This inspection took place on 19 and 28 September 2018. The first day of the inspection was unannounced. Dolphin View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Dolphin View provides care for up to 35 people. There were 34 people living in the home at the time of the inspection, some of whom were living with dementia.

When we completed our previous inspection on 8 August 2017 we found concerns relating to Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. At this inspection we found appropriate action had been taken and we have rated the service as good.

A registered manager was in post. 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 we found concerns with the safe management of medicines. At this inspection, we found the necessary improvements had been made.

Safeguarding policies were in place and staff were aware of the procedures to follow if they had any concerns of a safeguarding nature. Safe staff recruitment procedures were followed which helped to protect people from the risk of harm.

There were mixed views about the numbers of staff on duty. Some staff and visiting professionals felt staffing could be low at times, but no one had any concerns about the quality of care provided. We found suitable numbers of staff were deployed during our inspection, but we made a recommendation to keep this under close review in light of comments we received.

Infection control procedures were followed. There was some malodour from a faulty sluice during the inspection, we were notified this had been fixed immediately following our inspection.

Risks to people and environmental risks were assessed. A record of accidents and incidents was kept.

The premises needed redecoration and we received numerous comments about this. We were provided with dates of planned redecoration of communal areas following our inspection. We made a recommendation that attention to dementia friendly design features should be taken into account during planned refurbishment.

People’s needs and choices were assessed before they moved into the home.

Staff received regular training, supervision and appraisals. Competency assessments were carried out to ensure staff were competent to carry out specific tasks and nurses felt well supported to maintain their clinical skills.

People were well supported with eating and drinking, and prompt referrals were made where people had problems with swallowing or maintaining a healthy weight.

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

We observed numerous kind and caring interactions. Staff supported people to maintain their independence, privacy and dignity.

The needs of people were responded to and visiting professionals told us they received appropriate and timely referrals. End of life care was reported to be good and person-centred care plans were in place to ensure people were supported in the way they preferred.

A variety of activities were available including links with and involvement in community based activities.

A complaints procedure was in place and concerns raised by people or relatives were responded to promptly by the registered manager who was frequently described a

This inspection took place on 8 August 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Dolphin View Care Home provides care and accommodation for up to 42 people, some of whom have nursing care needs and/or dementia. On the day of our inspection there were 33 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Dolphin View Care Home was last inspected by CQC in June 2015 and was rated Good overall.

At this inspection, we identified issues with the management of medicines. For example, we found some gaps in the daily recording of medicines storage temperatures, some medicines that were time specific had not been administered at the appropriate time, advice had not been sought from the pharmacist regarding the crushing of a medicine, important information regarding ‘as required’ medicines had not been documented, medication administration records had not been consistently signed, and no records were kept for one person to show when and where topical medicines were to be applied.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The provider applied the Mental Capacity Act 2005 (MCA), including Deprivation of Liberty Safeguards (DoLS), in line with legal requirements and their responsibilities. However, some mental capacity assessments and specific decisions were not always fully recorded. People and family members told us they were involved in planning their care and had given consent, however, records did not include evidence of this consent being given. We have made a recommendation about this.

People’s dietary needs were catered for and people were offered a choice at meal times.

Care records contained evidence of people being supported during visits to and from external healthcare specialists.

People who used the service and family members were complimentary about the standard of care they received at Dolphin View Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

End of life care plans were in place for people as required, however, some records lacked specific information regarding people’s individual wishes.

Care records showed that people’s needs were assessed before they started using the service and records were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint. There had been not been any formal complaints recorded at the service for over two years.

The provider had a quality assurance process in place, however, this had not identi

We spoke with 12 people and three relatives to find out their opinions of the care and treatment at the service. One person told us, “I like being here, they look after me well.” A relative told us, “The care my mother receives is more than satisfactory.”

We were unable to speak to all of the people using the service because of the nature of their condition. We also spoke to staff and observed their practices to determine how care and support was carried out.

People were complimentary about the care and treatment and we found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. People were complimentary about the range of activities available. One person told us, “I like to do craft work and the activities lady brings me materials to encourage me.”

