This inspection took place on 24 and 25 October 2018 and was unannounced. We last inspected this service in June 2016 and rated the service ‘Good’ overall. At this inspection, we identified concerns that put people at risk of poor and unsafe care. This inspection identified five breaches of the regulations and we have rated the service ‘Requires improvement’ overall.

Dove House Care Home 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. The care home accommodates up to 42 people in one adapted building. The home is also registered to provide nursing care under some circumstances, however nursing care was not provided at the time of our inspection. We were informed the provider intended to amend their registration to remove nursing care.

There was no registered manager 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. The registered manager had recently left and a new manager had joined the service just over a week before our inspection. The manager told us they intended to support ongoing improvements to the service and to register with the Commission.

Systems were not effective to ensure people would always be safeguarded from abuse. We also found people were not always supported to have their risks safely managed, including some people’s support with their medicines. We also found staff were not effectively deployed to meet all people’s needs safely. The concerns around the safety of the service resulted in three breaches of the regulations related to safeguarding processes, safe care and treatment and the deployment of staff.

Feedback from people, relatives and staff showed they generally felt the service was safe. Routine checks helped promote the health and safety of the home. Recruitment checks were in place but not always carried out robustly. People had access to healthcare support.

People’s needs were not always effectively responded to, including support with people’s meals and drinks. We received positive feedback from most relatives and healthcare professionals about the support provided by staff. Improvements were underway to the support and guidance in place for staff to ensure people’s needs were always effectively responded to. Improvements were also required to ensure people were always supported in line with the requirements of the Mental Capacity Act 2005 (MCA).

People’s privacy was promoted and we often saw friendly and caring interactions towards people from staff, however this was not consistent practice. People were not always well engaged with and involved in their care as far as possible. Improvements were also required to ensure people were consistently supported to have their dignity and respect promoted.

Although we received positive feedback in relation to most people’s care, people’s care and preferences were not always met as far as possible, including around people’s access to activities. The provider told us they were driving improvements to the service to ensure people’s wishes and preferred routines were known and followed. Systems were not robust to ensure complaints would be used and learned from to improve the quality of the service.

The provider recognised improvements were required to the quality and safety of the service and steps to achieve this were underway. Staff felt supported by management and by the new manager who had joined shortly before our inspection. The ratings from our last inspection were displayed as required.

We identified a breach of the regulations becaus

This inspection visit took place on the 7 June 2016 and was unannounced.

Dove House is registered to provide accommodation and nursing care for up to 42 older people. There were 42 people who used the service at the time of our visit. The manager told us that the home was not currently providing nursing care to anyone.

The service 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.

At our previous inspection visit on the 12 June 2015 the service was meeting the regulations that we checked but we did ask the provider to make some improvements. This was because one area of the home was not independently accessible to people with limited mobility and people needed staff support to ensure their safety was maintained. The dining experience for people required improvement to ensure people were supported to enjoy their meal in a relaxed atmosphere and improvements were needed to enhance people’s social and therapeutic opportunities. At this inspection visit we saw that improvements had been made in all areas.

We observed and were told by people and their visitors that there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to work with people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Where people were unable to make decisions, assessments were in place to demonstrate how decisions were made in their best interests. Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and were involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We inspected this service on 12 June 2015. The inspection was unannounced. At our previous inspection in September 2013, the service was meeting the regulations that we checked.

Dove House is registered to provide accommodation and nursing care for up to 42 older people. The manager told us that the home was not currently providing nursing care to anyone. There were 36 people who used the service at the time of our visit.

The home is required to have 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. There was no registered manager in post at the time of our inspection. The manager was in the process of registering with us at the time of this inspection.

Assessments were generally in place that identified risks to people’s health and safety and care plans directed staff on how to minimise the identified risks. However one area of the home was not independently accessible to people with limited mobility and people needed staff support to ensure their safety was maintained.

The dining experience for people required improvement to ensure people were supported to enjoy their meal in a relaxed atmosphere.

