Dovedale Court

Dovedale Court provides accommodation for persons who require nursing or personal care or treatment of diseases, disorder or injury. The service can provide support for up to 32 people, including older people, younger adults and those living with dementia. At the time of our inspection, there were 31 people using the service.

The property is set over 2 floors with lift access to the upper floor. There were several communal areas and a large rear garden for people to enjoy. Aids and adaptions were in place to meet people’s individual needs.

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

Systems and processes kept people safe from abuse and medicines were managed safely. Detailed care records and risk assessments provided staff with information about people’s needs. Staff deployment was effective; we received feedback about consistency at the home and the positive impact this had on people. A relative said, “The staff know [person] so well and understand their needs, this helps keep [person] safe. They are so well looked after.” Another added, “[Person’s] needs are varied but staff have a good understanding of [person] and how to give them the best quality of life possible.” Several people on the upper floor could display heightened behaviours but these were managed by a knowledgeable and well-trained team. The home was clean and well maintained. Appropriate safety checks were carried out on premises and equipment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider and registered manager maintained good standards. One relative told us, “The home appears to be moving forward. The registered manager seems to be making changes in both the care and the environment.” There were robust systems to respond to incidents and accidents, and monitor the quality and safety of care. Action was taken to drive improvement. We received feedback that communication was good, and the registered manager was approachable and responsive to concerns. The provider engaged people, their relatives or staff and promoted good outcomes. Staff worked hard as a team, and they spoke about their colleagues positively; morale was high. A staff member said, “It’s such a good place to work, I love that we all work together as a team. Everyone supports each other.”

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

Rating at last inspection

The last rating for this service was good (published 3 March 2022).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dovedale Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dovedale Court is a nursing and residential care home, providing accommodation for adults who may be living with a dementia, and/or a physical disability. The home provides accommodation for up to 32 adults requiring help with personal and nursing care. The home is divided into two units. There were 31 people living at the home at the time of our inspection.

We found the following examples of good practice.

The home facilitated face to face visits, in line with government guidance. The manager told us this was essential to help support people's psychological and emotional well-being. Alternatives to in-person visitation, such as virtual visits, were also supported.

A ‘booking in’ procedure was in place for all types of visitors to the home including, a health questionnaire and evidence of a negative lateral flow test. This helped prevent visitors spreading infection on entering the premises.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

Infection control policies and audits were in place to ensure the home reflected best practice and current guidance.

Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection.

Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE. However, during the visit we observed staff were not consistently following the correct use of PPE such as face masks. This included not wearing masks when supporting people or pulling them down. We signposted the service to the local Infection Prevention and Control at the local authority for additional support and guidance and asked the management to take immediate action to provide the staff with refresher IPC training. They took immediate action

The home had adequate supplies of appropriate PPE.

The manager maintained links with external health professionals to enable people to receive the care and intervention they needed. Virtual consultations took place as and when necessary.

Dovedale Court is located in Ingol, a residential area of Preston. A bus link to Preston town centre is nearby. The home provides accommodation for up to 32 adults requiring help with personal and nursing care. The home is divided into two units. The Tessymann unit is a dedicated nursing unit for people with complex mental health needs and is based on the first floor. On the ground floor is the Memory Lane Unit which is residential care. There are separate secure gardens available for both units of the home to the rear. When we inspected there were 31 people living at the home.

The home is registered to provide accommodation for persons who require nursing or personal care. There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

During our last inspection, we found risks were not always managed and addressed. While the Tessymann unit had systems to manage and lessen the risk, we found systems on the Memory Lane unit did not always meet the needs of all people who lived on the unit. During this inspection, we looked at how risks to people were being managed. We found people were protected from risks associated with their care because the registered manager had completed risk assessments, which provided updated guidance for staff to keep people safe.

During the last inspection we made a recommendation the registered provider worked within good practice guidelines to develop a dementia friendly environment. During this inspection we looked at the premises and found it was suitable for the care and support provided.

During our last inspection at the home, we found there were concerns around record keeping we made a recommendation around this. During this inspection we reviewed the records and found improvements had been made.

