Doveridge Care Home

We found the following examples of good practice:

Staff had received infection control training and followed up to date infection prevention and control guidance to help people stay safe. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people. Staff and people were regularly tested in line with the government's current testing programme. Staff supported people with social distancing and frequent handwashing to protect against Covid 19. The home was clean and well maintained. Cleaning records showed increased cleaning of frequent touch points such as door handles and light switches.

All visitors were screened for any signs or symptoms of COVID 19 and underwent Covid 19 testing prior to their visit. Staff supported safe practise and made sure all visitors were screened and they wore the appropriate Personal Protective Equipment (PPE). When visitors were restricted, staff supported people to keep in touch with their families. Key workers helped people send loved one's messages via email with photographs, so they could see what each person has been doing. Feedback from families showed they loved receiving these which offered them comfort and reassurance. The registered manager kept people and families up to date with the current situation through regular emails and phone calls.

Staff found individual ways to support relatives to stay in touch. For example, the partner of a person who lived at the home was recruited as a volunteer, so they could safely spend more time with their loved one and support others. Where a relative could not visit because of risks of using public transport, staff took the person to go where their relative lived and arranged a socially distanced visit in the transport bus.

Staff had made adaptations to support effective communication with people because of wearing masks. For example, by speaking more slowly and clearly. They had also taught people simple sign language, for example, to say 'I love you' during visits or video calls with family. To support people's mental and physical wellbeing and prevent isolation, two additional activity co-ordinators had been recruited. This meant people had extra support with small group and one to one activities to meet their individual needs. Also, people who wished to could go out regularly.

Staff said they felt valued and that management support, teamwork and communication was excellent. Due to restricted space for staff breaks, the provider had installed a very comfortable 'pod' in the garden with a coffee machine that staff could use individually to have a break and catch up on record keeping. Staff comments included "Doveridge is doing a fantastic job," "The care here is brilliant" and "Staff are looked after really well, the team has coped incredibly well and supported one another."

Doveridge is a residential care home providing personal care for up to 20 older people who may be living with dementia. The home provides accommodation in one adapted building. At the time of the inspection there were 19 people living there.

People’s experience of using this service and what we found

People and their relatives were overwhelmingly positive about the care they received. A relative told us, “I think this place is amazing. Nothing is too much trouble. The staff are so kind. I can’t praise it highly enough”. People told us they felt safe and there were enough staff to meet their needs. Staff were safely recruited and given suitable training. Care was taken to ensure people received their medicines safely.

There was a stable, happy and competent staff team. Staff told us they were well supported by the management team and by their colleagues. A member of staff told us, “I have such a pride in my job”. Some staff had been appointed as ‘ambassadors’ specialising in topics such as palliative care, nutrition and diabetes. They carried out research and shared their knowledge with the rest of the staff team.

There was a strong emphasis on supporting people to stay healthy. There was a focus on healthy eating and maintaining safe fluid levels. A person told us, “The food is good here and we get choices of what we can have”. Staff knew each person well and were passionate about ensuring people received the best possible care. People’s needs were carefully assessed before they moved into the home and a plan of their care needs was drawn up and agreed with them. Risks to their health and safety were understood and well managed. The environment has been decorated, furnished and equipped to meet the needs of the people living there.

People were involved and consulted about all aspects of the service. Their views were welcomed, and suggestions acted upon. People knew how to make a complaint and were confident any concerns or grumbles would be listened to and addressed. Staff were determined to make people’s lives as happy and fulfilling as possible. They found out about the things people enjoyed, and they helped each person draw up a ‘wish list’ of the things they wanted to do. Two activities organisers were employed who provided a wide range of activities and outings to suit each person’s individual interests and abilities

People, visitors and staff praised the management team and told us the home was well-run. A person said “The manager listens to me and she does what she says she will. She is kind and caring and very easy to talk to”. The provider, management team and staff constantly looked for ways of improving care for people. There were systems in place to regularly check all aspects of the service and make sure people received a safe and effective service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: the service was previously inspected on 30 August and 1 September 2016 when the service was rated as Outstanding.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

People, relatives and professionals consistently told us about the excellent care they received from well trained staff with the knowledge and skills of staff, which had a positive impact on people’s health and wellbeing. People received effective care by staff who understood the needs of people living with dementia. The provider promoted best evidence based practice through the use of lead roles, called ‘Ambassador roles.’ Staff had ambassador roles for dementia, dignity, safeguarding, epilepsy, nutrition, diabetes as well as palliative and end of life care. Ambassadors undertook additional training and shared their knowledge within the team through championing and raising awareness in their topic area.

People’s independence and wellbeing had been enhanced by improvements made in the internal and external environment of the home. Staff took account of best practice evidence to make the environment of care more ‘dementia friendly’ and further improvements were underway. The home was decorated in themed colours with toilet/bathroom areas clearly identified by their colour and signage, which helped people navigate their way independently around the home. A new covered pergola had been built in the courtyard garden and planted with a sensory planting scheme. Great care and thought had been given to how to adapt this space to make it suitable for people living with dementia, in order to stimulate and encourage them to use the space and minimise restrictions on their freedom.

