Dorset House Also known as 1-119691686

Dorset House is a residential care home providing to provide personal care and support to up to 52 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 36 people living at the home.

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

People, their relatives and staff told us Dorset House was a safe place to be. People were supported by staff who were caring and responsive to their needs. Risks to people had been assessed and staff worked in safe ways to ensure risks were reduced or eliminated. Equipment was well maintained and general risks within the home were assessed, this included robust fire safety procedures.

Staff had training and a good awareness of safeguarding people. They told us how they check people are safe, what to look out for and who to report to if they had concerns. Everyone told us they felt confident the management team within Dorset House would address any concerns promptly and through the correct channels.

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. Where appropriate, people had received assessment of their mental capacity and the correct procedures had been followed where restrictions for people were in place. This meant that staff acted in accordance with the law to ensure people’s rights were fully protected.

People received their medicines as prescribed and medicines were managed safely within the home. There were enough staff. Staffing numbers were closely monitored by the registered manager to ensure the needs of people could be met safely. Recruitment of staff was ongoing, the home was experiencing difficulties, as many other providers were, due to unplanned sickness and the national shortage of workers in the care sector.

Accidents and incidents were recorded and monitored. Monthly analysis meant the registered manager and the team were working to identify themes and trends to reduce accidents, such as falls within the home. Lessons learnt were shared with staff and across the provider’s other homes.

A range of audits were carried out which all fed into an overall service improvement plan. The home actively sought feedback from people and their relatives about the care provided and used this to make improvements.

The home worked well with external health and social care professionals. Dorset House was known in the local community and had made links to support activities for people and fundraising.

Staff felt proud to work at Dorset House and were complimentary about their colleagues, they felt appreciated. People, their relatives and staff were positive about the management of the home and believed it was well led.

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 good (published 14 February 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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, which will help inform when we next inspect.

Dorset House is registered to accommodate up to 52 people. At the time of our inspection there were 37 older people living in one adapted building in a residential area of Poole.

We found the following examples of good practice.

There was a clear procedure in place to welcome pre-arranged visitors to the home, face masks available and hand sanitisers at the entrance. Visitors were asked to complete a health questionnaire. Staff had a designated area for putting on, removing and disposing of Personal Protective Equipment (PPE). The home had started routine testing for staff the week before our inspection but had not undertaken routine testing for people living at Dorset House, this was planned to start in the upcoming month.

The home had an infection control lead to support and guide with correct hand washing techniques and made regular checks. The home was clean and tidy and cleaning schedules were in place. Communal areas and high use touch points such as door handles, and handrails were cleaned frequently throughout the day. There was an agreed admissions process in place which involved testing before and after admission with a period of isolation in line with current government guidelines.

The home had a designated space for visitors outside and inside. There was a separate entrance for visitors with supplies of PPE available. There were various seating areas throughout the home to promote social distancing. Risk assessments for people and staff contributed to keeping them safe by reviewing their individual health conditions.

Further information is in the detailed findings below.

Dorset House is a residential care home providing personal care to older people. The service can support up to 52 people. At the time of the inspection 42 people were living there.

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

People’s needs around intimate relationships were not always met. Care plans did not reflect positive outcomes or give clear support guidance to staff on how to meet people’s needs in this area.

We have made a recommendation about relationships and sexuality in social care.

Improvements had been made to the management of medicines which meant medicines were now managed safely. Improvements had also been made to quality monitoring systems to ensure the delivery of care was both safe and of high quality.

People told us they were happy, felt safe. Relatives said that staff had a good understanding of their loved one’s needs and preferences. Risks had been identified and measures put in place to keep people safe from harm.

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.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards inclusion and enabling people to learn essential life skills. Equality, diversity and human rights (EDHR) were promoted and understood by staff.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging.

People received pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

Care plans were personalised and updated in response to people’s changing needs. Staff listened to what people wanted and acted quickly to support them. Staff looked to offer people solutions to aid their independence and develop their skills.

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 (published 22 January 2019) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

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.

Dorset House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dorset House accommodates up to 52 older people in one building. There are two floors, which are connected by a passenger lift. Nursing care is not provided. When we inspected there were 42 people there, many of whom were living with dementia.

There was a registered manager, which is a requirement of the service’s registration. 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. The registered manager had recently been providing management support to another care home operated by the registered provider as well as Dorset House. The deputy manager had stepped up to manage the home in the registered manager’s absence and confirmed that the registered provider had also provided additional management support.

We received allegations regarding poor staffing levels which were impacting on the provision of care, and about poor management of the service. We also had concerns about the management of some specific types of medicines following an incident in the home. We reviewed this information and carried out an inspection focussing on the questions, is the service safe? and is the service well led?

People were protected from potential abuse and avoidable harm by staff who were knowledgeable about recognising and reporting different signs of abuse. There were sufficient numbers of appropriately qualified staff available on each shift to ensure people were cared and supported safely. Medicines were not always stored appropriately and managed effectively. People were not always protected from the risks of infection. There was a system in place to review and learn from incidents when things went wrong.

