Dover House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found the service had made improvements since our last inspection and people were now receiving safe care and treatment. Staff knew people well and supported them to manage risks to their health and welfare. There was a learning culture within the service, when incidents or accidents happened, action was taken to reduce the risk of them happening again. People were supported by staff who had been recruited safely and had received training appropriate to their role. People received their medicines as prescribed, however, some improvements were required to the storage and ordering of medicines. Staff followed infection control guidance, and the service was clean. Staff understood their role to keep people safe from abuse, discrimination and avoidable harm. People were supported to access other healthcare services safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe and well looked after at the service. One person said, “Yes the carers care and the manager cares”. Another person told us, “Its a lovely place all the staff are very nice”. Relatives felt people were well supported. One relative told us how safety had improved in recent years. One relative said, “[My relative's] wellbeing is being looked after.”

The registered manager told us, it was important to ensure people were included in discussions about how things could be improved. They were able to give examples where they had learnt lessons and made changes as a result of learning from incidents. For example, they had made changes to how people’s needs were assessed when people moved to the service from hospital, to support a safe transfer. Staff knew how to report accidents and incidents and told us any lessons learnt from an incident were shared with them. Staff knew what to do if there was an incident. One staff said, “When there are accidents, each resident has their protocol it’s all in their care plan. If a resident falls. I push emergency buzzer; I don’t try to lift resident; the nurse comes and does an assessment.” Staff told us they felt supported to learn and develop in their roles and felt the service had a learning culture.

There were systems in place to record and act on incidents. The registered manager reviewed incidents monthly to ensure the appropriate action had been taken as a result of the incident. Action was taken to reduce risk where appropriate. For example, if someone had a fall staff would consider if they had an infection or were in pain and if this contributed to why the person fell. People were referred for specialist help, such as the falls clinic, as needed. There was an analysis of incidents for individuals. However, there were areas where analysis of trends could be improved to ensure opportunities to reduce risk were not missed. The way information was managed did not provide a clear view of overall trends. For example, looking at when and where most falls or other incidents occurred. There had been no in-depth review of trends. We raised this with the registered manager, who put plans in place to improve how incidents were to be reviewed going forward.

People told us they were supported to access healthcare when they needed to be. One person said, “They would get me the help I needed”. Relatives told us staff identified when people needed medical attention and sought this. One relative told us their relative was unwell and said, “I thought that was good that the staff noticed and sorted medical attention.”

Staff told us there were systems in place to ensure people received safe care. Staff told us there were daily meetings to discuss the management of the home and people’s health concerns. There were handovers between shifts to ensure that messages were passed on which supported people to receive the care they needed.

Concerns had been raised by some health and social care professionals about the service prior to the assessment. However, other health and care professionals advised us that the service had made improvements. Partners did have the opportunity to provide feedback to the service using the electronic system. The feedback recently received had been positive.

There were systems in place to ensure information about people’s needs were shared when people moved between services. For example, if people went to hospital staff could print off their hospital passport from the care plan system. This ensured information in the passport was based on people’s current care plan. There were also processes to reduce the risk of people’s important items, such as dentures and glasses, being lost if they went to hospital. There were daily calls with the GP to discuss people's health concerns and ensure people received prompt treatment. Staff used best practice tools such as NEWS to assess how unwell a person was. NEWS is the National Early Warning Score and is used to determine the degree of someone’s illness. The score helps staff in different settings communicate how unwell someone is quickly and clearly.

People told us they could raise concerns with staff. One person told us, “If I was worried about anything I could talk to them I would confide in them especially the ones I like”. Another person said, “The staff are very good at listening”. Relatives agreed, they thought concerns would be listened too. One relative said, “Occasionally I will raise things, and the staff are very accommodating.”

Staff described the signs of potential abuse and understood their duty to protect people from harm. Staff told us they felt able to raise concerns to senior staff and knew which external organisations they could raise concerns to. Staff told us about examples of actions that had been taken to safeguard people from any potential harm.

