Dolphin View Care Home

Updated 7 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Act.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Dolphin View Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post. The home manager was planning to apply to register with CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with 7 people, 10 relatives and 7 staff, including the home manager, supporting manager and care staff. We contacted 5 external professionals via telephone and email.

We observed interactions between staff and people, including at lunchtime. We reviewed a range of records. This included 4 people's care records and medicines records. We reviewed a variety of records relating to the management of the service, including policies and procedures, investigations, training records.

Updated 7 February 2024

About the service

Dolphin View Care Home is registered to provide accommodation, nursing and personal care to a maximum of 35 older people, including people who live with dementia. The service was across two floors, with a range of communal and outdoor space. At the time of the inspection, there were 27 people living at the home.

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

People were not always kept safe because not all risk assessments were in place or up to date. Some observations, key to ensuring people remained safe, had not always been recorded. Staff demonstrated a good understanding of the risks people faced and how to reduce them.

Governance and audit systems and processes were not always effective in identified areas for improvement. When actions were identified they had not always been completed.

Lessons learned and updates to staff were not always shared effectively or consistently. Opportunities for practice improvement had therefore been missed. Delegation of responsibilities to staff and empowering them through specific responsibilities, such as champion roles, had not yet happened. We have made a recommendation about this.

Medicines administration and the storage of medicines had improved.

The culture had not always been open, with multiple staff experiencing a lack of support under the previous registered manager. At the time of inspection the new home manager had made a positive impact on the culture. They were more open, accessible and supportive. People, relatives, staff and external professionals all commented on this improvement in the culture. The provider planned to move the manager’s office from the entrance to the building into a room inside the care setting. They committed to continuing these cultural improvements by supporting the new manager with sufficient supernumerary time to gain oversight of the service and make the necessary improvements.

Staffing levels had improved since our last inspection. The provider was less reliant on agency staff and sickness levels had reduced. Staff morale had improved in the time the home manager had been at the service. Staff needed more support and upskilling from the provider. We have made a recommendation about this.

Staff worked well with a range of external health and social care professionals to ensure people got the right care and treatment. Clinicians had confidence in the ability and knowledge of staff, although recognised communication was an area to improve.

Care planning was not as person-centred as it needed to be and information was at times difficult to locate and to read. The provider recognised this and was prioritising a review of care planning information, as well as bringing forward the rollout of an electronic care records system. We have made a recommendation about this.

Activities had improved recently and there was a range of positive feedback in this area. The service had made some positive initial links with local organisations and groups.

People were supported to have maximum choice and control of their lives and to live in the least restrictive way possible and in their best interests; policies and systems in the service supported this practice. Where improvements were required to practice, the home manager and supporting manager were responsive.

People felt safe and supported. Staff regularly checked on people’s wellbeing and call bells were answered promptly. Relatives had confidence in the ability of staff to safely look after their loved ones.

The environment was clean and well maintained. There was a refurbishment plan in place to ensure the dining room and other areas were improved in early 2024.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 April 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made, however further issues found, meant the provider was still in breach of regulation 17 good governance. They were also found to be in breach of regulation 12 regarding risk assessments.

At our last inspection we recommended that staffing levels be kept under review, that systems were in place to provide activities and that people were promoted to be involved in daily decision making. At this inspection we found recommendations had been addressed and there were improvements in staffing and activities.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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

The overall rating for the service remains requires improvement based on the findings of this inspection. This service has been rated requires improvement for the last three consecutive inspections. We have met with the provider to discuss this and to encourage improvement at the next inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach of regulations in relation to safe care and treatment, and good governance. We have made recommendations regarding the provider’s approach to lessons learned, the detail in care planning, and their use of champions.

Follow up

We have requested regular updates from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.