This inspection took place on 9 July 2018 and was unannounced. Our last full comprehensive inspection of this service was in November 2017. At that inspection we rated the home overall as Requires Improvement, with the key question of is the service Well Led rated as Inadequate. At that inspection there were seven breaches of legal requirements within the Safe, Effective and Well Led areas.

Following the last inspection in November 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well Led to at least Good. We also met with the provider in March 2018 to discuss the progress of this.

During this latest inspection the registered manager and provider demonstrated to us that improvements had been made and the home is no longer rated as Inadequate in any of the key questions. The provider is no longer in breach of five of the regulations that we found at our inspection in November 2017. However, the provider remains in breach of Regulations 12 and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Further improvements are needed in some areas as detailed below.

Docking House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Docking House provides personal care for up to 39 people in one adapted building. At the time of our inspection, there were 38 people living there. Docking House provides personal care to people living with a range of health conditions, including physical disabilities and people living with dementia.

The service had 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.

There were inconsistencies in people’s care records. Risks to people’s safety were assessed but information was sometimes conflicting and lacking in detail about the action staff should take to minimise them. The way in which staff were deployed, did not always ensure people that people were kept safe in line with the provider’s requirements.

People felt safe living at Docking House. Staff understood how to safeguard people from risk of abuse and were confident the registered manager would ensure any allegations of abuse were appropriately managed. Staff were trained in relevant areas, including health and safety and moving and handling. People’s medicines were managed safely. New staff working at the home had been subject to the appropriate checks before their employment began designed to check they were safe to work within care.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people. Their competency to do this effectively had been assessed however, we saw that on some occasions staff used poor practice that placed people at risk of harm and was not caring.

Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence on how to assist people who may regularly become upset or distressed. Staff also received adequate support and guidance in their roles.

Improvements had been made to the monitoring of people’s nutrition and hydration needs, but oversight of this did not always identify when people had not met their daily fluid intake target in a timely way.

Improvements had been made to the provision of activities to enhance people’s wellbeing and stimulation but was not yet delivered consistently. The provision of staffing resources to provide this had n

This inspection took place on 20 and 22 November 2017 and was unannounced.

Docking House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Docking House accommodates 39 people in one adapted building, some of whom may be living with dementia. On the day of our visit, there were 38 people living at the home.

The home 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 in November 2016, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in respect of sufficient staffing, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs and good governance. We rated the key questions of safe, effective, responsive and well-led as ‘Requires Improvement’.

We asked the provider to complete an action plan to show what they would do and by when to meet these legal requirements. They told us these would be fully met by 16 November 2016. As they told us they would be meeting these requirements at the time of this inspection, we checked to see if improvements had been made. At this inspection, we found that the required improvements had not been made and that the provider continued to be in breach of these five legal requirements.

We also found the provider to be in breach of Regulations 11, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. These relate to the need for consent, safe care and treatment fit and proper persons being employed. You can see what action we told the provider to take at the back of the full version of this report.

Risks to people's health were not always identified. Where they were identified, the service had not always taken appropriate actions to minimise the risks to people's welfare. In some cases, potential risks to people had been wrongly and inaccurately assessed.

The numbers of staff on duty and their deployment was not effective in ensuring people’s needs were met in a timely way. People often waited for their care and did not receive enough interaction and stimulation.

Staff training and checks of their competency, to ensure that they could meet the needs of people living at the home, had not been fully completed. Not all staff had supervision and development to support them in their role. New staff were allowed to work without supervision before being deemed competent to do so.

There were significant gaps in staff completing or refreshing mandatory and essential training. Some staff did not have the skills, abilities and confidence to support people living with advanced dementia.

Maintenance of the premises had been routinely undertaken and records about it were complete. Fire safety tests had been carried out and fire equipment safety-checked.

There was limited understanding and application of the Mental Capacity Act 2005 other than at a basic level. Staff did not always seek peoples consent before providing them with support. Staff did not always respect and maintain people’s dignity.

People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a high standard of care and support to people. People’s preferences had not always been identified so that staff could provide care in the way people wanted.

Complaints to the service had been managed in line with the provider’s stated procedure.

People were supported to maintain their relationships with people who mattered to them. Relative

This inspection took place on 14 and 16 November 2016 and was unannounced.

The home 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.

Docking House provides accommodation and personal care for up to 39 older people, some of whom may be living with dementia. On the day of our visit, there were 38 people living at the home.

At this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in respect of sufficient staffing, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs and good governance. You can see what action we told the provider to take at the back of the full version of this report

Staffing levels were not calculated in a way that ensured people’s care needs were taken into account. The home did not currently employ enough staff to safely care for people. Not enough action had been taken to obtain temporary staff. The registered manager was not authorised to adjust staffing levels according to the needs of the people living in the home. Staff morale was low and they were tired.

Not all staff had received training on how to provide people with safe and effective care, which resulted in staff not recognising possible abuse or reporting it. Assessment of staff’s competency had not been carried out to assess if their level of skill was adequate. Improvements were needed to ensure staff understood their role in recognising potential harm or abuse and in protecting people.

People received their medicines when they needed them, they were stored and managed safely.

Improvements were needed to ensure staff had regular supervision and support in order to reflect on their practice and develop their skills. Appropriate pre-employment checks had been carried out for new members of staff.