We found that there were suitable numbers of skilled, qualified and experienced care staff.

We found that staff received the appropriate support and training for their professional development.

Management systems were in place to identify, assess and manage risks to health, safety and welfare of people using the service and others.

We saw that people’s personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Thirty one people were using this service at the time of this inspection. We spoke with five of them about their experiences of the care and support they received. We also spoke with relatives of another two people and we spoke with the manager and six staff.

Relationships between staff and people were good. We found that staff spoke to people in a friendly and respectful manner.

People told us they were happy with the care they received. Comments included, “It’s champion (great), I cannot complain” and “If I’ve got to be anywhere, this is as good as it gets.” However, we found that care was not always planned and delivered in a way which met people’s individual needs.

We found there were suitable infection control measures in place.

Staff told us they felt supported in their work and we found there were suitable staff induction procedures in place. However, 20 per cent of staff training was overdue and staff were not receiving regular supervisions or appraisals.

People and relatives told us they would feel comfortable approaching the manager if they wished to discuss any concerns. Comments included, “Any issues have always been sorted” and “I made a complaint once to the manager, he was very good.” We found there was a complaints system in place and complaints were fully investigated.

We visited the home to check that planned improvements to the premises had been completed. We did not seek the views of people who used the service at this visit.

People spoken with were happy about the changes that were taking place since the manager had started working at the home permanently. They said they could approach the manager if they had any concerns. They said they liked the food and more activities and outings were available as an activities organiser had been employed. Some relatives were also spoken with and they were aware of the refurbishment that was taking place around the home.

The unannounced inspection took place on 2 June 2015 with a further announced day on the 3 June 2015. We last inspected the service in August 2014. At that inspection we found the service was meeting all the regulations that we inspected.

Dolphin View Care Home provides residential and nursing care for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 29 people living at the service.

The service had a new manager in post who had applied to become the 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.

Staff knew about safeguarding procedures and what to do if they had any concerns. We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations.

Medicines were generally managed appropriately, although we found the raised temperature in the medicines room needed to be addressed and we have made a recommendation.

People’s human rights were upheld and we saw evidence of this, for example the right to vote.

Risk assessments were in place and these were regularly reviewed and updated as changes occurred. The service had emergency contingency plans in place. The plans detailed what staff would do in particular emergencies. Accidents and incidents were recorded and monitored for trends and discussed at regular health and safety meetings. We found thickeners were not always stored securely and this was addressed by the manager. Thickeners are usually powders added to foods and liquids to bring them to the right consistency/texture for people with swallowing difficulties

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff had the skills and training required to adequately support the people in their care. Staff felt supported and received suitable and regular supervision and yearly appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required. We observed people consenting before support was commenced.

People told us they enjoyed the food and refreshments at the service. People received enough support if they needed it and special diets were available for the people who required them.

Access and appointments to healthcare professionals were made available to people who asked or for those who needed additional support.

People and their relatives and visitors told us staff were very caring. We observed warmth and kindness shown to people throughout our inspection.

People’s dignity, privacy and respect were maintained by staff. We saw staff being discreet and remembering to speak quietly when asking people about supporting them with personal care when in the company of others.

Care was planned and regularly reviewed to ensure it met people’s needs.

A good and varied programme of activities was available for people to choose from should they wish to participate. The home had an activity coordinator who was passionate about providing a full range of different entertainment.

We saw a copy of the provider’s complaints policy and procedure and people knew how to make a complaint if they needed to. The provider had also received many compliments about the support provided by the staff to people in their care. People had a choice of what they had to eat or what they wanted to do.

Meetings were held for people and their relatives and also for staff and all concerned had a chance to air their views and improve quality. Surveys were also completed and the provider was in the process of implementing a new system to support this.

The provider had systems and procedures in place to monitor the quality of the service provided. When issues or shortfalls were identified, corrective actions were taken.

We made one recommendation, that the provider considers best practice guidelines on storing medicines in care homes.