Dovecote Manor is registered to provide care and support for 30 older people. The home is situated close to Southport town centre and shops and public transport are easily accessible. The home provides en-suite facilities and is equipped with aids and adaptations to assist people who may have limited mobility.

This was an unannounced inspection which took place on 16 November 2016. The service was last inspected in October 2015 and at that time we found breaches of regulations with respect to: People living in the home were not protected against the risks associated with unsafe or unsuitable premises because of inadequate safety equipment on staircases; people were not protected against the risks associated with security and confidentiality because records were not stored securely; quality assurance systems did not identify risks and omissions in care files and people’s personal preferences were not met.

Following the inspection the provider sent us an action plan which told us how the regulations would be met. This inspection was a comprehensive inspection, during which we reviewed the previous breaches. We found all of the breaches had been met and the home was operating safely.

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 found the home supported people to provide effective outcomes for their health and wellbeing. We saw there was effective referral and liaison with health care professionals when needed to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there were sufficient staff on duty to meet people’s care needs.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

We saw there were good systems in place to monitor medication safety and that nursing staff were supported with updates to help ensure their competency so that people received their medicines safely.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

We made a recommendation regarding the induction training for staff. The provider needs to develop the induction training to include the ‘Care Certificate’ which is the governments blue print for ensuring effective induction for new care staff.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the registered manager of the home.

We saw people’s dietary needs were managed with reference to individual pr

The home took account of people’s ability in terms of decision making and worked with people, their families and external professionals. This was evident in the assessments carried out before and after people moved into the home.

We spoke with six people living in the home and two relatives on the day of our visit. They spoke positively about the care provided and told us staff were 'attentive' and 'caring'.

The manager was identified as the appointed infection control lead for the home to ensure effective controls and checks were in place. The home carried out monthly audits regarding laundry, kitchen, room cleaning and infection control standards. We looked at the last two audits from June and July 2013 which indicated standards were being maintained.

People we spoke with told us that staffing levels were good and that they did not have to wait long for call bells to be answered if they needed assistance.

The home had accurate and up to date records related to the running of the home which assisted in maintaining a safe environment for people and staff to live and work in.

We spoke with six people who lived at Dovecote Manor and they were able to tell us about what it was like to live at the home and how staff provided the care and support they needed.

People who lived at Dovecote Manor told us they had been asked about their care and treatment and understood and consented to it. Three people told us that the staff had sat down with them and explained the support they needed. We were also informed that any changes made to their care and treatment were discussed with them. People we spoke with made the following comments:

“I am happy with the care I am getting”

“I was asked how I wanted to be looked after”

“I can decide if I want to see a doctor”

All the people we spoke with expressed the view that their dignity was maintained, as staff supported them well with personal care.

With regards to the menu, people told us they were offered a good choice of meals and that the chef was willing to prepare an alternative if they did not like the meal at lunch or tea time.

People we spoke with said they were able to join in with a variety of social activities and these were arranged as a group or on a ‘one to one’ basis. The activities organiser was on duty during our visit and a number of people joined in during the morning session.

Three people commented on the professionalism of the staff and the manager. We were told the staff were, “Well trained.”

People told us the home was run well. Three people commented on the good communication that existed between the staff and people who lived at the home. We were also informed that regular residents’ meetings took place and staff listened to people’s views.

A health care professional told us the manager invited them to attend meetings at the home to discuss people's care needs. They told us the meetings were arranged at the appropriate time and with consultation with family members.

We carried out an unannounced inspection of Dovecote Manor on 8 and 16 October 2015.

Dovecote Manor is registered to provide care and support for 30 older people. The home is situated close to Southport town centre and shops and public transport are easily accessible. The home provides en-suite facilities and is equipped with aids and adaptations to assist people who may have limited mobility.

A registered manager was in post at the time of 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 told us that they felt safe living at the home but raised concerns about the security of their personal belongings.

Prior to the inspection we had been made aware of concerns relating to the safety of the environment and in particular to unprotected staircases. We were escorted on a tour of the building by the registered manager and saw that some staircases did not have handrails. We also saw that people were not protected from the risk of falling down stairs by safety gates. Before the inspection was finished the provider had installed additional handrails and two safety gates.

The provider had not reviewed the risks for people living at the home as their needs changed and had not adapted the home sufficiently to minimise the risk of falls.

Medicines were managed safely but we saw that records relating to the administration of medicines was placed on top of the medicines trolley and not stored securely. Other confidential information was not always stored securely.

The content of care files was inconsistent and there was no schedule for review evident. Of the six files provided one file contained a sufficient level of detail to inform the delivery of care. Omissions were identified in the other five files including blank assessments for nutrition and capacity. This means that staff cannot be certain if the delivery of care is appropriate to meet the needs of people living at the home.

Staff communicated effectively with people living at the home and their relatives. We saw that staff spoke to people throughout the inspection to check on their wellbeing, to encourage activity and to explain what they were doing. Staff were trained in a range of topics suited to the needs of people living at the home. Staff were required to complete a programme of training and to refresh this training a minimum of every three years.

We were told that none of the people currently living at the home was subject to a Deprivation of Liberty Safeguard’s [DoLS] authorisation and that their capacity was reviewed with the involvement of family members. We saw that capacity was assessed using a generic approach. This meant that capacity in relation to specific decisions was not assessed. The files that we saw did not contain evidence of regular review of for people who lacked capacity.

The dining room was bright with tables laid appropriately with cutlery and crockery. Some cutlery and crockery was adapted to allow people with physical disabilities to eat independently. The food was well presented and looked nutritious.

People were supported to maintain good health by staff. Health checks were undertaken on a regular basis and staff were vigilant in monitoring general health and indications of pain.

Throughout the inspection we observed staff interacting with people in a manner that demonstrated care, understanding and compassion.

Staff were able to explain the importance of privacy, dignity, choice and human rights in relation to the people living at the home.

Relatives and friends were free to visit or contact the home at any time. We saw evidence of regular contact with, and visits by, relatives. Relatives spoke positively about the home and the quality of care and communication.

The delivery of care did not always respect people’s views and preferences. One person living at the home told us that they were given personal care by a male carer when they would have preferred a female.

We were told that the activities coordinator attended the home for one day each week and that that care staff provided support at other times. There was a schedule of activities which included; exercise with a ball, hairdressing, nails, looking at the papers, film and a music afternoon.

All of the people that we spoke with told us that they felt confident enough to speak directly with the staff or the manager if they had a complaint or concern.

The registered manager was highly visible throughout the inspection and was supported by senior colleagues. The registered manager was aware of the day to day operations and culture of the home. They were knowledgeable about each of the people living at the home and their care needs.

The staff that we spoke with were positive about the home and the leadership of the management team. Staff understood their duties and knew how to access support and guidance when required.

The management team and the proprietor (owner) demonstrated an understanding of their roles in leading the team and developing the location. Where areas for improvement were identified during the inspection they responded in a positive, professional and timely manner. However, the systems for monitoring the quality and safety of the service were not always effective.

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