We undertook this unannounced inspection on the 13 and 17 December 2018. Dorcas House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Dorcas House provides care to people living with dementia or mental health needs. Dorcas House can accommodate up to eleven people in one adapted building. At the time of the inspection six people were living at the home.

The service has been in breach of regulations relating to the governance of the service since February 2017. We have carried out two subsequent inspections since this time and at out last inspection in November 2017 we found the home had continued to not meet regulations around the governance systems in place and we placed conditions on the providers registration. These conditions instructed the provider to send us regular updates on checks that had been carried out at the service to ensure the quality and safety of the service. The provider has submitted these updates as per the conditions in place. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our inspection in November 2017 had been made. We found that whilst improvements had been made to the governance systems they had not been sufficient or sustained and the breach of regulation continued to not be met. The conditions will remain on the providers registration.

We found notifications had not been submitted as required to the Commission on three separate occasions. This is a breach of Regulation 18 Notification of other incidents. You can see what action we told the provider to take at the back of the full report.

The home has a registered manager who was present throughout the inspection. 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 risks associated with peoples’ care had not always been identified or well managed. Where incidents had occurred, there were no robust systems in place to analyse the cause or put steps in place to reduce the chance of reoccurrence. The risks around managing peoples’ diabetes had not been managed well and we saw people had been provided with foods that were not in line with a diabetic diet. We found the provider had breached the regulations in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

People received their medicines safely although we found improvements were needed in the identification of medicines. Staff understood safeguarding procedures and action to take should they have concerns.

People had their privacy respected although we found some practice where supporting people in a dignified manner could be improved.

People were supported by staff who had the skills and knowledge to meet their needs. Staff training had been provided around people’s individual needs. However, we found the support people living with mental health conditions received needed improving. People had their healthcare needs met and were assisted to have foods and drinks they enjoyed.

People’s care had been reviewed to ensure it continued to meet their needs, although these reviews did not involve the person themselves.

Not all people had been involved in activities of interest to them.

Staff felt supported in their roles and felt able to provide feedback to the registered manager should they have any.

Dorcas House is registered to provide personal care and accommodation for up to eleven people who live with dementia, mental health related conditions or physical disabilities. At the time of our inspection six people were living at the home.

At the last unannounced comprehensive inspection in February 2017, we judged that improvements were required in delivering a safe, effective, caring, responsive and well-led service. During this inspection we found the provider continued to be in breach of the regulation related to governance. We carried out an unannounced focused inspection of this service on 18 July 2017, when we looked only at the key question of Well-led. During this inspection we found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. After our inspection in July 2017 we served a Warning Notice to the registered provider which required them to be compliant with this regulation by 13 October 2017. A Warning Notice is one of our enforcement powers.

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 ‘is the service well-led’ to at least good.

We undertook an unannounced focused inspection of Dorcas House on 30 November 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection in July 2017 had been made. The team inspected the service against one of the five questions we ask about services: is the service well led. This was because the service was not meeting legal requirements. This report only covers our findings in relation to this focussed inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorcas House on our website at www.cqc.org.uk.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At this inspection we found the required improvements had not all been made since July 2017. Some of the improvements we had identified as required at our previous comprehensive inspection in February 2017 were on-going. We found partial improvements had been made to meet the Warning Notice of Regulation 17. Further improvements were needed and we are considering what further action to take. The service continues to be rated as 'requires improvement', because, although some action had been taken, other actions had been planned, but not yet fully implemented.

There was a registered manager in post who was present throughout the inspection. 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 and their relatives were satisfied with the service they received however we found that the service was not consistently well led. The systems in place to assure the safety, quality and consistency of the service were not consistently effective. Checks and audits had not been effective at identifying matters that needed to improve. Despite this being brought to the attention of the registered manager at our last inspection; they had not taken timely or sufficient action to improve this aspect of the service.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 14 and 17 February 2017. During this inspection we found the provider to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service.