There was an open, honest, friendly culture and people told us they had confidence in the management team and the staff. People and their relatives were consulted and involved in their care and support. There was a programme of quality checks and audits to ensure the quality of the service was maintained. These had not always been effective in identifying concerns and the registered provider took immediate steps to remedy this.

Further information is in the detailed findings below.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Safe to at least good. They told us they would meet the relevant requirements by 5 July 2016. At this inspection we found the improvements had been sustained. The evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service met all relevant fundamental standards. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Dorset House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dorset House accommodates up to 52 older people in one building. There are two floors, which are connected by a passenger lift. Nursing care is not provided. When we inspected there were 38 people there, many of whom were living with dementia.

There was a registered manager, which is a requirement of the service’s registration. 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.

At the last inspection in June 2016, we found shortcomings in relation to risk assessment and management, with particular reference to the stairs, and the administration of medicines. Some people had not received pain relief when they might have needed this. One person had missed a number of doses of some of their medicines, yet their GP had not been consulted about this. These constituted breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider took immediate steps to address the shortcomings and returned an action plan, stating they would meet the legal requirements by 5 July 2016. At the current inspection we found the relevant legal requirements had been met.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. The provider had updated their risk assessments and put measures in place to manage the risks stairs presented to people. There was no longer open access to stairways and people were supported to use the lift instead.

People’s medicines were managed and administered safely. Staff who administered medicines were trained and competent to do so.

People were treated with kindness and compassion. Their privacy, dignity and independence was respected and promoted. The care staff and managers knew and respected the people they were caring for.

People were protected against abuse and neglect. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Staffing levels were sufficient for people to receive care they needed. The registered manager acknowledged that call bell responses had at times been slow and was already acting to improve these.

Safety was promoted in the staff recruitment process, with pre-employment checks to help ensure staff were of good character and suitable to work in a care setting.

The premises and equipment were well maintained. The building was visibly clean and smelt fresh. Staff had training in infection prevention and control, including hand hygiene. They used protective equipment, such as disposable gloves and confirmed this was readily available.

Staff followed clear reporting procedures for accidents and incidents. There was robust oversight by the registered manager and by the provider’s senior management team.

People’s physical, mental health and social needs were assessed holistically, and care was planned and delivered accordingly. Assessments and care plans were reviewed regularly with the involvement of people and their relatives. People received individualised care that was responsive to their needs.

Technology and equipment was used to enhance the delivery of care and support

Care was delivered by staff with the skills and knowledge to provide effective support.

People told us the food was very good, always served hot and with ample portions. Where people required assistance from staff, this was provided sensitively, at the person’s pace.

People’s weights were monitored and appropriate action taken if people were identified as being at risk of malnutrition, such as pursuing referral to a dietitian. Similarly, if people were observed to have difficulty swallowing, a swallowing assessment was sought with a speech and language therapist.

People had access to healthcare services, such as doctors and district nurses, and were supported to manage their health.

Staff worked in line with the requirements of the Mental Capacity Act 2005, including the deprivation of liberty safeguards. People were supported to express their views and to be involved in decisions about their care.

The service was actively involved in building community connections. Many people using the service and its staff were drawn from the local community.

A team of activity coordinators facilitated a programme of individual and group activities based on people’s interests, needs and secret ambitions.

People’s concerns and complaints were taken seriously and used to improve the service.

People were supported, at the end of their lives, to have a comfortable and dignified death.

The service had an open, friendly, informal culture. The registered manager and deputy were accessible to people, relatives and staff. Staff morale had improved since the last inspection and there was a sense of more going on at Dorset House. This included the development of links with local community organisations, which had benefited both residents and staff. Staff were supported through observed practice and supervision.

The service operated openly and transparently. Whenever there was an accident or incident involving a person who used the service, the management team exercised their duty of candour, ensuring that the person, and where appropriate their next of kin, was kept informed. Staff understood and had confidence in the provider’s whistleblowing procedures.

The registered manager and provider maintained oversight of the service, to manage risks, maintain and improve the quality of the service and meet legal requirements.

Dorset House is a care home without nursing for up to 52 people. There were 38 people living there during our inspection, many of whom were older people who were living with dementia. Accommodation is located on the ground and first floors. The two floors are connected by a passenger lift as well as stairs. There is a large enclosed garden at the rear, with lawns, paved areas, seating, flower and vegetable beds and trees. Sizeable parking areas are situated to the front and side of the building.

The service has an established registered manager, who has been in post for several years. 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 were able to access the stairs. A range of environmental risk assessments had been undertaken in relation to the premises. However the risks posed generally by unguarded staircases had not been assessed and managed. At the time of the inspection the provider had started an investigation into the incident and begun to review the risks posed by unguarded staircases at Dorset House, and the other homes run by their organisation. The provider informed us after the inspection about measures they had taken to improve safety by restricting resident access to the stairs.

People’s individual risks were assessed and reviewed, with care plans in place to address identified risks. However, one person’s individual risk assessments and care plans did not accurately reflect how the person would remain safe on unguarded stairways.