People who lived at Dovedale Court told us they felt safe and supported by staff and the management team.

We looked at how reporting of safeguarding incidents were being managed and found people were protected from the risk of abuse because staff understood how to identify and report them.

We looked at how accidents and incidents were being managed. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.

We checked whether the home was working within the principles of the Mental Capacity Act (MCA). We found mental capacity had been considered and written consent to various aspects of care and treatment was observed on people's files.

We checked care records and saw these were written in a person centred way. Staff took note of the records and provided personalised care.

We found there were quality monitoring systems to help drive up improvements in the home. This helped to ensure people were living in a safe environment.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had carried out checks. This was done to ensure staff had the required knowledge and skills, and were of good character before they were employed at the home.

We found the home was pro-active in supporting people to have sufficient nutrition and hydration. People said the quality of the food was good. One person said, “The meat is tender and tasty.” Care plans showed where appropriate, the staff had made referrals to health care professionals such as the community nursing team and GP's.

People received care which was relevant to their needs and effective because they were supported by an established staff team. The staff had received appropriate training and had a good understanding of people’s needs.

We received consistent positive feedback about the care provided at Dovedale Court from people who lived at the home and their relatives. We observed staff as they went about their duties and provided care and support during this inspection visit. Staff understood the needs of people they supported and it was apparent trusting relationships had been created.

The registered manager and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

People were supported and encouraged to take part in activities, these were provided by the care staff and included one to one time and singing.

People were encouraged to raise any concerns or complaints. The home had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

The registered manager kept up to date with current good practice guidelines by attending meetings at which they shared learning and discussed new developments in care. We found the management team receptive to feedback and keen to improve the home. The registered manager worked with us in a positive manner and provided all the information we requested.

Dovedale Court is located in Ingol, a residential area of Preston. A bus link to Preston town centre is nearby. The home provides accommodation for up to 32 adults requiring help with personal and nursing care. The home is divided into two units. The Tessymann unit is a dedicated nursing unit for people with complex mental health needs and is based on the first floor. On the ground floor is the Memory Lane Unit which is residential care. There are separate secure gardens available for both units of the home to the rear.

There was not a registered manager in place. 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 spoke with the regional director about the arrangements for ensuring there was a registered manager at the home. They advised us a manager had been recruited and had started the registration process with the Commission. We looked upon our information system which confirmed this. The manager was unavailable at the time of the inspection visit as they were completing their induction at another Barchester Healthcare Homes limited home.

The service was last inspected on 15 May 2014. At this inspection we identified no concerns and found the service was meeting all standards we assessed.

At this comprehensive inspection visit carried out on 06 and 07 October 2016, we received positive feedback from people who lived at the home and relatives. Staff were described as kind, caring and hard working.

Although people told us they felt safe we found risks were not consistently managed and addressed. Whilst the Tessymann unit had systems in place to manage and mitigate risk, we found systems in place on the Memory Lane unit did not consistently meet the needs of all people who lived on the unit. This placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014.

Observations of interactions between staff and people who lived at the home demonstrated people were happy and content. On the days of the inspection visit, we observed staff offering comfort to people who were upset.

People told us they were supported to remain busy with activities if they wished. We observed the activities coordinator carrying out activities taking place on the first day of our inspection visit.

We received mixed feedback about staffing levels. Staff on the Tessymann unit told us staffing levels enabled them to meet the needs of the people who lived on the unit. Staff on the ground floor unit told us they were busy and could not always meet people’s needs in a timely manner. We found deployment of staff on the ground floor was not always sufficient to meet people’s needs.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required. We noted organisational policy was not always followed on the Memory Lane unit, which resulted in one person not having a care plan developed in the required time. We have made a recommendation about this.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. Consent was gained wherever appropriate.

Suitable arrangements were in place for managing and administering medicines. Records were concise and complete and medicines were secured in line with current guidance. Regular audits of medicines took place.

Suitable recruitment procedures were in place to ensure people employed to work at the home were of a satisfactory standard for working with vulnerable people.

People who lived at the home and relatives praised the quality of food on offer. There was a variety of food choices on offer at the time of the inspection visit.

