Dorrington House (Dereham)

We found the following examples of good practice.

One to one and group activities were in place to keep people entertained and prevent the risk of social isolation. This included the use of technology, for example, enabling people to experience country walks from their beds using a hand held computer programme.

The home was visibly clean throughout. There was enhanced cleaning schedules in place, including the regular cleaning of touch points and risk areas within the home.

Staff supported people to maintain relationships with their families and implemented risk assessments and the use of the essential care giver status to meet people’s individual well-being.

Policies and processes were in place to support people being admitted to the home. Testing regimes and individualised risk assessments were in place if people were unable to self-isolate.

There were designated areas of the home for staff and visitors to enter on arrival. These areas contained personal protective equipment, and documentation to ensure where appropriate visitor’s COVID-19 vaccination status was being checked.

Improvements had been made to the service following our previous inspection in November 2017 to address concerns and breaches of Regulation. The risks to the quality and safety of the service were identified and acted on. People's records clearly identified their preferences but daily records were not always completed and needed more detail. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received. People, their relatives and staff told us the provider and managers were approachable, they felt listened to when they had any concerns or ideas.

There was enough staff on duty to enable people to remain safe and receive care in a timely way. The environment was safe and people had access to appropriate equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely. People were supported to take their medicines in a safe way, their health was well managed and staff had positive links with professionals which promoted wellbeing for them. Staff provided effective care for people which met their needs through person-centred care planning. This enabled people to achieve positive outcomes and promoted a good quality of life. People enjoyed the activities that were provided, but some felt more should be provided and felt bored at times.

Staff were kind and caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensure they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

Staff were motivated and enjoyed strong team work. The provider had implemented a programme of improvements, including the appointment of a regional manager.

More information is in Detailed Findings below:

Rating at last inspection: Requires improvement (Published 24 November 2017), at this inspection we have changed our overall rating to Good.

About the service: Dorrington House (Dereham) is a residential care home that is registered to provide accommodation and personal or nursing care to a maximum of 45 people. At the time of our inspection, 43 people were living there.

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

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 last inspection of this home in October 2015 we awarded it an overall rating of Good. At this inspection we found that not all aspects of the quality of care provided was good. Therefore, our judgement is that the overall rating for the home is now Requires Improvement. There were three breaches of regulations. These were in respect of regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some risks to people’s safety had not been adequately assessed or managed. Some prescribed creams were not secure within people’s rooms and it had not been assessed whether this was safe. Staff were not always vigilant to particular risks such as falls and therefore, did not take appropriate action to reduce the risk of harm to people.

Consent had not always been obtained in line with the Mental Capacity Act 2005. This Act states that certain steps need to be followed when a person is unable to consent to their care and treatment. There was a lack of evidence to show that all the required steps had been followed as are required.

Some of the systems the provider had in place to monitor the quality of care provided were not effective. This included ensuring people received their prescribed creams correctly and the management of some risks to the premises. Although staff had received training in a number of different subjects, the provider did not have an effective system in place to ensure staff understood this training and consistently used good practice.

People and relatives we spoke with were happy with the quality of care they received and were happy living in the home. There were enough staff working at the service to keep people safe. The provider had conducted the necessary checks about their character to make sure they were safe to work in the home, before they commenced their employment.

People received their oral medicines when they needed them. However, we were not assured that people had received their prescribed creams correctly.

Staff had a good knowledge about how to recognise abuse and were confident to report this. However, accurate and thorough information in relation to how the staff needed to support people when they became upset and/or distressed was not always in place. This meant staff had an inconsistent approach when this occurred.

People received enough to eat and drink to meet their individual needs. Where there was a concern about people not eating and drinking enough, this was monitored and acted upon. People were supported with their healthcare needs.

The environment required improving for people living with dementia so that it was more stimulating and helped them orientate themselves around it. The provider had identified this and was actively working with the local authority to make the necessary improvements.

People had access to a number of planned activities to stimulate them and improve their well-being. However, there were missed opportunities with staff not always actively engaging or distracting people which would improve this further.

People and/or relatives had been involved in making decisions about their/their family members care when they started using the service. Staff practice in respect of involving people in day to day decisions about their care was variable.

Most staff were kind and caring but some staff practice regarding treating people with dignity and respect at all times was variable. Any complaints or concerns raised by people or relatives had been acknowledged and investigated.

The provider had good links with the local community that benefited people who lived in the home. They were continuously looking for ways to improve the quality of care people received.

We have made one recommendation. This is in respect of risk assessing the premises in relation to hot surfaces in line with relevant guidance.

There was no registered manager at Dorrington House at the time of our inspection. However the provider was in the process of formalising the acting manager's position as registered manager.

The purpose of this inspection was to check that people who used the service were provided with safe and effective care that met their needs. We spoke with the manager and staff members who told us about recent improvements made in the service to meet people's needs and expectations.

We conducted this inspection to establish the following about Dorrington House, Dereham:

' Was the service safe?

' Was the service effective?

' Was the service caring?

' Was the service responsive and

' Was the service well-led?