Some people’s risk assessments identified that they needed well-fitting footwear to help prevent the risk of falls. Most people’s footwear was well fitting with intact soles. Staff had identified that one person required new footwear and were arranging for their slippers to be replaced. Following the inspection, the management team informed us staff had checked everyone’s slippers and new slippers had been purchased for four people.

There were two instances of people not receiving pain relief when they might have needed this.

One person had often missed doses of some of their regular medicines because they were asleep or refused the medicine. Staff had not flagged the missed medicines to the GP so they could consider whether the person might benefit from changes to their treatment. Recognised pain scales to help staff recognise when people living with dementia might be in pain were available but not in regular use.

You can see what action we told the provider to take in relation to risk assessment and management, and medicines and pain management at the back of the full version of the report.

A further person who was at risk of falling and needed spectacles to see clearly was not always wearing them. We saw that their spectacles were very dirty. The management team confirmed that staff handovers would include a reminder to staff about the cleaning and wearing of spectacles. This person’s spectacle care, foot care and nail care were not always recorded. The maintenance of complete care records is an area for improvement.

People were protected against the risk of abuse. Staff understood their responsibilities for reporting accidents, incidents or concerns. When people had accidents, incidents or near misses these were routinely recorded and monitored by the registered manager to look for developing trends to reduce the risk of re-occurrence.

Staff had first aid awareness training and more senior care staff had more in depth first aid training.

Lifting equipment was maintained and serviced at the required intervals.

Most areas of the premises were clean. The downstairs lounges had been refurbished and the carpet had been replaced. Floor coverings elsewhere were intact. Whilst most bathroom and toilet areas were in reasonable decorative order, there were a few cracked tiles that would be difficult to clean effectively and could harbour germs. This is an area for improvement.

People were supported by sufficient staff with the right skills and knowledge to meet their individual care needs.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. The managers were aware of the recent Supreme Court judgement about DOLS and informed us they had submitted applications for most people living at the home, although they were still awaiting the outcome of these. They were aware of the legal requirement to notify us of the outcome of these applications. This showed that the home met legal requirements relating to DOLS.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was adequately maintained. The premises were laid out in a way that met the needs of people living at the home. One person's relative commented that they found the home 'really light, airy' and said, 'The rooms are nice.'

There were enough qualified, skilled and experienced staff to meet people's needs. People told us they were able to find staff when they or their family member needed assistance. For example, a relative said, 'Whenever I've called them for whatever reason, somebody's come. I haven't waited.' We observed that care staff supported people in a calm, unhurried manner, which indicated that there were enough staff on duty. Staff received the training they needed to perform their roles safely and had opportunities to gain qualifications in health and social care.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We observed throughout the inspection that staff checked that people wanted assistance before helping them. We saw that they allowed people time to express their wishes and that they respected these.

The people and visitors we spoke with all talked positively about the care they or their family member received. Two relatives commented that they noticed their family member's health and wellbeing had improved since they moved into the home. For example, one said that the person was much calmer and 'tends to join in a lot more than they would have done before'. One told us that their family member seemed to be doing something different every time they saw them and that staff 'interact quite a lot with people.'

Is the service caring?

We observed that staff acted swiftly and discreetly to support people to maintain their dignity, for example if they needed assistance to use the toilet. Staff assisted people in a kind and respectful manner, calling them by their preferred name.

Is the service responsive?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The home's management ensured the home would be able to provide the level and type of support people needed before they moved in. The care plans we examined reflected people's assessed needs and contained clear instructions for staff so that people received the help and support they needed. People's assessments and care plans were regularly reviewed and kept up to date.

Staff ensured people's health care needs were met.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People told us that they were able to raise any concerns with the staff or manager, who listened to them. For example, one visitor said there was 'always someone around' if they needed anything and another that they could always speak with staff 'who do something about it'. Staff told us they felt able to raise issues that were listened to and acted upon.

People we spoke with were satisfied with the care and support they received at Dorset House. One person told us the home had, 'Superb' staff, and that, 'Nothing is too much trouble'.

Staff we spoke with told us that people received a good service at Dorset House. One staff member said, 'Each resident is an individual', and another said,'It's a great place'.

People's needs were assessed. However care and support was not fully planned and delivered in a way that protected people's health, safety and welfare.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Dorset House regularly checked the quality and safety of the service people experienced.

We spoke with eight people living at Dorset House, two visiting healthcare professionals and three visiting relatives to obtain their opinions about the home. People living at the home said they were 'well taken care of' and received the help they needed. Other people were complimentary about the care the home provided. We saw staff providing people with the help they required.

People told us that the food they had was 'good' and 'plentiful'. We saw people were asked about choices and special dietary needs were met. They said equipment was used to help meet their needs such as assisted baths, hoists and air mattresses. We saw that this equipment was regularly checked and serviced.

There was a system for checking the suitability of potential staff before they started work at the home.

People said they knew about the home's complaints procedures and were confident about using it.

We saw that records about people were kept securely and managed properly.