Staff had received training in The Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) We saw evidence these principles were put into practice when delivering care.

Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

There was a training and development plan in place for all staff. We saw evidence staff had been provided with relevant training to enable them to carry out their role. Staff praised the training opportunities provided by the registered provider. Staff told us they received supervisions and appraisals as a means for self-development.

The service was supported by a senior management team employed by Barchester Healthcare Homes Limited. The management team had worked closely with the service during the transition of managers. Staff spoke highly of the management team and the support provided to enable the service to run smoothly.

The service had systems in place for on-going monitoring of the quality of service. Senior managers audited the service every two months to ensure quality and safety. Monthly audits of care records and health and safety audits took place.

Staff told us the home was a good place to work. They told us staff received praise and recognition for hard work and commitment. We saw evidence staff and teams had been nominated for awards both internally and externally.

The service had implemented a range of quality assurance systems to monitor the quality and effectiveness of the service provided. Feedback was positive.

You can see what action we have asked the provider to take at the back of the main body of the report.

At the time of our inspection the manager had applied and was going through the registration process. The home was registered to accommodate 32 people and currently had three vacancies.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, and their relatives, care staff, the manager and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with who used the service told us they felt well looked after.

People told us that the staff were kind and responsive to their needs. Pre- admission assessments had been carried out by senior staff and care plans contained sufficient information to ensure staff had the correct information to provide safe and effective care.

Safeguarding procedures were in place and staff understood how to protect people they supported. People we saw were not being put at unnecessary risk and where possible, they (or their relatives) were able to make decisions about the care and support provided.

Is the service effective?

We observed staff interacted with people who used the service and saw that staff met people's needs in a friendly and relaxed manner. Relatives we spoke with told us they were satisfied with the care provided and they would recommend the service to others.

The health and personal care needs of people who used the service had been thoroughly assessed.

We saw that people who used the service had been involved in the care planning process. We also saw evidence that people and their relatives had been involved in reviews of care planning and risk assessments.

Is the service caring?

We spoke with eight people who used the service and four relatives. We asked about the care they or their relative received. Feedback was all positive. People told us staff were kind and caring towards them and relatives we spoke with had nothing but praise for the home and the staff.

Throughout our time at the home we observed staff treated people with dignity and respect. People who used the service were offered choices and care was provided in a relaxed and calm manner.

When we spoke with staff it was clear that they genuinely cared for the people they supported and they were observed speaking with people in a respectful and friendly manner.

We looked at care files for people who used the service and found that information was recorded in a person centred way. Risk assessments were in place and files contained sufficient information for staff to meet the needs of people who used the service.

Is the service responsive?

We observed that staff responded to people well by anticipating their needs appropriately.

We saw from records that where people's circumstances changed, risk assessments and written plans of care were reviewed and amended if necessary. Where people were at particular risk, professional advice was sought and incorporated into plans of care.

Is the service well-led?

Where shortfalls or concerns were raised these were acted upon by the service. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

We found that service had effective monitoring systems in place so the quality of service provided could be reviewed and if necessary changed.

Relatives told us that they were asked for their opinion on the service at virtually every visit.

Audit systems were in place to check the safety and quality of the service provided. All equipment was regularly serviced and tested.

Staff we spoke with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the manager.

We found robust recruitment procedures had been adopted by the home and those living at Dovedale Court looked comfortable in the presence of staff members. People we spoke with were very complimentary about the staff team and the manager of the home. The environment was, in general clean and hygienic. Methods for monitoring the quality of service provided had been established. Systems had been developed, in order to protect the health and safety of those living at the home.

Comments from those living at the home and their relatives included:

"The staff are very nice with me."

"This place is A1."

"I am quite content here. It is very homely and comfortable."

"As far as homes go, this one is just fine. I am happy with the care my mum receives."

"This is the best place ever."

During our inspection we assessed standards relating to care and welfare and how people consented to the care and treatment they received. We also looked at recruitment practices, infection control and monitoring the quality of service provision. We did not identify any concerns in any of the outcome areas we assessed.