Dorrington House Watton provides accommodation and personal care for up to 52 older people, some of whom may be living with dementia. There were 50 people living in the home on the day of our inspection.

This inspection took place on 13 and 14 September 2016 and was unannounced on both days.

A registered manager was in post at the time of 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.

During our inspection of the home in August 2015, we found that the provider was in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in respect of sufficient staffing, meeting nutritional and hydration needs, dignity and respect and good governance.

Following the inspection in August 2015, the provider sent us a plan to tell us about the actions they were going to take to meet the above regulations.

At this inspection we found that improvements had been made and the provider was no longer in breach of the regulations.

The home had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager knew how to report any safeguarding concerns to the appropriate local authority if necessary.

The home followed safe recruitment practices to ensure only suitable staff were employed to work with people who lived at the home. The home had ensured risks to individuals had been assessed and measures put in place to minimise such risks.

Caring relationships had been built between people and staff. Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. Where people needed support in order to make their own day to day decisions this was provided by staff. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

People were looked after by kind staff that treated them with respect and dignity. They and their relatives were given opportunities to be involved in the setting up and review of people's individual care plans.

Staff were kind and caring and treated people with respect. Staff knew people's likes and dislikes which helped them provide individualised care for people.

People were supported to maintain a balanced diet. Records of support provided with nutrition were not always in place to show that this care had been delivered.

People felt supported by the service manager. Management processes and audits were in place. People and their relatives were involved in their care assessments and care plan reviews. The manager was supported by senior staff, including a deputy manager. People and staff told us the home was well run and that the manager was approachable.

Our observations showed us that staff assisted people to understand the choices available to them and that they were provided with the care, support and attention they required.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people were well cared for and that staff were very kind and knew how to care for people living with dementia.

Medication was administered, recorded and stored accurately and safely.

People told us that the home was a comfortable place to live and that they liked living there.

Staff members were trained and were supported to provide an appropriate standard of care and support through regular supervision and staff team meetings.

People told us that their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We spoke with people who used the service and their relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They were provided with a choice of suitable and nutritious food and drink.

People using the service and relatives told us that people received the care and support they needed but that sometimes there were not as many staff available.

We spoke to six people who use the service when we visited the home and two of them commented in detail about their experiences of using the service.

One of them recently moved into the home and explained her admission process. She said that she visited the place before the admission. She did not particularly like it as it was too noisy after her bungalow. She explained that she did not have a choice as she could not manage on her own and her daughter insisted and helped her move in.

She then stated that the place now seems lovely, she met other people and liked the company. She said that staff were excellent, played games with her and that the “girls are lovely and nothing is too much for them. “

She continued and stated that she liked her room and had all she needed there. She stated that she could get up when she wanted, or stay in her room if she wanted.

She told us that her daughter sorted all aspects around the contract and that she was happy with it.

When we asked about written records, she explained that they asked both her and her daughter about her needs and risks and that she knew what is written down in her care plan.

She told us that staff were excellent and they already knew her, although she had only been in the home for only three days.

Having the chance to mix with others and to be in the company of others is something that she did not expect to go so well, she said.

She stated that she was happy for staff to keep her medication and that she knew how to complain, but did not have any complaints “whatsoever.”

Another person who spoke in detail to us was using oxygen equipment. He was brought in a wheelchair by a staff member. After checking him and the equipment the staff left to help others and he then spoke to us. He said to us: “I could not go a minute without my oxygen machine. Staff are excellent, they are always ready to help. They are busy, but always respond when someone calls them. Staff check my machine and arrange to change the mouthpiece when necessary and change my oxygen bottle regularly. If someone gets unwell they call a doctor. They are really very good, indeed.”

He explained his medication and showed to us that he knew what tablets were for and how to take them, but added that he was happy for staff to administer his medication.

He commented that the home was very clean and explained what happened if someone drops something: “Staff always clean everything, they are on top of that.”

He was very happy with food and also explained about choices and how people with special dietary needs get food appropriate to their diet.

He told us that staff always listens to him and talks to him about his care and anything else he had to say.

He considered that there were enough staff covering each shift and explained that when someone calls in sick, it does not take long to find someone else to step in. In his opinion staff were very well organised, trained and knew what they were doing.

He said: “If we want anything, the manager would come, listen to us, and will sort it in minutes.”

This was an unannounced inspection carried out on 19 and 20 August 2015.

Dorrington House (Watton) provides accommodation for up to 52 people who need personal care. The service provides care for older people most of whom live with dementia. There were 44 people living in the service at the time of our inspection.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

We last inspected Dorrington House (Watton) on 28 and 30 October 2014. At that inspection we found the registered persons were not meeting all the regulations that we assessed. This was because there were shortfalls in the way medicines were stored and dispensed. After the inspection the registered persons told us that these shortfalls had been addressed. At this inspection we reviewed what steps the registered persons had taken to put things right and we found that the breach had been addressed. However, we noted that further improvements still needed to be made to the way in which medicines were managed.

At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not enough staff on duty to enable people to promptly receive all of the care they needed. In addition, the arrangements made to support people to eat and drink enough were not robust. Another problem involved people not being offered the opportunity to pursue their hobbies and interests. These shortfalls had not been identified and resolved because quality checks had not been rigorous and effective. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the back of the full version of this report.

Staff (care workers) knew how to recognise and report any concerns so that people were kept safe from harm. People were helped to avoid having accidents and background checks had been completed before new staff were appointed.

Staff had not received all of the training and guidance they needed to assist people in the right way. Although people had benefited from seeing a range of healthcare professionals, the service had not always provided people with the support they needed to keep their skin healthy. Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. The safeguards protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had asked the local authority to review most of the people living in the service to ensure that their rights were being protected.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received a wide range of practical assistance including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and they were being supported to celebrate their diversity. There was a system for resolving complaints.

People had not been effectively consulted about the development of the service and they had not benefited from staff receiving good practice guidance. The service was run in an open and inclusive way that encouraged staff to raise any concerns they had.