About the service:

Dorley House is a residential care home. The home provides personal and nursing care for up to 24 people aged 65 and over. At the time of the inspection there were 24 people living at the home, some of whom were living with dementia. The rooms are arranged over three floors with a lift to all floors. The home has several lounges including a sun lounge which opens out to the front garden and a large garden at the rear of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We undertook a comprehensive inspection on 6 November 2018 which was unannounced. This inspection was in response to information of concern that we received in relation to; people not being treated with dignity and respect, inconsistent care planning and delivery, people’s consent to care and treatment, quality monitoring, restrictive practice and poor management.

The local authority has taken action to work closely with the provider to help them improve their systems and processes to deliver safe care and treatment. The provider has taken proactive steps to introduce action plans to improve key areas of practice. Subsequent to the inspection on 6 November 2018, the provider shared their action plan with us to demonstrate how they intend to address areas of concern, their plan for improvement and their intended timescale for completion. We undertook a second day of inspection on 22 January 2019 to ensure that improvements that the provider had planned had been implemented. Whilst action has been taken to reduce risks to people and improve the level of care people receive, these action plans will need to be fully embedded to show improvements have been made and sustained. This report covers our findings from both days.

People’s experience of using this service:

•Quality assurance processes did not always identify issues in practice to effectively evaluate and monitor care delivery and drive improvements.

•People’s care plans were not always consistently reviewed and updated to ensure changes to people’s health and support needs where recorded.

•People’s consent for the use of CCTV had not been sought. We have made a recommendation about involving people in decisions about the use of CCTV.

•People’s needs had not been assessed to identify if people required specialist equipment such as plates guards to support them to eat independently.

•People were safe from the risk of abuse and staff followed the local authority’s policy and procedure to raise concerns.

•Accidents and incidents were managed and lessons learned to improve people’s care.

•The home was clean and people were protected from infection risks.

•Staffing levels met people’s needs and staff were suitable to work with people.

•People received effective care from skilled and knowledgeable staff.

•One person told us, “It’s very nice here, they look after us well.”

•People were respected as an individual, with their own social and cultural diversity, values and beliefs.

•People received kind and compassionate care.

•One person told us, “I have a good relationship with the staff; they like me and I like them. They have time for a chat If I want.”

•A range of activities were available to people to enhance their lives.

•There was a complaints procedure in place which was accessible to people and relatives.

•People’s wishes for end of life care were recorded where appropriately.

More information is in the detailed findings below.

Rating at last inspection:

Good. (The last report was published on 17 January 2018)

We inspected Dorley House Residential Care Home on 21 and 27 November 2017.

Dorley House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Dorley House Residential Care Home provides accommodation for up to 33 people. There were 25 people living at the home at the time of the inspection. People who lived at the home required a range of care and support.. Some people required support for example with personal care and moving and walking safely and some people were living with a dementia type illness. Staff provided end of life care with support from the community health care professionals but usually cared for people who needed prompting and personal care support. There was no-one at the home requiring end of life care at the time of the inspection.

This comprehensive unannounced inspection took place on 21 November 2017. A further day, 27 November 2017 was spent talking with health professionals and relatives. Dorley House was last inspected in March 2016 and was rated good. We brought this inspection forward to follow up on concerns raised and because there had been a number of safeguarding referrals. This inspection found that the service remained ‘Good’ overall

A registered manager was in post. 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 and associated Regulations about how the service is run.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However this inspection found that improvements were needed to ensure that learning from complaints and concerns were taken forward and monitored for improvement within the quality assurance systems. Not all care documentation was up to date and accurate. This included peoples’ resuscitation status and not all ‘as required’ medication was supported by a protocol.

The service continued to provide safe care. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policies to support people in taking their prescribed medicines safely. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. There were enough suitably skilled staff to meet people's needs. Staff had been recruited using safe recruitment practices.

Staff sought people's consent before providing care and people's mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguards (DoLS). A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible). People received care from staff who had received training to meet people's specific needs, and had supervision to assist them to carry out their roles. People were supported to access healthcare professionals and staff were prompt in referring people to health services when required. Staff understood people’s dietary needs and people received a balanced diet which they enjoyed. Staff had a good understanding of Equality, Diversity and Human Rights.

Staff treated people with respect and helped to maintain their dignity. People received

Dorley House provides accommodation for up to 33 people. There were 23 people living at the home at the time of the inspection. People who lived at the home required a range of care and support related. Some people required support for example with personal care and moving and walking safely and some people were living with a dementia type illness. Staff provided end of life care with support from the community health care professionals but usually cared for people who needed prompting and personal care support. There was no-one at the home requiring end of life care at the time of the inspection. People spoke well of the home and the staff. They told us they were happy living there.

There is a registered manager at the home. 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 inspection took place 22 March 2016. It was undertaken by four inspectors.

Staff knew people really well and had a good understanding of people’s individual care and support needs. They supported people to make choices, respected their right to make decisions and promoted their independence. People were looked after by staff who were kind and caring. They were treated with dignity and staff demonstrated an interest in their welfare and views. People and their relatives were involved in the development and review of care plans however these did not always reflect people’s current needs. There was an activities programme in place and people had the opportunity for social interaction with staff on a regular basis throughout each day.

There was an audit system in place which had identified the shortfalls we found throughout the inspection in relation to care plans and record keeping. There was an action plan was in place and work had commenced to address this.

Staff had a good understanding of risks associated with supporting people and what steps they should take to mitigate the risks. Nutritional assessments were in place and people were supported to eat and drink food they enjoyed. People had access to healthcare professionals which included the GP, district nurse, optician and dentist whenever they required it.

There were enough staff with the appropriate experience, skills and character employed to work at the home and to meet people’s individual care needs. Staff received on-going training and supervision to support them in their roles.

Staff communicated clearly with people in a caring and supportive manner. There was an open and relaxed atmosphere within the home, where people were encouraged to express their feelings.

Because many of the people living in the home had dementia, they were verbally unable to tell us their experiences. We used different methods to gain information. We spent time observing people’s interaction with staff and observed body language and facial expressions.

Six people that expressed an opinion told us that they were happy living in the home. Comments included. “I was not sure before I came in here but I would not want to be anywhere else now.”

Processes were in place to ensure that people were supported to make informed decisions about their care and support wherever possible and families and other professionals were involved.

Each person living in the home had a detailed plan of care that included their individual needs and wishes. The plans also recorded people’s physical and emotional healthcare needs.

The home worked with a variety of healthcare professional including district nurses and mental health teams.

The environment was homely and comfortable and people had the specialist equipment they needed to support their health and welfare needs.

Five relatives that spoke with us were positive about the care and support being provided in the home. Comments included. “The staff are wonderful, so caring and nothing is too much trouble.” Another relative said. “ It’s always open house and they are really good at keeping us involved and informed.”

We saw that complaints and concerns are taken seriously and acted upon in a timely manner.

We used a number of different methods to help us understand the experiences of people using the service because some of the people had complex needs which meant that they were not able to tell us their experience.

We observed staff supporting people living in Dorley House, we looked at documents and talked to the care staff and the manager.

People who spoke with us told us that they liked the staff very much and they were “very kind”.

The people we spoke with said they enjoyed living at Dorley House. One person said they would be ‘heartbroken’ if they had to leave. Another person said ‘I love it here’. People felt they were respected and well cared for by a good staff team. A relative of someone who lived at the home told us that staff were ‘caring and friendly’.