Dovecote Residential Care Home

Dovecote Residential and Nursing Home is a residential care home providing personal and nursing care to up to 61 people. The service provides support to people aged 18 and over, some of whom were living with a dementia. At the time of our inspection there were 37 people using the service.

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

People were not always supported in line with their assessed needs and staff did not always follow people’s care plans. Feedback provided by professional visitors to the home, described instances where staff had not acted in a timely way to support people. Care plans were not always person-centred, did not always include all of the necessary information to support people and required a review.

Staffing levels and the high use of agency staff had a negative impact on people. Relatives said that permanent staff were kind and caring with people, but agency staff did not provide support in a timely way or at all. People told us they had to wait long periods of time for support from staff. Relatives commented, “Staff are overworked” and, “They just have too much on.”

People did not have regular access to activities or social interaction. People and relatives told us there was normally no activities to be part of and staff did not have time to engage with them. During the inspection we observed that staff were very busy, and they did not have time to interact with people unless they were carrying out a task.

Medicines were not safely managed. There was an issue with medicine stocks at the home. We could not be assured that people were receiving creams, ointments and patches as prescribed. People did not always receive their medicines. Relatives described instances where people had not received their medicine for several days. Medicine records were not always completed, and medicine care plans did not always contain all the relevant information for staff to follow.

Staff were not always wearing their PPE appropriately or following the provider’s guidance for infection prevention and control.

There was no clear leadership at the home. The registered manager was in the process of leaving the service and a new manager was completing their induction. Staff and relatives commented that they did not know who the responsible manager was. Relatives did not feel that they were communicated with and had to regularly chase staff and management for information.

Since our last inspection, the quality and assurance systems in place had been reviewed and the provider’s quality team were supporting with checks and audits. The systems in place had not been fully imbedded and we found the home manager’s checks had not been completed.

Records relating to people’s care and the quality and assurance systems were not fully completed or completed in a timely way.

We discussed our concerns with the provider and regional management team who had already taken proactive steps to address the issues found during the inspection.

People and their relatives told us they were supported to be independent, but this was affected by staff availability. People were complementary about the permanent staff team and had a good relationship with them.

People were supported to maintain a healthy balanced diet and were very complimentary about the food. Relatives commented that people had re-gained their appetite and were eating lots of varied meals. There was a positive atmosphere at meals times and we observed a very relaxed and happy environment in the dining rooms.

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 and update.

The last rating for this service was requires improvement (published 2 September 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

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

The inspection was prompted in part due to concerns received about staffing levels, staff knowledge, medicines management, skin integrity issues, record keeping, person-centred care and the overall governance of the service. A decision was made for us to inspect and examine those risks.

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.

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.

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

Since the inspection the provider and management team have taken action to address the issues identified. The management team are currently working in partnership with the local authority, health partners and the CQC to improve the service.

Enforcement

We have identified breaches in relation to person-centred care, medicines management, infection prevention and control, management oversight at the home and staffing issues at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dovecote Residential and Nursing Home is a care home providing nursing and personal care to up to 61 people. At the time of our inspection there were 37 people using the service. Care was delivered in a purpose-built building over two floors.

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

The opportunity to learn from incidents was not fully utilised. A new process for lessons learnt had been introduced but was not embedded yet. People did not always have enough meaningful activities to keep them occupied. Records of people’s fluid intake were insufficiently detailed to show they were meeting their fluid targets. The registered manager and provider had governance systems in place but they had not identified all the issues we found.

Staff training was not up to date in fire safety, safeguarding, and medicines. Supervisions and appraisals for staff took place regularly. Staff worked well with external professionals to ensure people received the support they needed. Feedback from external professional was mixed in relation to the management of the service.

People and their relatives spoke positively about the care they received. Care plans were generally person-centred and included appropriate risks assessments. Medicines were managed safely. People were safeguarded from abuse. Effective infection prevention and control systems were in place.

Care was personalised to 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.

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 2 February 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 and the provider was no longer in breach of regulation 9 (person-centred care). We found the provider remained in breach of regulation 17 (good governance).

At our last inspection we recommended that the provider reviewed people’s personal risk assessments and improve the mealtime experience. At this inspection we found that the provider had acted on the recommendations, risk assessments had been reviewed and mealtimes were pleasant experiences.

Why we inspected

The inspection was prompted in part due to concerns received about the care people were receiving and whether people were being treated with dignity and respect. 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 effective, responsive and well-led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the effectiveness of the quality assurance processes of the service. We have made recommendations in relation to activities for people. 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.

Dovecote Residential and Nursing Care is a purpose-built care home providing personal and nursing care to 43 people aged 65 and over at the time of the inspection. Thirteen of the 43 people required nursing care. The service can support up to 61 people.

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

Governance processes did not always keep people safe. People’s care records including risk assessments were incomplete and required updating to ensure people received safe care and treatment. Records were not always person centred. Professionals who visited the service were welcomed by staff but found staff could not account for their actions using the records for the treatment people had received. The provider had arranged for additional staff to bring these records up to date. We made a recommendation about the provider working with other professionals.

The home was clean and tidy with staff understanding how to use PPE. COVID-19 screening was carried out with visitors to the home. Suitability checks were completed on staff before they began working in the service. People’s medicines were administered in a safe manner.

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 nutrition and hydration needs were documented and the kitchen staff were aware of the type of food people needed. We found people’s mealtime experiences required improvement and we made a recommendation about this.

Staff were provided with support through induction, training and supervision. They made referrals to healthcare professionals if people’s needs changed. The home was warm and comfortable throughout with adaptions in place to support people’s mobility and orientation.

Staff were caring and kind towards people. People responded warmly towards staff. The care they provided was constrained by some limited information about people’s needs.

An activities programme was available to people who wished to join in. People were engaged in making Christmas decorations during the inspection. People’s end of life wishes had been addressed by staff.

The provider, the registered manager and the staff had adapted to working through a pandemic. Staff provided a positive working atmosphere in 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 This service was registered with us on 10/10/2018 and this is the first inspection.

Why we inspected

This was a planned inspection as the service had not been rated under the latest registration.

The inspection was prompted in part due to concerns received about the standards of nursing care and record keeping. A decision was made for us to inspect and examine those risks.

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.

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.