About the service: Dovercourt House Residential Care Home provides personal care for up to 27 older people, including people living with dementia. At the time of the inspection 22 people lived in the service.

What life is like for people using this service:

¿ Risks associated with people’s environment, health and wellbeing were not always being identified and acted on.

¿ People did not live in an environment that was well maintained. We have recommended that the environment is made more dementia friendly.

¿ There was not always enough staff on duty to monitor people’s needs and provide personalised care.

¿ People and their relatives were not always involved in making decisions about their care.

¿ Care records did not always provide enough information to support personalised, safe care and show what people had consented to.

¿ People were not sufficiently supported to take part in activities or pursue interests, to enhance their wellbeing.

¿ People said staff were friendly, that they could enjoy exchanging banter and having a laugh. Their visitors felt welcome.

¿ Staff supported people in a compassionate, dignified and engaging way which provided positive experiences for people.

¿ The service was not well led and systems were not in place to ensure that people received care that met their needs.

Rating at last inspection: Requires Improvement (Report published 23 November 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

The inspection took place over two days: 17 August 2017 which was unannounced, and 21 August 2017, which was announced. Dovercourt House Residential Care Home is providing accommodation and personal care for up to 27 older people. People who use the service may also be living with mental health needs, a physical disability or dementia. At the time of our inspection there were 21 people living in the service.

This was the first rating inspection under the service’s new provider who registered with the Commission on the 2 September 2016.

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.

The quality assurance systems were not robust enough to independently identify and address shortfalls. The leadership team were working to improve systems and develop the service. However this needed further time to be embedded.

Risks to people’s health and well-being were not fully explored and therefore opportunities were missed to reduce the chance of potential harm. This included risks associated with people’s health and welfare deteriorating, environment, fire safety, medicines and evacuation plans.

The service had a process for the safe recruitment of staff and had recognised the need to recruit to activities posts and someone other than care staff to do laundry. In addition they were planning to increase the management structure to help effective oversight.

Although training had improved and more had been made available to staff, further development was needed to ensure staff had the right skills and competency. This included supporting people living with dementia and ageing process.

People were not always treated with dignity and respect due to practices in the service. Care was not always person centred to meet their needs. We have made a recommendation to support the service to improve this area.

People’s care plans did not always provide clear guidance for staff on meeting people’s needs. This included promoting independence and having access to stimulating occupation / actives, linked to latest research.

The quality assurance audits were not sufficiently robust to ensure that people received a service which met their needs and protected their safety.

Although improvements had been made to the service’s medication systems, further development was needed to ensure accurate, person centred records were being completed. This include the use of ‘when required’ medicines, to support staff in monitoring when they should be used, and their effectiveness.

The service worked closely with relevant health care professionals. Generally, people received the support they needed to have a healthy diet that met their individual needs. However improvements were needed in staff’s awareness of how to support people with low appetite, and in promoting fluids to support wellbeing.

Although staff skills and knowledge needed improvement, people were positive about staff and the leadership team. People and their relatives were able to raise concerns and give their views and opinions and these were listened to and acted upon.

We found breaches in the Health and Social care Act. You can see what action we told the provider to take at the back of the full version of the report.