We observed staff engaging positively with people. Staff provided people with reassurance and took the time to explain things to them which helped to reduce their anxiety. Staff spoke respectfully to people. People were clean and appropriately dressed.

There were processes in place to record, investigate and report safeguarding concerns. When concerns were raised these were investigated as required and action was taken if needed. Staff had undertaken safeguarding training as required. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. In care homes this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). There were effective systems in place, to ensure the appropriate authorisation had been sought, where people were deprived of their liberty.

People and their relatives told us staff provided good levels of support and met people’s needs. Comments included, “They look out for me and see that I am well.” And “They allow me to do as much as I can for myself but help when necessary.”

Staff had a good understanding of the risks to people’s health and wellbeing and knew how to support people. For example, staff understood why some people needed support to eat and what that support was. Staff told us it was important for them to be observant. Staff understood their responsibility to support people to take positive risks. Where people had capacity to decide to take risks the service provided support and guidance where needed. For example, one person wanted to continue an activity which increased the risks to their health. Staff supported the person to access professional guidance. Staff worked with the person to agree how best to reduce the risk whilst still enabling the person to enjoy the activity.

People had the equipment in place they needed to enable staff to support them with risks. For example, people had pressure relieving equipment in place where they were at risk of pressure injuries to their skin. People were supported to move about the building safely. People were supported safely by care staff. We observed people being supported to eat and drink in line with their care plan. For example, staff supported one person to drink using a modified cup to reduce the risk of scalding. People who needed modified diets were provided with such and supported to eat as needed.

There were some of areas where care plans needed more detail. For example, when people were supported to move with a slide sheet or hoist. There was a lack of detail about how to carry out these tasks. We raised this with the registered manager who agreed to address this. There were no fire risk assessments in place for people prescribed paraffin-based skin products. Some people in the service smoked and this increased the risk of harm if exposed to a heat source. However, other areas included the information staff needed to effectively manage risks. For example, where people were on modified diets there was information on this so staff knew how to support the person safely. Any equipment people used was now detailed in the care plan, so staff knew this. For example, care plans listed what size sling people used when they were hoisted.

Feedback about the environment was mainly positive. One relative said, “It feels good, well maintained.” Another said, “Its modern and decorated well throughout.’ Most relatives also told us issues were fixed within a reasonable time frame. One relative told us when their loved one had an issue with their bed, “the maintenance man was there straight away to fix it.” However, one relative told us they have had to wait for some issues to be fixed.

Staff told us they supported people to maintain a safe environment. Staff said they checked people’s equipment before use to ensure it was working properly and any concerns about the environment were reported to the maintenance team. One staff said, “I recently reported [a] fault, it was fixed that day.”

Environmental risks were safely managed. For example, areas were kept free from clutter and there were clear wide walkways for people to move about safely. Doors were locked to areas such as the laundry room, stairs and medicine storage areas to reduce the risk of people accessing these unsupported. Radiators were covered to reduce the risk of people burning themselves on these. People’s call bells were in reach as well as pull cord alarms so people and staff could call for help if needed. Window restrictors were in place throughout. Fire doors, exits and fire extinguishers had clear signage and exit ways marked.

There were systems in place to identify and mitigate risks to people from the environment. For example, appropriate checks of the utilities were completed to ensure these systems were safe. The lifts and other equipment had been checked. Regular checks of the environment were carried out and any issues reported. Action was taken to address any issue raised. Actions had been taken to reduce the risks from fire. For example, people had individual fire evacuations plans in place. Fire equipment was regularly tested, and staff practiced evacuation. Staff used electronic devices to access care plans. On one of these devices they could also report any maintenance issues which were shared with the maintenance lead.

People told us they thought there were enough staff. One person said, “They always have time they never rush me as I need a lot of help.” Most people said staff came quickly when they called. Where people said they had to wait they told us, this was not to the extent where it had caused them any problems. People were happy with the skills and knowledge staff had. Comments included, “They seem to know what they are doing and are competent, they have lots of training.” And “Can’t fault with them for the care they give me”.