The service purchased sensory glasses to help train staff in innovative ways to help them understand people’s experiences of how visual impairment affected their perceptions. In response, staff identified more personalised ways to support each person with a visual impairment, for example, by providing coloured, rather than white crockery which for some people, helped them to see their food more easily and made their dining experience more positive. People with cognitive difficulties and conditions such as arthritis had specialised cutlery and crockery, which enabled them to eat and drink independently.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. People were treated with dignity and respect and with compassion. Staff knew each person as an individual, people mattered, they were patient, and demonstrated empathy in their conversations with people and in how they spoke about them. They were exceptionally kind and made time for each person, there were lots of hugs and kisses. A staff member held a person’s hand, and offered people a reassuring touch, hug or kiss when they looked sad or bewildered. Staff forged strong relationships through music and singing, which was an everyday part of life at the home.

Staff had signed up to the national ‘Dignity in care’ initiative and they were committed to upholding the ten good practice steps to demonstrate compassion and respect for people. Empathy dolls were used to promote nurturing and bring comfort to people. People received exemplary end of life care in line with national best practice guidance and were kept peaceful, comfortable and pain free. A relative wrote, ‘We were able to stay in mum's room with her until the end. The kindness and care were exceptional. A better place I will never know.’

People received personalised care which was holistic and individualised, staff put them first and knew each person well, such as what made a good day for them. People were relaxed and comfortable with staff who were attuned to their needs. Staff could recognise from their non-verbal cues such as gestures and body language, and they responded appropriately. There was a relaxed, calm and happy atmosphere at the home with lots of smiles, good humour, fun and gestures of affection. Staff spoke with pride about the people they cared for and celebrated their achievements.

Care was focused on people’s wishes and preferences and people were supported to remain active and independent. Staff went that extra mile for people, for example, on the day we visited, a person’s key worker came in on their day off to accompany the person for a dental procedure. The person had a developed a special bond with them, and trusted them and the staff member had prepared them well by doing several ‘dry runs’ in preparation. The service used the ‘Living well through activity’ toolkit to find ideas and suggestions about activities people would enjoy. Staff organised a trip to a RAF museum in response to a chance remark they made about their war experiences and that meant so much to the person. Another person, who previously had an allotment, had their own mini greenhouse growing runner beans and staff sourced equipment to help another person be able to put on their own socks when they experienced difficulties. People were supported to maintain links with the local community were known in local shops and cafes. Staff supported a person to continue go to their local exercise class and hairdresser, organised a men’s curry and beer pub night regularly and several people enjoyed attending the local ‘Memory café’ each week.

People, relatives and professionals spoke about the exceptional quality of care provided at Doveridge Care Home. Visiting professionals spoke about the ‘can do’ attitude of staff at the home, excellent leadership and team working. The service had received a top 20 care home award from the care homes association for the past two years for their caring ethos. The average review score of 9.9 (maximum of 10) was based on 19 reviews/recommendations over the past two years, all of whom were ‘Extremely likely’ to recommend the home to others.

People received a consistently high standard of care because staff were led by an experienced, and proactive registered manager. The staff team were highly motivated and enthusiastic, and committed to ensuring each person had a good quality of life. There was a clear management structure in place, staff understood their roles and responsibilities and were accountable. The home was organised and well run and the culture was open and honest. Staff told us about excellent teamwork, support and effective communication between staff, they felt supported and valued for their work. Senior staff acted as role models to support staff to achieve high standards of care and The provider had a range of well- established quality monitoring systems, and made continuous improvements in response to people’s feedback, the findings of audits, and in response to accidents and incidents.

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. People said they felt safe living at the home. Staff knew the signs of abuse and how to report concerns; any concerns reported were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had a written complaints process. Any concerns or complaints were investigated with actions identified to make improvements. All record systems relevant to the running of the service were well organised and reviewed regularly. The registered manager had notified the Care Quality Commission (CQC) about significant events. We used this information to monitor the service and ensure they responded appropriately to keep people safe.

Visitors told us that they were made to feel comfortable and welcome whenever they visited. Relatives commented that "The staff are sympathetic to (my relative's) needs" and "The staff are nice here, that makes a tremendous difference." Frequent comments from everyone we spoke with was that the care home had a "homely" feel, one relative commenting that they "...even swopped recipes with the cook."

People's rooms reflected their interests and appeared clean and comfortable. There were a range of communal areas for people to sit in, though we noticed that most people who were ambient chose to congregate in the conservatory that also served as a walk way. From there people could observe the comings and goings of the home

We spoke to six staff and asked them about the needs of people who lived at the home. The staff we spoke with demonstrated a high regard for people and had good knowledge of each person's care needs and preferences and how to meet those needs. Staff undertook regular training and updating appropriate to the needs of the people living at the home. Everyone we spoke with confirmed they felt safe living at the home. We observed how people were treated with dignity and respect and there was lots of warmth, fun and laughter throughout the day.

We found the home was compliant with the five essential standards we inspected.