An adult social care inspector carried out this this inspection on 21 August 2014.

As part of this inspection we spoke with four people living at the home, three family members of people living at the home, the manager, and three members of care staff. We reviewed records relating to the management of the home which included four care plans two of which were kept in the residents' rooms and the remainder in the treatment room. We also looked at staff training files.

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Was the service safe?

We found that there were not effective systems in place to reduce the risk and spread of infection. An infection control audit had taken place in July 2014. This showed some areas of potential risk which needed to be addressed. However during the inspection we identified other areas of potential risk which needed to be addressed in order to meet the Department of Health's code of practice on the prevention and control of infections.

People were able to indicate to us that they felt safe living at Dorrington House. We saw that the provider had satisfactory recruitment procedures in place. This ensured that only suitable people were employed to work with vulnerable adults.

The manager was able to tell us how they protected vulnerable adults. They told us how they responded to and reported safeguarding incidents to the relevant authorities. Staff we spoke with demonstrated knowledge of safeguarding adults and how to respond to and report safeguarding issues.

There was a system of assessing risks designed to keep people living in the home, and staff, safe from harm. Risk assessments were appropriate to people's current and changing needs.

The provider had an effective system of recording person centred information. This meant that staff relayed important information to other staff relevant to the person's care. People were provided with their medication when they needed it.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people living in care services. At the time of the inspection one person required these safeguards. Applications had been made to the appropriate authorities, although the provider had been told of a long delay in processing the submissions. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when DoLS should be implemented.

Staff understood their roles and responsibilities in making sure people were protected from the risk of abuse. The provider ensured that all staff were kept up to date with safeguarding training and accompanying reporting procedures.

There were emergency and contingency plans in place to secure and maintain the safety of people using the services and staff.

Was the service caring?

We observed that people received helpful, consistent and respectful support from care staff. One person told us, 'It's lovely here, much better than the last place.' Care and support plans were up to date and reflected the support needs of people living in the home. People we spoke with understood their care plans. They told us who they would speak to if they had any concerns.

Was the service responsive?

People's care and social needs were assessed and reviewed on a monthly basis or as and when needed. GPs, district nurses, and chiropodists were noted to input to people's care when requested. Where changes to people's needs occurred such changes were documented and recorded.

An activities and events programme was in place to entertain and stimulate people. This included games and tournaments, music for health and sing-alongs. No one was pressured to take part in activities if they did not want to.

A family member of one person living in the home told us, "It's okay I suppose, but I'm not sure we are getting the best possible care for them. Still it's relatively early days yet, so we'll see."

Was the service effective?

People using the service that we spoke with said, or indicated to us, that the care and support provided was satisfactory. There was a pre admission assessment of people's needs to ensure that the service could meet them and the provider took reasonable steps to ensure continuity of care throughout the person's stay.

People's care needs were monitored through a review system. This helped the home to meet people's expectations and needs.

One person living in the home told us that the food was, 'lovely, I enjoy it very much' Another said, 'There is plenty of choice.' When asked if they were given enough to eat people replied, 'Always."

Was the service well led?

The views of people using the service and, where possible, their families were sought by the service. Staff also had frequent opportunities to say what was going well, or not. Staff told us that they felt supported and had received sufficient training to carry out their role effectively. Staff training records reflected this. Staff added that if they felt they needed further or additional training or support, they were confident that this would be arranged by the provider. This told us that the provider took reasonable steps to keep the staff updated and trained to a high professional standard.

Quality monitoring systems were in place to ensure people received a good service and a programme of audits was scheduled.

People's personal care records, and other records kept in the home, were kept safe and filed appropriately and securely.

Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.

Before people received any care they were asked for their consent. People told us how staff knocked on their doors and gave them time to answer before they went in. We heard staff asking people if they wanted any assistance with their meals or if they wanted some help when moving around the home. Where people were unable to consent decisions were made in people's best interests with mental capacity assessments made if necessary.

Communication books in people's rooms allowed staff and visitors to communicate with each other. These books included messages left by staff for relatives requesting further toiletries as well as messages of appreciation and queries left by relatives. This was a good system which enhanced relationships between the home and people's visitors.

The food was universally popular with people we spoke with living at Dorrington House. We observed a lunch time and found that the service was well paced. Those who needed support and encouragement received it.

We reviewed staff records and found that appropriate checking systems were in place to ensure that staff were suitable for their role upon recruitment.

Our last inspection in November 2012 identified heaters that presented a risk of scalding. These had all now been replaced or made safe.

The care plan folders containing the documents for each person were written clearly and were focussed on the individual with person centred details telling us the support the person required.

Although we found the home clean and tidy we expressed concerns regarding the uncovered heaters in the home that were too hot to touch. A risk was identified and action needs to take place to reduce/remove the risk. The home was not compliant for the safety and suitability of premises.

The staff in the home were suitably trained and supervised to ensure they could carry out their job safely and correctly.

We found that complaints were acted upon appropriately and that people and their relatives were listened to and that action was taken when concerns were mentioned.