After our comprehensive inspection in February 2017, the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We carried out this unannounced focussed inspection on 18 July 2017 to see if the registered provider had followed their plan and to determine if they were now meeting legal requirements. This report only covers our findings in relation to this focussed inspection which looked at whether the service was ‘well-led’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorcas House on our website at www.cqc.org.uk.

Dorcas House is registered to provide personal care and accommodation for up to eleven people who live with dementia, mental health related conditions or physical disabilities. At the time of our inspection nine people were living at the home.

We undertook this announced focused inspection on 18 July 2017 to check that the provider had followed their own plans to meet the breach of regulation and legal requirements. Although the registered provider had addressed some of the concerns that we had identified at our last inspection, we found that there continued to be no effective quality assurance processes in place and this inspection identified a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance. We are considering what further action to take.

There was a registered manager in post who was present throughout the inspection. 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.

We found that whilst there were some systems in place to monitor and improve the quality and safety of the service provided, these were not always effective and did not identify if the service was consistently compliant with the regulations. The processes that had been introduced had failed to identify concerns raised at our inspection in February 2017. Records were not always robust to ensure the effective running of the home. Staff felt supported by the registered manager.

We identified that there was a continued breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We inspected this home on 14 and 17 February 2017. This was an unannounced Inspection. The home was registered to provide personal care and accommodation for up to eleven people who suffer from mental health related conditions or physical disabilities. At the time of our inspection nine people were living at the home. The service was last inspected in October 2014 and was meeting all the regulations at that time.

The registered manager was present during our inspection. 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 told us they felt safe living at the home. Staff knew what action to take in the event of a fire; however the fire risk assessment was not current. Staff knew how to report any concerns so that people were kept safe from abuse. Risk associated with people’s health conditions had been assessed. People and their relatives told us there were sufficient numbers of staff to meet their individual needs. The management of medicines was not always safe and did not always follow good practice guidelines. We recommend that the service consider current guidance and take advice on safe storage of medication and take action to update their practice accordingly.

People were supported by staff who had been provided with most of the key training they needed to safely meet people’s needs. Not all the staff who we spoke with were confident about how to comply with the principles of the Mental Capacity Act. People had a choice of nutritious meals and drinks but the dining experience needed improvement. People told us that they had regular access to a range of health care professionals which included general practitioners, diabetic nurses, dentists, options and chiropodists.

The majority of people we spoke with told us they were happy at the home and were happy with the care provided. Generally people made decisions about their daily lives. People’s privacy and dignity had not always been protected.

People’s preferences and choices about their care and support needs were sought and were known. However, people and their relatives told us they had not consistently contributed to the routine review process. Some people told us some activities of particular interest to

them were provided for them to participate in. However the activities offered on occasions were not engaging enough for all people in the home. People knew how to make complaints and the registered provider had arrangements in place so that people were listened to.

We found that whilst there were some systems in place to monitor and improve the quality and safety of the service provided, these were not always effective and did not identify if the service was consistently compliant with the regulations and failed to identify concerns raised in our inspection. People and their relatives considered the home to be well-led and the registered manager was consistently described as kind, supportive and approachable.

You can see what action we told the provider to take at the back of the full version of this report.

On the day of our inspection eight people were living at Dorcas House. We subsequently spoke to three people who used the service, the manager of the care home and two members of care staff.

People were very complimentary about care staff and the standards of care being provided. Comments included, “I like the staff, they are nice” and “Yes I like it here, the food is good.”

We examined care plans and found that people’s needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. We found that people who used the service had given their consent and were consulted about the care and support they received.

People’s privacy, dignity and independence were respected and their views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We found that care staff were suitably trained, supervised and supported to deliver care safely and to an appropriate standard.

On the day of our unannounced visit we found nine people were living at Dorcas House; one was resident on a short term basis. We subsequently spoke to two people who use the service, two of their relatives and three members of care staff.

We found the home to be clean, homely and comfortable. People were complimentary about the care staff. Comments included, “It’s good here, I like the food and the staff” and “They are pretty good to me.”

From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support and that people were treated with respect.

