We carried out this comprehensive inspection of Dovedale Court on 25 and 28 September 2018. The inspection was unannounced on the first day but announced on the second.

Dovedale Court is a 'care home'. People in care homes receive accommodation and 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. Dovedale Court also provides nursing care to some people that live there.

Dovedale Court was built for purpose, and consists of two floors, with the nursing unit based on the first floor, and dementia unit on the ground. There is also a variety of internal and external communal space people can access if wished. Dovedale Court is registered to accommodate 76 people. There were 68 people living at the home when we inspected.

The service provides personal care with nursing where assessed as needed to predominately older people, although can accommodate younger adults. The service can also accommodate people with dementia.

The service had a registered manager who was present during our inspection. 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.

Our last inspection report for Dovedale Court was published on 02 September 2017 at which point we rated the service as ‘Requires improvement’ overall. At this latest inspection we found the provider had made improvements and the service and the overall rating is now ‘Good’.

People were protected as any risks to their well-being were identified understood by and followed by staff. People were kept safe as there was sufficient staff to respond to their needs. There were some concerns that the nurse workload was at time difficult but the provider was pro-actively exploring ways to manage this. Staff knew how to recognise, and report abuse. People received their medicines as required. People were protected as appropriate checks were completed on staff before they commenced work.

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People’s consent was sought by staff, with any restrictions to promote safety managed in accordance with the law. 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. People were supported by trained staff, and the provider was planning further training to maximise staff skills and knowledge. People had access to community healthcare services as needed. People had access to a range of meals and drinks that gave them choice, and met with any health requirements.

People were supported by kind, caring staff and respectful staff. People could have their privacy and their independence was promoted. People could maintain friendships and contact with families, and when needed had access to advocates.

People were involved in assessments and care plans that reflected their needs, wishes, preferences and advance wishes. Care plans were understood by staff who knew people’s needs and personal preferences. People had access to a range of leisure opportunities if wished, that stimulated them. People and relatives knew how to complain and were confident they would have a response from the provider.

People and relatives had confidence that they or their loved ones would receive a good standard of care. The provider had systems to allow them to monitor and improve the service as well as ensure potential risks were well managed. People’s views were sought by the provider and these were acted upon. Most staff felt well supported by the management team. The provider understood their legal responsibilities and how to maintain a current knowledge of any changes in the law or social

Our inspection was unannounced and took place on 24 July 2017.

At our last inspection in June 2015 the service was rated as good in four of the five questions we ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? And requires improvement for the remaining question; Is the service well-led? This was because the provider had not notified us and the local authority of incidents where they should have done. At this inspection we found that those specific issues had been addressed but some new issues were evident regarding protecting people from harm, medicine safety and a lack of a registered manager for a long duration. As a result the questions; Is the service safe? and Is the service well-led? have been rated as requires improvement.

The provider is registered to accommodate and deliver nursing and personal care to a maximum of 76 people. At the time of our inspection 71 people lived at the home. People who lived there were elderly and had needs associated with old age and dementia.

The manager was present on the day. They told us that they had only commenced work at the home two weeks previously. 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.

Processes were not always followed by staff to prevent people from the risk of harm and abuse. Medicine systems, although improved, needed to be strengthened to further enhance safety. Staffing levels needed to be reassessed to give assurance that people’s needs could be met. Recruitment systems prevented unsuitable staff being employed. People felt safe and action had been taken to promote safety.

Induction processes were in place to provide new staff with the knowledge they needed to provide appropriate support to people. Staff confirmed that they were adequately supported in their job roles. However, one to one formal sessions had been lacking but were being addressed by the new manager. People received care in line with their best interests and processes were in place to ensure they were not restricted unlawfully. People were offered and supported to have the food and drink that they enjoyed.

Staff and people who lived at the home had a positive relationship. Staff were friendly and polite to people. People were enabled and encouraged to make everyday choices and were supported to maintain their independence skills. People’s dignity, privacy and independence were promoted and maintained by staff

People needs were reviewed regularly to ensure that they could be met. A complaints system was available for people and their relatives to use if they had the need. Activities were available for people to engage in.

