Dover House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found the service had made improvements to oversight and governance, since our last inspection. The registered manager completed audits on the quality of the service and acted when shortfalls were found. There was an open and transparent culture within the service. Staff told us they felt supported, were comfortable to raise concerns and felt they were listened to. The service worked with community groups and healthcare professionals to improve the service.

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.

There was a positive culture at the service which was to the benefit of people and staff. The culture of the service was led by the management. Staff and the registered manager agreed the vision of the service was to put people at the centre of their care. The registered manager told us, “I inspire staff to treat people as individuals”. One staff said, “We have to make sure we provide the help residents want, make sure life is happy here. The main things is always, resident first.” Staff told us they liked that the registered manager knew the residents. The registered manager told us they felt involving family and professionals in care reviews was also something they felt was important.

There were regular meetings where staff could discuss how the service was delivered as well as individual people’s needs. The registered manager also used technology to communicate with staff through chat groups and making videos which were shared with staff. There were daily walk arounds undertaken by the registered manager or deputy manager. There were random checks to ensure staff were providing good quality care and to guide staff practice.

The registered manager was clearly passionate about their role. They were a registered nurse and so had the clinical background needed to provide staff with this knowledge and support. They were supported by a knowledgeable and committed management team. The registered manager also told us they felt supported by the provider. The registered manager told us they felt it was important to build a family environment for staff as well as people. Staff told us they felt supported by their peers and management. One staff member said, “[The Registered Manager is] very supportive…they are so approachable, they have an open-door policy.” Another staff told us they felt the service was, “well managed, [the registered manager] will always make sure their residents [are] supported.”

The registered manager had worked as a nurse in hospitals and in the community. They had then moved into management within healthcare before moving to focus on adult social care. The registered manager had grown and learnt in the role and had made changes and improvements to reflect this.

Staff told us they felt confident to raise concerns to the management team. One staff member said, “Whenever I have concern, they support me.” Another said, “[The registered manager] takes views from staff. We can tell her…she will make some changes.” The registered manager told us they had spent time at the service at different times of the day to build relationships with both day and night staff. When they made big changes, such as opening a new floor, at the service they increased their hours and were available to staff at all hours in case there were any issues.

There were multiple routes for staff to provide feedback, including electronically and anonymously. People who used the service and their relatives were also supported to provide feedback about the services as were visiting professionals. Staff meetings were two-way discussions, and staff were able to raise issues and concerns for discussion.

The registered manager told us they valued the diversity in their workforce and people had also embraced it. If challenges did arise the registered manager addressed these and provided support to the staff. Staff told us they felt the registered manager promoted workforce equality and inclusion. One staff member said, “I can say proudly that we have a multicultural staff team here and we had a BBQ, which promoted cultural values to be shared. The manager is able to connect with everyone and know their culture. If someone is doing something we check each other’s beliefs to ensure it does not affect them.”

There were systems in place to ensure equality was promoted within the workforce. Some staff were new to the area. The registered manager set up a private social media group for new staff so they could ask questions and help each other settle into a new place. Internationally recruited staff told us they felt well supported through regular meetings and guidance offered by the registered manager. The registered manager understood the importance of retaining good staff and staff retention levels were positive. There were systems in place to ensure people were able to access reasonable adjustments as needed.

Staff were aware of the expectation of them in their roles. They felt the service was well managed. Staff were aware of the management processes within the service and felt they were able to be involved in the processes as well as receive updates on any findings. One staff member said, “Last time we did the audits we realised there were some issues, so we were called into a meeting, we were educated... and we’ve seen improvements.” The registered manager understood their responsibilities as a registered person including duty of candour which means they must act in an open and transparent manner.

There were systems in place to monitor the quality of the service. There was a mixture of paper based and electronic monitoring. Audits included reviews of the building, health and safety, care plans and the care and support provided. Where audits had identified issues, action was taken or was in the process of being so. For example, there were areas where the paintwork was looking tired, and quotes were being obtained to repaint the service to address this. There was a dashboard system that was used to monitor a wide range of quality standards from call bell response times to support to ensure constipation was safely managed. There were areas where records could be improved to make audit trails clearer, which was an area for improvement. However, where concerns had arisen, these were addressed by the management team. Medicines were regularly audited. However, at the time of the inspection a new medicines system was being implemented and this had impacted on oversight. The registered manager had also been providing support to another service which had diverted some of their focus. During the inspection the registered manager recognised that this was not ideal given that changes were being made to how medicines were being delivered. They told us they had learnt from this. Notifications were submitted as required by law and the CQC rating was on display.

People and their relatives were happy with how the service worked with partners to provide people with support.

Staff worked in partnership to ensure people’s needs were holistically met. Staff were aware of different healthcare professionals who came to the service and helped to support people’s physical health and wellbeing. Staff gave examples of working with health and social care professionals to ensure people’s needs were met and also gave examples of collaborating with families. Staff told us people were encouraged to remain part of communities important to them for example a community worker came to the service to provide some people with religious support.

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 improvement. Partners did have the opportunity to provide feedback to the service using the electronic system. The feedback recently received had been positive.

The service worked in partnership with a wide range of other organisations to ensure people were provided with effective care. The registered manager had met with the GP surgery to build relationships and develop working together principles to improve efficiency and effectiveness for both services whilst ensuring people got their medicines and healthcare in a timely way. Where there had been opportunities to meet and share learning with other services the service had participated in this to help foster common understandings. For example, the timing of admissions had improved after a meeting with the NHS which included the ambulance service. This ensured the service had more time to get a person settled in when they first moved in. Where people had complex needs care plans were developed with relevant health care professionals.

There was an open culture to learning at the service. The registered manager was open about areas where lessons had been learnt and improvements made. For example, changes had been made to admissions to ensure clinical staff could manage demand effectively. They told us, “I have grown and want to continue to grow.” Staff gave numerous examples throughout the assessment of ways in which learning was shared in the service, feedback was listened to and improvements made for both people living at the service and ways of working for staff. For example, wound care had been identified as an area for improvement to help with this staff had received extra training, documentation had been improved and equipment had been purchased to ensure people received safe and effective wound care and staff were supported to deliver this.

The service operated a care companion model where staff were assigned to a small number of service users. The registered manager told us this helped staff stay focused on providing person centred care. The service had introduced a relationship centred care model. The registered manager told us this is what had attracted them to the service. The model focused on building relationships with people and their family and friends. Relatives were able to access care records in real time, where this was appropriate, relatives told us this helped them to be informed about the care their loved one was receiving.