People were happy with the food provided and were able to make choices about what they wanted to eat. Where people were at risk of not eating or drinking enough, this was not always monitored regularly. Actions were not always taken to ensure that people had enough to eat and drink. The staff responsible for the monitoring of peoples intake of food and drink had not had their competency to do so assessed.

The registered manager ensured that people had access to appropriate healthcare. People were able to see a GP when they needed to and access support from community healthcare professionals.

People were involved in planning their care where appropriate, plans contained information about choice, routines and interests to guide staff. Risks to people had been identified and assessed to reduce and mitigate potential harm. However, plans and records had not been reviewed or updated for some time, so were at risk of containing out of date or inaccurate information.

Staff were kind and friendly towards people living at the home, people responded warmly to staff and relationships were positive. Visitors were welcomed in to the home.

Activities were provided for people, although these were not advertised and people were not told about them in advance.

The governance systems in place were not effective at assessing and identifying improvements that were needed to the quality and safety of the care that was being provided. They had not been completed recently and information that was available did not provide an accurate view of the service.

Although the environment was well maintained, not all checks to prevent cross infection were completed, which put people at risk. The service did not check for the risk associated with legionella’s disease, although had taken action to start doing this very soon.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection on 08 July 2014. This meant that the provider did not know when we were inspecting the service. At the last inspection on 05 July 2013 we found that there were no breaches in the legal requirements in the areas we looked at.

Docking House provides accommodation for up to 39 older people mostly for those living with dementia. The service is not registered to provide nursing care. On the day of the inspection there were 38 people living at the home. There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

 As not everyone in the home was able to fully communicate with us we used staff and people’s care plans to help us understand their care and support needs.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw information that best interest meetings had taken place where people lacked capacity to make decisions for themselves.

From the three care plans we looked at we saw that people had their health needs met. We discussed with the registered manager that it would be useful to provide more detail in the care plans to ensure a complete picture of people’s needs. Staff we spoke with and our observations throughout the day, showed that staff were knowledgeable of how to meet people’s needs and how they preferred to be supported.

Staff were seen to treat people with respect and preserve their dignity at all times. We saw staff knocking on people’s doors and waiting for an answer before they entered, or saying who they were as they entered the room.

There was a complaints procedure in place, although no formal complaints had been received since our last inspection in July 2013. They had a folder containing a number of compliments about the care provided at Docking House.

Records showed that appropriate pre-employment checks had been carried out to ensure that only suitable staff were employed to work with vulnerable adults.

We saw that a variety of audits were in place to assess the quality of the service that was provided. This was also done by involving people who used the service, their relatives, and health care professionals. We also saw that health and safety checks were carried out to ensure the safety of the environment for people who lived in the home.

We were not able to speak with people, however our observations confirmed that their privacy and dignity was respected. One visitor we spoke with stated they were involved in reviewing their relative’s care plan and staff members supported their relative to make decisions regarding their immediate care needs and wishes.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members.

The service had a policy and procedure to guide people in how to make a complaint but there was inadequate information about taking complaints further. We observed that staff members took people's concerns seriously, even if they were not able to easily identify the nature of the concern or resolve it.

Most of the people living in Docking House were living with dementia and were not able to tell us verbally about their experiences of the service. During our inspection on 10 April 2012 we spoke with four people who were able to discuss their views. We spent time in the communal areas of the home, observing how staff interacted with people and how care was provided. We spoke with three family carers.

We heard several positive comments about the service. People told us that they were well cared for. One person told us, "I am very happy here, it's my home." We saw that people were happy and relaxed around staff. There were staff in the lounges at all times, which meant they could provide support and reassurance to people as soon as they needed it. We saw that staff approached people in a calm and reassuring way. The three family carers we spoke with were satisfied with the care their relatives received.

We observed people's experiences during the lunchtime meal in one of the dining rooms. There were sufficient staff to provide the level of support that people needed and those who required physical assistance were offered this in a sensitive way. People we spoke with told us that they enjoyed the meals served at Docking House. We were told that the food was well cooked and the portion sizes were good.

Everyone we spoke with told us that the staff were very good. One person commented, "They are all well trained, they know what they are doing."

Many of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we were able to hold conversations with five people. A few others commented about the meals and their rooms. Some of the information about people's experiences of Docking House was gathered through our observations.

We observed that staff treated people using the service with respect and provided support in a way that promoted their dignity. One person using the service told us, "Staff are great, they are very polite."

People told us they were happy with the care they received and said that they received the care they needed. People gave us examples of how staff helped to look after their physical health. One person said, "They look after you very well when you are poorly, I couldn't ask for anything else."

Two people told us that they didn't think there were enough social activities. One person said, "I do go out sometimes with staff but there is not really any entertainment."

We asked several people about their views of the meals. Their comments were all positive. One person said, "The food is sufficient, well cooked and presented. There are limited choices but I have no complaints." Another told us, "In my opinion meals are very good; we get more than enough, I am very well satisfied." Our observations during lunch showed that not everyone had a positive experience of that particular meal because there was not enough supervision by staff.

People said that they were happy with the home and with their bedrooms. We were told that the home was kept clean and was warm enough.