There was an unacceptable duration of time when there was no registered manager in post. People knew who the new manager was. The new manager was visible within the service. Quality monitoring processes, the use of provider feedback forms and meetings helped to ensure that service was being run in the best interests of the people who lived there.

No-one knew we would be visiting that day as our inspection was unannounced. Our inspection team consisted of an inspection manager, an inspector and an expert by experience. On the day of our inspection 71 people lived at Dovedale Court.

The day following our inspection we received some alleged concerns regarding care and quality of life issues. We have forwarded these concerns to the registered provider to investigate and provide us with a written report of their findings.

During our inspection we spoke with ten people who lived there, seven relatives, ten staff members (including a member of night staff) and the registered manager. All people and their relatives we spoke with were very complimentary about the overall service and the care that was provided. One person said, “It is very good. I am happy here” Another person told us, “I am looked after well”. A relative said, “It is excellent. They are well looked after and are safe”. Another relative said, “They have been in other homes before so I can compare. This one is the best yet. I cannot say a bad thing about it”.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Staff knew about Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.

We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies.

We identified that equipment required was available and that it was serviced regularly to ensure that it was safe.

We found that instructions had been produced for each person if there was a fire or emergency. However, they did not capture all risks that may present if that circumstance were to arise, for example a risk of wandering and falling or getting lost.

Is the service effective?

All people, relatives and staff we spoke with told us that people who lived there were safe and well cared for which gave assurance that an effective service was provided.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The majority of care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received support from senior staff to ensure they carried out their role effectively. Staff we spoke with told us that they felt well supported.

People told us they could make choices about their food and drink. We saw people were provided with a choice of food and refreshments and given support to eat and drink where this was needed.

Arrangements were in place to request heath, social and medical support to help keep people well.

We found that although, audit processes were in place these needed to be improved upon to ensure that all shortfalls for example, some record keeping, were identified and corrective action was taken to improve.

Some aspects of record keeping were not effective. Records we looked at did not highlight all people's needs and risks.

Is the service caring?

We found that care and support was provided with kindness and compassion. All people and relatives we spoke with were very positive about the staff. One person told us, “The are all kind”. A relative told us, “This is a good home. The staff care about the people here very much”.

The staff knew of people's care and support needs which ensured that individual personal care was provided in a way that people preferred.

Is the service responsive?

We found that meetings were held to enable people and relatives to raise any issues they wanted to. This showed that the provider was willing to listen to the views of the people who lived there.

When people became unsettled the staff noticed this and acted appropriately to defuse the situation.

We found that the provider had taken note of our previous concerns and had learnt from past experiences. For example, changes had been made to the environment to make it safer and ensure that people’s needs were better met.

Is the service well led?

A registered manager was in post which meant that the provider was complying with the law, as it is a requirement to have a registered manager and consistency and familiarity was provided.

The staff were confident that they could raise any concern about poor practice at the home and it would be addressed to ensure people were protected from harm.

Staff were generally organised to ensure people’s needs were met and support was available for activities.

No one knew we would be inspecting that day as our inspection was unannounced.

Sixty eight people lived at Dovedale Court on the day of our inspection. The premises were divided into three units. There was one unit on the ground floor providing dementia care and two units on the first floor providing nursing care.

During our inspection we spoke with eleven people who lived there, seven relatives, seven staff and the registered manager. People and their relatives were generally happy with the service that was provided. One person said, “I am happy here”. Another person told us, “It is nice here and the staff are kind”. A relative said, “Overall I am happy with the care provided”. One staff member said, “I think that people are well looked after”. However, relatives did raise some issues with us for example, bedroom redecoration needs and an incident that had occurred the Friday before our inspection. The registered manager assured us that they had started to investigate that issue.

People who lived there had complex needs and were not able to tell us about the experiences of the care and support that they received. To address that, during our inspection we used different methods to help us understand people’s experiences, including observation. We observed interactions between staff and people who used the service.

We found that overall people were treated with respect and that staff supported people where possible to be independent and to make some choices.