During our inspection we found that one person's care plan had insufficient detail about their needs and risk assessments had not been undertaken. There were few activities or outings provided for people to enjoy. We concluded that overall care and support was not delivered in a way that ensured people's safety and welfare.

Care staff did not have regular supervision or appraisal meetings with their manager and they were not always properly supported to provide appropriate levels of care to people who used the service. We also found that some members of care staff were in need of refresher training.

We saw that people were protected against the risks associated with medicines and the provider had an effective system to regularly assess and monitor the quality of service that people received.

On the day of our unannounced visit we found ten people were living at Dorcas House. We subsequently spoke to four people who use the service, two of their relatives and three members of care staff.

We found the home to be clean, homely and comfortable. People were complimentary about the care staff. Comments included, “I like it here, the staff are good to me” and “The care staff are great.”

From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

Records showed that two people had recently fallen and sustained injuries. Examination of their care plans revealed that there had not been any investigation into the circumstances of these incidents to try and prevent further occurrences. We checked other care records and could not find any documentation which indicated people's likes and dislikes and their preferences towards food and bathing. We could not find any documentation showing when and how often people were receiving personal care.

The findings of our inspection identified that overall care and support was not delivered in a way that ensured people's safety and welfare. We found that people who use services were not always involved in making decisions about their care and support. Comments included, "It would be nice to go out more often."

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

Due to the mental health conditions of people who use the service, they were not able to provide comments about the standards of care they received

We inspected this home on 7 and 10 October 2014. This was an unannounced inspection.

Dorcas House provides accommodation for a maximum of eleven people who suffer from mental health related conditions.

At our last inspection of this home in April 2014 we found some concerns with record keeping, how the provider responded to and dealt with complaints and the effectiveness of the system the provider used to check that the home was providing a good quality service. We found that improvements had been made and the regulations were being met.

There were eight people living at the home when we visited. We found that the home had a registered manager. 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.

We spoke with five people who lived at the home. They told us that they felt safe, trusted the staff and were happy with the care provided and the staff who delivered support.

We found that the home followed safe recruitment practices and had appropriate policies and procedures in place to keep people safe from harm. For example there were arrangements in place to deal with foreseeable emergencies.

People were safe and their health and welfare needs were met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. At the time of our inspection, we found that no-one was being restricted (or denied their rights) under this legislation. The manager demonstrated to us that she knew about protecting people’s rights and freedoms and how to make appropriate referrals under this legislation to keep people safe and respect their independence.

People’s health needs were met and care and support was provided by well trained staff. We saw that staff received effective support, supervision, appraisal and training which meant they had the knowledge, skills and support they needed to deliver safe and effective care.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet. We found that people living at the home had been assessed for the risks associated with poor diet and dehydration and care plans had been created for those who were identified as being at risk. Care staff told us that they were aware of people’s nutritional needs including those who needed thickened fluids or fortified foods.

People living at the home and their relatives told us that the staff were kind, considerate and caring and it was apparent to us from our observations that staff were attentive, polite and sought consent before they delivered care and support.

People’s health and care needs were assessed and care was planned and delivered in a consistent way. From the three plans of care we looked at, we found that the information and guidance provided to staff was detailed and clear. We saw that people had regular access to a range of health care professionals which included general practitioners, dentists, chiropodists and opticians. Staff showed us that they had a good knowledge and understanding of people’s care needs.

People who lived at the home told us that activities at the home were limited and they were not always able to participate in interests of their choice. Whilst checking a care plan we noted that one person had indicated a wish to attend church and participate in other outside events. However our checks showed that this person had not been supported to engage in any of the activities they had expressed an interest in. Activities did not always reflect the wishes and preferences of all the people who lived at the home.

People told us that they were encouraged to make their views known about the care, treatment and support they received at the home. The provider had achieved this by holding group meetings and sending out survey questionnaire forms on a variety of topics that were important to people who lived at the home. This meant that people had regular opportunities to provide feedback about the quality of care and support they received.

A check of records showed that the provider had an effective system to assess and monitor the quality of service that people received at the home on a regular basis and a system to manage and report accidents and incidents.