CQC report explained · a residential care home
What the CQC found at Dothan House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- The building, staffing, recruitment, safeguarding and risk assessments were generally safe. However, some medicines had been given but the records were incomplete, and the audits had not identified the errors.
- Effective?
- Good
- Staff had suitable training and supervision. People received support with nutrition, healthcare and their individual health needs, and the home worked with health professionals.
- Caring?
- Good
- People and relatives described staff as caring, respectful and compassionate. Staff supported privacy, dignity, independence and people's choices.
- Responsive?
- Good
- Care plans reflected people's needs, preferences, interests and beliefs. The home offered activities, supported communication and responded to complaints within its stated timescales.
- Well-led?
- Good
- Management had made improvements since the previous inspection and staff felt supported. Quality checks were in place, although medicines audits had not found the recording errors identified by inspectors.
What inspectors found, January 2020
Rated Good overall; inspectors found kind, effective care, but medicines recording was not always safe.
This was an unannounced inspection on 26 November 2019. The inspector spoke with people living in the home, relatives and staff. They also reviewed care plans, recruitment files, training records, medicines records, complaints, incidents and audits.
The home had improved since the previous inspection in October 2018. The building and equipment were safer, staffing levels were suitable, and risks to people's health and mobility were assessed more consistently. Staff were trained and people received support with their health, food, communication and daily choices.
Inspectors found staff to be caring and respectful. People had personalised care plans, activities and support to maintain relationships. Complaints were handled within the home's stated timescales, and management systems had improved.
The overall rating was Good. However, Safe remained Requires Improvement because some medicines had been given but not recorded. The home was no longer in breach of regulations from the previous inspection, but inspectors recommended stronger medicines recording and auditing.
Improved safety
Electrical faults identified at the previous inspection had been repaired. Fire safety, equipment servicing and personal evacuation plans were in place.
“Enough improvement had been made at this inspection and the provider was no longer in breach of Regulation 15.” from the report
Suitable staffing
Inspectors saw enough staff on duty and people were not left isolated or alone. Recruitment checks were completed before staff started.
“We observed that people were not left isolated or alone and there was always staff present.” from the report
Kind and respectful care
Staff asked about people's choices, protected their privacy and supported them to remain as independent as possible.
“We observed staff asking people politely about their choices and respecting their wishes.” from the report
Personalised support and activities
Care plans recorded people's interests, preferences, life histories and beliefs. The home offered activities such as music therapy, arts and crafts, reminiscence and outings.
“There was a programme of meaningful activities for people to participate in that were relevant to people's needs and interests.” from the report
Improved management
The home had improved its management systems since the previous inspection. People, relatives and staff had confidence in the management team.
“At this inspection, this key question has improved to good. This meant the service was consistently managed and well-led.” from the report
Incomplete medicines records
seriousSome medicines had been given but staff had not recorded this. This could create a risk that a person received more than the prescribed dose.
“This meant there was risk of a person taking more than the prescribed dose of medicine because staff had not recorded they had already been administered.” from the report
Audits missed errors
needs fixingWeekly medicines audits had not identified the missing entries. Inspectors recommended more robust recording and auditing so errors are found sooner.
“We recommend the provider seeks best practice guidance on medicine administration, recording and auditing to ensure medicine errors are identified.” from the report
- 01What changes have been made to medicines recording and auditing since the inspection?
- 02How are missing or incorrect medicines entries identified during handovers and checks?
- 03What action is taken, and who is informed, if a medicines recording error is found?
- 04How will you make sure there are enough staff if agency staff are needed?
- 05How will my relative's communication needs, preferences and activities be recorded and kept up to date?
This was an unannounced planned inspection based on the previous rating and covered all five CQC questions. This explanation was written from the published report of 9 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2018
Rated Requires Improvement and now out of Special Measures; inspectors found much safer, kinder care but continued safety, training and management shortfalls.
This was a comprehensive inspection on 23 and 24 October 2018. It was unannounced on the first day and announced on the second. Inspectors spoke with people, relatives, staff and managers, and reviewed care records, medicines, staff files, complaints and safety checks.