We determined that some people's needs had been assessed by health care professionals including dieticians and specialist doctors. However, we found that care planning and care actions did not always ensure that people’s needs were met or that they were safe. We also found that on our inspection day activity provision was not adequate to support people’s individual dementia and support needs.

We found that processes were in place to safeguard people from the risk of harm and abuse.

We saw that recruitment processes ensured that staff employed were suitable and safe to work with the people who lived there. This protected people who lived there from the risk of harm and abuse.

We found that some systems were in place aimed to ensure that the home was run in the best interests of the people who used it.

On the day of our visit there were seventy-six people living at the home. No one knew we would be visiting. We spoke to eight people who lived at the home, five relatives, four staff, and the manager.

The people who lived at the home had dementia and nursing care needs. People told us about their experiences, we looked at records and observed staff caring for them. One person told us ‘’the staff are alright, they see to us.’’

Staff we spoke to was able to tell us about people's needs so that they received care in a way that they preferred. Relatives told us they were kept informed about their relative's health so they felt involved in their care. One relative said ‘’any concerns staff call me to discuss the issue and make sure I’m happy with what they are doing.’’

We saw that systems were in place to ensure people receive nutritional meals according to their needs. A relative told us ‘’Since X has been there X has put weight on because they enjoy the food.’’

We spoke with eight people who used the service, two visitors, seven members of staff and the manager.

We spent time sitting in the lounge areas in the three units observing how staff and people got on with one another. Staff were chatting with people, encouraging and supporting them with their chosen activity.

We saw that some people were unable to verbally communicate but they were able to indicate either by smiling or nodding when asked how they were. We saw by observing people’s body language that they appeared comfortable, well cared for and well nourished.

People we did speak with told us they were satisfied with the staff, the care they received and their accommodation. Visitors told us they had regular discussions with staff about the care being provided.

People told us that they enjoyed the food and they had enough to eat and drink. One person told us that they liked to go into the dining room at mealtimes as they liked to meet up with their friends. We saw staff supported people with their meal when help was needed.

We saw a group of people participated in a religious service. They appeared to be enjoying this as we heard them singing along to the hymns. Other people declined when asked if they wished to attend.

Visitors and people who used the service told us the staff were attentive and did not have to wait long periods for assistance when they needed help. Staff told us of the recent improvement with dividing the nursing unit into two. They felt that they now had more time to give to people and didn’t feel so rushed when they attended to care needs. Staff told us they felt the staffing levels were sufficient to meet the needs of the current occupants.

People who used the service told us the staff were all very good at their job and looked after them “very well”. Staff told us of the training opportunities that had taken place in 2011, with more planned for this coming year.

The provider is registered to accommodate and deliver nursing and personal care to 76 people. People who lived there are elderly and some may have needs associated with dementia.

Our inspection was unannounced and took place on 1 and 8 June 2015. At the time of our inspection 64 people lived there.

At our last inspection in 2014 the provider was not meeting one of the regulations that we assessed which related to record keeping. During this inspection we found that although some improvements had been made concerning the specific issues at that time another non reporting of an incident had occurred.

The manager was registered with us as is required by law. 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 and their relatives told us that staffing levels were adequate to meet people’s needs.

We found that staff were trained to support the people who lived there effectively and safely. Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

Staff knew what to do to ensure the risk of harm to people was prevented and that people received care and support in a safe way.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

Staff supported people with their nutrition and health care needs. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered. Systems were in place for people and their relatives to raise their concerns or complaints.

People were encouraged and supported to engage in recreational activities which they enjoyed. Staff supported people to keep in contact with their family as this was important to them.

People were encouraged and supported by staff to be independent and attend to their own personal care needs when they could.

All people received assessment and treatment when needed from a range of health care professionals including their GP, specialist consultants and nurses which helped to promote their health and well-being.

People and relatives we spoke with were all positive about the quality of service. The management of the service was stable. A number of processes were used to monitor the quality of the service provided. However, we found that some attention was needed regarding medicine management systems and the notifying of us and the local authority of incidents that occur.