Staff told us, they felt there were generally enough staff and the levels met the staffing ratio at that particular time. Some staff told us when there was sickness there could be times when they were more pressured. Staff felt they had received the training they needed to carry out their roles. One staff member said, “We are getting enough training; we are well trained for everything.” Another staff member said, “All the training I request, I do get them.”

Staff were visible in all lounges and were not rushed. Call bells were answered in a timely manner. We observed there was enough staff to keep people occupied. Staff were available and chatting to people, people were enjoying music, talking with their neighbour about politics or the news, their families and pets. Some people were reading or undertaking a hobby. People had drinks within reach. People received assistance from staff when they requested it.

The service used a dependency tool to help them to calculate the number of staff they needed to provide support to people. The number of staff on the rota reflected the assessed need. Staff had the skills they needed to support people safely. Staff were also supported by nursing staff who met people’s clinical support needs. Training was provided as a mixture of online and face to face learning. Team meetings were also used as an opportunity to promote learning. For example, recently staff discussed infection control, pressure care and the importance of hydration. Staff had recently had a competency check for medicine administration as a new electronic system was being rolled out. However, the registered manager told us these checks had not always been regular. We discussed this with the registered manager who agreed regular checks would be made going forward. Staff had been recruited safely. Appropriate checks were undertaken to ensure staff were recruited safely. For example, Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff supervisions were up to date to ensure staff were supported in their role.

People and their relatives did not have any concerns about infection control at the service. One relative said, “I’m always there, I have nothing bad to say.” Relatives told us they were happy with the standards of cleanliness.

Staff were aware of the infection control officer and told us they reported any concerns about infection control to them. Cleaning staff told us, they had everything needed to do their role. Staff knew the signs to look for which might indicate someone as unwell and told us they would report their concerns to the nurse. Staff told us, what action they would take to help prevent the spread of infection. For example, one staff member said, “We always use sanitisers on every corridor, we have personal care trolley we carry hygienic things wipes and everything. In the lounge we have infection control wipes, we do it every half hour, one hour…we are cleaning all the time.”

There was some inconsistency on where and when staff were hand washing between supporting people. The registered manager investigated and undertook competency checks on staff handwashing. As a result, they took action to improve staff practice. They also reviewed how handwashing was checked in the future and made changes to ensure standards were maintained going forward. There were some areas of the service where there were unpleasant odours. The registered manager was aware of this, and some actions had been taken to address this. We spoke to the registered manager who agreed more action was needed to fully address the concern. Cleanliness of the environment was generally of a good standard with a fresh and sanitary aroma in other areas of the service. Some soft chairs were stained, these were in the process of being replaced.

Staff had undertaken infection prevention control and food hygiene training to ensure they had the knowledge they needed to provide good support. There were cleaning schedules in place to ensure areas were regularly cleaned. Equipment was kept clean and slings, used to hoist people, were not shared. Staff wore and disposed of personal protective equipment (PPE) correctly and there was plenty of stock available and visible on each floor. There were yellow bins around the service for staff to dispose of PPE and other waste appropriately. People were supported to access vaccinations.

People were receiving their medicines safely and as prescribed. People were receiving when required [PRN] medicines appropriately. Staff used psychological intervention techniques to support people if they became distressed or agitated. People’s medicines had been reviewed and stopped where appropriate by healthcare professionals. People’s risks with prescribed medicines were identified and managed. This included medicines which could increase the risk of bleeding and bruising.

Staff were trained to safely administer medicines, however, at the time of the inspection they were not being competency checked yearly in line with best practice. Since the inspection the provider has ensured routine competency checks are being completed for all staff who administer medicines. Staff told us they worked closely with other healthcare professionals to provide safe care and treatment to the people living in the service. We saw evidence of this joint working helping to meet people’s individual needs.

There were processes in place to ensure that people received medicines safely. This was supported by an electronic medicines administration record (e-MAR). The service completed regular audits into medicines optimisation and management. However, these audits had not identified, the processes for disposing of out of date medicines and the ordering of some medicines had not been effective. There had been no impact on people. However, people’s care plans did not always contain all the information needed to support staff with insulin-controlled diabetes and epilepsy.