Staff understood people’s needs and abilities but further development was needed to enhance people’s social and therapeutic needs.

People we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Staff had all the equipment they needed to assist people. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Checks were made to confirm staff were of good character to work with people and sufficient numbers of staff were available to meet people's needs. Staff received training to make sure people’s medicines were stored, administered and disposed of safely.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People knew how to make a complaint if they needed to. They were confident that the manager would listen to them and they were sure their complaint would be fully investigated and action taken if necessary.

Arrangements were in place to assess and monitor the quality of the service, so that actions could be put in place to drive improvement. Accidents, incidents and falls were investigated and actions put in place minimise the risks of a re-occurrence. People their relatives were encouraged to share their opinions about the quality of the service.

This inspection was unannounced which meant the provider and the staff did not know we were coming. At our last inspection on 22 June 2013 we made one compliance action regarding capacity and consent. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in this area.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate how arrangements to seek people’s consent to care, support or treatment had been agreed in the person’s best interests.

The home has recently changed status and was now registered with us to provide nursing care. A new manager had been appointed.

We spoke with three staff, and three people using the service. All the comments received were positive. One member of staff said, “It is so much better, well led, the manager runs a tight ship.” A person using the service said, “I have settled in well, I like it here and the staff are very good.”

The manager had identified a number of concerns with the environment and the equipment in the home; we saw a major refurbishment was underway. This meant the manager had been responsive to people’s needs to ensure they were living in a safe, clean and well equipped home.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

Twenty four people were in residence when we undertook our inspection; the home supports people with dementia related conditions. We spoke with three people living in the home, two visitors, seven staff, a visiting healthcare professional and the deputy manager.

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a safe home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw that care was provided by skilled staff who knew the needs of people well. They felt that the management of the home was supportive and encouraging. One staff member told us, “We are well supported and work as a team.”

We checked records were stored safely and correctly and systems were as required. This was to ensure people’s confidential information was stored appropriately.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with six people using the service, a visitor, two visiting health professionals, three staff and the registered manager.

Some people using the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views we observed interaction between people and the staff. We saw staff provided sensitive support and people using the service were treated with respect.

Medication was recorded correctly to demonstrate the quantity of medicines in the service and how these had been administered. This meant people could not be confident the records matched what had been prescribed to them.

The staff told us they enjoyed working at the home. We saw that all the checks were made to ensure they were fit to do their job.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.

During the unannounced planned review in May 2011 people were satisfied with the service they received. They told us their needs were met and that they were consulted about the care they were provided with. People said they were given the opportunity to participate in activities that were of interest to them and were complimentary about the staff. The staff were considered to be helpful and easy to talk to, polite and respectful.

During the review in May 2011 we made one compliance action about cleanliness and infection control. This meant the home had to make improvements in this area. We said that people who used the service could be confident that procedures were in place to promote a clean environment but the home needed to demonstrate that its practices and procedures were meeting the standards.

During this review people who used the service told us the home was clean and tidy, visitors confirmed there were no malodours. We saw systems were in place to demonstrate how the home now managed infection control and ensured a safe and hygienic environment.

People were satisfied with the service they received and were complimentary about individual staff members. All staff were considered helpful and easy to talk to, which took away their anxieties with regard to their need for support. Comments included;

“They are kind and thoughtful.” “Yes I am happy here, the staff are good.”

People who use the service and their relatives were asked for their views on the quality of care in the home. We were told by people visiting the home that the staff were, ‘friendly and knowledgeable’ and people had confidence in their abilities. They confirmed the staff were respectful and polite. One visitor told us, “I have no worries my relative is well cared for.”

People said they enjoyed the food at Dove House Care Home. We noted there was a good variety and choice of food, the food was well cooked and nicely presented. People told us they could have meals delivered to their bedrooms if they wished and we saw examples of this during our visit.

Comments from visiting professionals included; “They are good; we receive plenty of calls from the home. They refer well and appropriately, the staff are respectful. They maintain people’s privacy and understand people’s needs well.”