This inspection took place on 6 January 2017 and was unannounced. On our previous inspection in July 2016 we found improvements were needed with how people were supported to make decisions. On this inspection we found improvements had been made. When people were not able to make decisions for themselves; capacity assessments had been completed and decisions about their care and support were made in their best interests. Where restrictions had been identified; applications to restrict people of their liberty had been made to ensure this was lawful.

Dover Cottage provides residential care for up to 15 older people, some of whom may be living with dementia. There were eight people living in the home at the time of our inspection.

The service does not 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. The current manager of the service is completing an application to register with us.

Quality assurance systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement. However improvements were needed with how medicines were audited to ensure there was an accurate record of all medicines kept in the home.

People were protected from abuse as staff knew how to identify harm and were confident about how to raise any concerns. Potential risks to individuals were identified and staff supported people in a safe manner. There were enough staff to meet people’s needs and staff were recruited in a safe way.

Staff had received training so that people’s care and support needs were met. People had sufficient to eat and drink to maintain their health and there was a choice of food and drink at each mealtime.

People were treated in a kind and caring way, and their dignity and privacy was promoted and respected. Relatives were also encouraged to be involved with the planning and review of people’s care. Staff knew people well and supported them to take part in activities and follow their interests.

People knew how to raise any issues or complaints and were encouraged to share their experiences of the service and felt their views were listened to.

This inspection took place on 7 July 2016 and was unannounced. At our last inspection in December 2015 we identified concerns with how people were supported to keep well and how people’s privacy and dignity was maintained; we rated this service as Requires Improvement. On this inspection we saw that improvements had been made.

Dover Cottage Rest Home is registered to provide residential care for up to 15 older people. Following the concerns we identified during our inspection visit in September 2015, we issued a condition on the provider’s registration to prevent further admissions into the home. This meant on the day of our inspection visit seven people were using the service. As a result of the improvements demonstrated by the provider at this inspection, we will remove this condition.

There was a registered manager in post, although they were no longer working within the service. 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 a new manager who had submitted an application to us to become the new registered manager.

People were able to make decisions and chose how to spend their time. Where people needed support to make some important decisions, these had been made by people who may not have the authority to make these.

Staff understood their role in protecting people and knew how to identify potential harm and assess risks. There were a sufficient number of suitably recruited staff to provide care to people. Staff were provided with training and support to enhance their skills and knowledge to improve people’s care.

People were supported to eat and drink what they liked and chose what to eat at each meal. People’s health and wellbeing was monitored and the support of healthcare professionals was sought whenever specialist advice was required. People received their prescribed medicines to keep them well.

People were treated with kindness and compassion by staff who knew them well. We saw that people’s privacy and dignity was respected and people were called by their preferred name. People were confident that staff supported them in the way they wanted. People had opportunities to socialise together and stayed in touch with people who were important to them. Visitors could come to the home at any time.

People were involved in developing their care plan and discussed what was important to them. People’s care and support was reviewed and their care records were updated to ensure they received consistent, safe care.

People knew how to make complaints. They were confident that the staff and registered manager would respond to any concern and they could approach them at any time. Complaints were managed in line with the provider’s complaints procedure and people were informed of any investigation and actions.

We found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on the 14 December 2015. At our last unannounced inspection in July 2015 multiple regulatory breaches were identified and the service was judged to be 'Inadequate' and placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing

inadequate care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care

and work with, or signpost to, other organisations in

the system to ensure improvements are made.

• Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek

to take further action, for example cancel their

registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted.

We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement. At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

There was a new manager in post, however they had not yet registered with CQC. 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's medicines were not always managed safely and the guidance for staff to follow on the administration of 'as required' medicines was not clear.

People's right to privacy and their dignity was not always respected

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The manager had made referrals for further investigation when they had suspected abuse had taken place.

People were supported to be as independent as they were able to be by staff that knew them well and the following of people's risk assessments.

There were enough suitably qualified staff who had been recruited using safe procedures available to maintain people's safety and to support people in hobbies and activities of their choice.

The provider was working within the guidelines of the Mental Capacity Act 2005. The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people's best interests where they are unable to do this for themselves. People's capacity had been assessed and staff knew how to support people in a way that was in their best interest and was the least restrictive.