The home had improved since its February 2018 inspection, when it was rated Inadequate and placed in Special Measures. Fire safety, staffing, recruitment, safeguarding, medicines and care planning had improved. People were treated with dignity and respect, and the care was rated Good for Caring and Responsive.
However, electrical repairs had not all been completed after an unsatisfactory safety check. Risk assessments, fluid records, medicines administration, Mental Capacity Act records, staff training and quality checks were not always reliable. The home was therefore rated Requires Improvement overall and for Safe, Effective and Well-led.
The home is no longer in Special Measures. The report says the provider had two breaches of regulations and was required to take action.
Improvement since the last inspection
The home had made significant progress from its previous Inadequate rating. It was no longer in Special Measures and none of the five key questions was rated Inadequate.
“During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions.” from the report
Kind and respectful care
Inspectors saw staff supporting people respectfully and protecting their privacy. People and relatives spoke positively about the care.
“People were treated with respect and dignity by staff.” from the report
Enough staff
Staffing levels had improved since the previous inspection. Inspectors found enough staff to support people, and staff were not rushed.
“There were enough staff available to provide care and support to people.” from the report
More personal care planning
Care plans included people's histories, preferences, routines and support needs. They were reviewed monthly and updated when people's needs changed.
“Care plans were reviewed monthly and updated to reflect people's changing needs when they occurred.” from the report
Fire safety
The home had completed fire safety improvements and regular evacuation checks. The London Fire Brigade was satisfied with the fire safety arrangements.
“The London Fire Brigade carried out a fire safety inspection of the home in Sept 2018 and were satisfied with the home's fire safety procedures and mechanisms.” from the report
Unfinished electrical repairs
seriousAn electrical safety report judged the installation unsatisfactory, with dangerous and potentially dangerous items. Repairs had still not all been completed seven months later, creating a potential risk of accident or injury.
“This meant that by not completing the repairs that had been identified on the electric safety report in March 2018, the building and premises was not fully safe.” from the report
Incomplete risk assessments
needs fixingSome people's known health risks, including diabetes, strokes and arthritis, did not have consistent risk assessments or clear guidance for staff.
“This meant that risk assessments were not always robust to ensure all risks to people were known and what guidance staff should follow to reduce the risk.” from the report
Medicines not always given correctly
seriousOne medicine was not given according to the manufacturer's instructions, and another type of tablet was crushed even though it should not be crushed. The report says staff did not always have correct information.
“This meant that staff were not always given correct information to administer medicines safely.” from the report
Mental Capacity Act records
needs fixingSome capacity assessments were incomplete or out of date. Best interest meetings and signatures were missing in some cases.
“However, we found some shortfalls with MCA assessments because there was not a consistent approach.” from the report
Fluid monitoring
needs fixingFluid charts for two people at risk of dehydration did not show recommended amounts over several days. The records did not clearly show whether people were getting enough fluids.
“This meant the charts were not fully accurate to determine if people were meeting the recommended daily amount of fluids.” from the report
Quality checks missed problems
seriousAudits and management checks did not identify all the issues found by inspectors. The website also still did not show the latest CQC rating, which was a continued registration breach.
“This did not always identify shortfalls such as the issues we found during our inspection.” from the report
- 01Have all the electrical works identified in the March 2018 safety report now been completed, and can we see the completion evidence?
- 02How do you check that every person's health risks, including diabetes, strokes or arthritis, have a current risk assessment?
- 03How do you make sure medicines are given in the correct form and according to the manufacturer's instructions?
- 04How are Mental Capacity Act assessments and best interest decisions recorded, signed and reviewed?
- 05How do you record and act on fluid intake when someone is at risk of dehydration?
This was a comprehensive inspection covering all five key questions, following an Inadequate rating and Special Measures placement at the February 2018 inspection. This explanation was written from the published report of 7 December 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Dothan House
4 rated inspections over 3 years: the service has held its Good rating throughout.
- January 2020Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 7 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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