governance. We have made recommendations regarding the provider’s approach to lessons learned, the detail in care planning, and their use of champions.

Follow up

We have requested regular updates 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.

Dolphin View Care Home is a care home providing accommodation and personal care with nursing for up to 35 people. At the time of the inspection, 29 people were living at the home.

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

Medicines were not always managed safely. We were unable to assure ourselves people had received all their medicines as prescribed.

Systems were in place to monitor the quality of the service. These checks had not always identified the shortfalls we had found. Staff morale was poor, and the management of the service was sighted as the main reason for this.

The provider had not always ensured there were enough staff on duty to meet people’s needs, including with activities. We have made a recommendation about this.

People felt safe and staff understood their responsibility to keep people safe from harm. People were treated with dignity, respect and equality by kind staff.

Risks to people had been assessed with actions in place to help keep people safe. Checks were carried out on staff before they started work to assess their suitability.

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 home 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 and update

The last rating for this service was requires improvement (published 1 July 2022)

At this inspection we found some improvements had been made, however further issues found, meant the provider was still in breach of regulation 17 good governance. They were also found to be in breach of regulation 12 regarding medicines management.

At our last inspection we recommended that staffing levels be kept under review, that systems were in place to provide activities and that people were promoted to be involved in daily decision making. At this inspection we found recommendations had not been fully addressed.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, caring, responsive and well led which contain those requirements. 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.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dolphin View Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and good governance. Please see the action we have told the provider to take at the end of this report.

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 and what we found

We have made a recommendation about staffing levels being kept under review, so people receive timely and person-centred care.

We have made a recommendation about ancillary staffing levels being kept under review to ensure an appropriate standard of hygiene.

All people and relatives were complimentary about the direct care provided by staff. They trusted the staff who supported them. They said staff, although, “very busy”, were kind and caring and supportive of people and their families.

We have made a recommendation to ensure people have a range of activities that were person-centred and of interest to them.

There were opportunities for staff to receive training, to give them insight into people’s support needs.

People received food and drink to meet their needs. Improvements were needed to people’s dining experience, to make it a sociable experience if they wished to engage and to ensure people were supported to eat.

We have made a recommendation that systems are developed to promote people's involvement in daily decision making, whatever their level of need.

Records provided guidance to ensure people received safe and consistent care and support from staff members. Systems were in place for people to receive their medicines in a safe way.

There was evidence of collaborative working and communication with other professionals to help meet people's needs.

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.

A quality assurance system was in place, but it needed to become more robust to assess the standards of care in the service. Improvements were needed to the running of the service to ensure people were the main focus of care delivery and they were involved in daily decision making and received person-centred care.

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

Rating at last inspection

This service was registered with us on 18 May 2020 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 11 December 2018.

Why we inspected

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.

The service was inspected and all domains were reviewed as it has not been previously rated. It was prompted in part due to concerns received about staffing and people’s care. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

We found the following examples of good practice.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

The manager worked well with external agencies to ensure they adhered to national good practice guidance regarding infection prevention and control.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and visitors to use. Hand sanitiser was readily available throughout the service. Staff had received training on the use of PPE and we observed staff wearing it correctly during the inspection.

Increased daily cleaning schedules were implemented including regular touchpoint cleaning.

People living in the home and their relatives were supported to maintain contact.