People and their representatives were involved in decisions relating to their care, treatment and support. Care was planned and delivered based on people's preferences and regularly reviewed with people.

People were supported to have a healthy diet dependent on their assessed individual needs. People were given choices and asked what they would like to eat and drink.

People had access to a range of health professionals and staff supported people to attend health appointments when necessary.

Staff felt supported to fulfil their role effectively through regular support, supervision and training applicable to their role.

The provider had put systems in place to monitor the quality of the service and an on-going improvement plan. Further improvements were required to ensure people's needs were met in a dignified manner.

This inspection took place on 23 July 2015 and was unannounced. Dover Cottage Rest Home provides residential care for up to 15 older people. There were 11 people using the service at the time of the inspection some of whom were living with dementia.

There was a manager in post; however they were not yet registered with us to manage Dover Cottage Rest 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.

People were not protected from the risk of abuse and people had been abused by other people who used the service. Incidents were not identified as potential abuse; they were not reported or investigated.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed to ensure the risk of harm was reduced.

People were not always able to have their prescribed medicines when they needed them because there were insufficient numbers of trained staff.

The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so and the DoLS ensures that people are not unlawfully restricted.

People did not always receive medical support and interventions in a timely way to ensure their health and well-being.

Staff had a good knowledge of people’s individual care needs. Risk assessments and care plans did not reflect the current support and care needs of people.

People told us they were happy and they liked the staff. People’s privacy was upheld and respected, however people’s rights were not upheld.

People’s care was not personalised and did not reflect their individual needs and preferences. Most people were disengaged and spent long periods of time with little or no stimulation.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. Poor care was not being identified and rectified by the provider.

We found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

When we inspected Dover Cottage Rest Home, we found the home to be clean, warm and homely. Twelve people were living there. Each person had dementia and some people had additional disabilities. We saw that people’s privacy, dignity and independence were respected.

We saw that care plans provided clear guidance for care workers to follow when caring for people. Staff were kind, well-trained and experienced. Family members who were visiting their relatives told they were very happy with the care their relatives received. One family member described the home as, “Brilliant” and told us that staff, “Deserved medals” because of the patience they showed with people.

We found that staff had received safeguarding training and understood their responsibilities to protect people from harm. There were no safeguarding concerns about Dover Cottage when we made our inspection.

The service provider operated a safe recruitment policy and followed disciplinary processes where appropriate to ensure that staff employed were fit to work as care workers.

We found that appropriate records were maintained in respect of the people who lived at Dover Cottage and the people who worked there. Documents relating to the management of the service were well-organised. All records were stored securely and appropriately.

We went to Dover Cottage rest home in January 2013 to follow up a report we had received that the heating had broken down in December 2012. We had initially responded to the information on the day we received it. We had contacted Dover Cottage during the early evening and we asked the staff who were on duty to check temperatures. Care workers told us that the temperatures that evening were 18 degrees in two of the bedrooms they checked and 20 degrees in the lounges. They told us that a heating engineer had made adjustments to the heating system that day and that at the time of our call, the heating was working as it should be.

When we made our unannounced visit to Dover Cottage, we measured the temperatures around the home. We found these to be between 20 degrees and 28 degrees. The atmosphere in the home was cosy and comfortable. We asked some people if we might touch their hands. We found that people had warm hands.

We will make a further visit to Dover Cottage to follow up record keeping at the home, which we had found to be non-compliant when we inspected the home in October 2012 and to follow up other matters which have been brought to our attention.

When we inspected Dover Cottage Rest Home, we saw that people’s dignity and privacy were respected. Care plans provided clear guidance for care workers to follow when caring for people. Staff were kind, well-trained and experienced. They understood people’s needs and there were enough staff on duty to meet people’s needs. Family members who were visiting their relatives told us they were very happy with the care their relatives received. One family member described the home as, “Absolutely fantastic”.

Staff were committed to ensuring the safety of the people they cared for. They had received safeguarding training and understood their responsibilities.

There were some quality assurance measures in place to minimise risk to people. We found that some documents relating to people’s care and to the management of the home had not been filed. This meant that some information was difficult to find.