CQC report explained · a residential care home
What the CQC found at Dovecote Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, February 2023
Dovecote Residential and Nursing Home is rated Requires Improvement; inspectors found kind care but serious problems with staffing, medicines, care planning and management.
Inspectors visited unannounced on 8 and 9 November and 22 December 2022. They reviewed care and medicine records, recruitment files and management records. They spoke with people, relatives, staff and health professionals, and observed care in communal areas.
The home was not always safe or effective. There were not enough suitably qualified staff, agency staff were not always safely recruited or inducted, and people sometimes waited a long time for help. Medicines were not always recorded or given as prescribed. Infection control practices also needed improvement.
Care plans did not always contain the right information or reflect people's needs. People had too few activities and limited social interaction. Inspectors also found weak management oversight and incomplete records. The home was rated Good for Caring, but Requires Improvement overall and for Safe, Effective, Responsive and Well-led.
Kind and respectful staff
Permanent staff were described as kind and caring. Inspectors saw staff asking people about their choices and supporting privacy and dignity.
“The staff are kind and caring, the regular staff. They talk to them nicely.” from the report
Good mealtime experience
People were offered varied meals and supported to maintain a balanced diet. Inspectors saw a relaxed and happy atmosphere in the dining rooms.
“People were provided with a varied diet that supported them to maintain a balanced diet.” from the report
Choice and decision-making
People were supported to make choices about their care. Capacity assessments were reviewed and staff had training about mental capacity and liberty safeguards.
“People's capacity was reviewed regularly, and new assessments updated to reflect a change in support needs or decision making.” from the report
Complaints were usually recorded
The home had a complaints policy and records showed that formal complaints were logged, answered and used for learning.
“Records of complaints showed that any formal complaints were logged, responded to and lessons learned to improve the quality of care provided.” from the report
Staffing and agency workers
seriousThere were not enough suitably qualified staff. People sometimes waited a long time for help, and some agency staff had not been safely recruited or inducted.
“There were not enough suitably qualified staff available to support people.” from the report
Medicines
seriousRecords did not always show that creams, ointments and patches were given correctly. Inspectors could not be assured that some medicines had been administered as prescribed.
“We could not be assured people receiving topical medicines, for example creams and ointments, were receiving these as prescribed.” from the report
Care plans and risk information
seriousCare plans contained missing or conflicting information and did not always guide staff properly. Some risks had not been fully identified or reviewed.
“Care plans lacked detail around the choices and needs of the individual person.” from the report
Infection control
seriousSome areas needed cleaning, PPE was not always worn correctly and creams were not always stored safely. Inspectors also found that a deep clean was not requested after a positive COVID-19 test.
“Staff were not following safe infection prevention and control practices.” from the report
Activities and social contact
needs fixingPeople did not have regular meaningful activities or enough social interaction. The activities board listed events that were not taking place, and there was no activities co-ordinator.
“People did not have access to activities which were meaningful to them.” from the report
Management oversight
seriousStaff and relatives were unclear about who was managing the home while the manager changed. Audits and checks did not identify important problems, and records were incomplete.
“The systems and processes in place were not robust enough to demonstrate good governance.” from the report
- 01What staffing levels are now in place, including the number of agency workers, and how do you check that they can meet each person's needs?
- 02How do you now check that creams, ointments, patches and other medicines are given and recorded correctly?
- 03How have care plans and risk assessments been reviewed to remove missing or conflicting information?
- 04What regular activities and social opportunities are now available, and who is responsible for providing them?
- 05Who is currently responsible for managing the home, and how are audits and family communications being overseen?
This was an unannounced comprehensive inspection covering all five CQC questions, including the care provided, the premises and infection prevention and control. This explanation was written from the published report of 10 February 2023 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, September 2022
Rated Requires Improvement; inspectors found safe and caring support, but concerns remained about staff training, activities, records and management oversight.
Inspectors visited the home without notice on 20 and 21 June 2022. They spoke with people, relatives and staff, observed care, and checked care records, medicines and quality checks.
The home was rated Good for Safe and Caring. People were protected from abuse, medicines were managed safely, staffing levels were sufficient, and people were generally treated with kindness, dignity and respect.
The home was rated Requires Improvement for Effective, Responsive and Well-led. Fluid records did not clearly show that people met their targets, some mandatory training was out of date, meaningful activities were lacking, and management checks had not found all the problems.
The overall rating remained Requires Improvement, as it had at the previous inspection. Some improvements had been made, including better risk assessments, mealtimes and care plans, but the home remained in breach of Regulation 17 about good governance.
Safe care and medicines
Inspectors found that people were protected from abuse, risks had been reviewed and staffing levels were sufficient. Medicines were stored, administered and audited safely.
“Medicines were managed and stored safely.” from the report
Kind and respectful support
People and relatives spoke positively about the care. Staff supported people's choices, privacy and independence.
“People were treated with dignity and respect, and their independence was promoted whenever possible.” from the report
Improved care planning
Care plans were generally more person-centred than at the previous inspection. The earlier breach about person-centred care had been resolved.
“Care plans were more person-centred, and staff were proud of the improvements they had made.” from the report
Improved mealtimes
Mealtimes were calm, people were offered choices and staff supported people to eat independently where possible.
“Mealtimes were calm and provided people with a balanced diet.” from the report
Access to other professionals
Staff worked with healthcare professionals and people were referred for healthcare support when needed.
“People were referred to other healthcare services for support when needed.” from the report
Quality checks did not find all problems
seriousThe home's monitoring systems were not strong enough to identify issues or show ongoing improvement. This was a breach of Regulation 17.
“The systems and processes in place were not robust enough to demonstrate good governance.” from the report
Gaps in staff training
needs fixingSome staff had not completed mandatory training, including fire evacuation, safeguarding and medicines training. The manager said this was being addressed urgently.
“Some staff had not completed mandatory training.” from the report
Fluid records
needs fixingRecords did not contain enough detail to show whether people were meeting their fluid targets, although people were seen receiving drinks.
“Records of people's fluid intake were insufficiently detailed to show they were meeting their fluid targets.” from the report
Not enough meaningful activities
needs fixingAdvertised activities did not take place on either inspection day, apart from some entertainment on the second day. Inspectors saw people who were not engaged in meaningful activities.
“People were not provided with meaningful activities.” from the report
Lessons from incidents
needs fixingThe new process for recording lessons from incidents was not yet embedded. Records and meeting minutes did not always show how learning would be shared or prevent similar incidents.
“It was not always clear whether lessons had been learnt from incidents and accidents.” from the report
- 01How do you now record and check people's fluid intake against their individual targets?
- 02Have all staff completed fire evacuation, safeguarding and medicines training, and how do you monitor this?
- 03What regular activities are available for people who may be at risk of social isolation?
- 04What changes have been made to the quality assurance system since the Regulation 17 breach?
- 05How are lessons from accidents and incidents shared with all relevant staff?
This was an unannounced inspection covering all five CQC questions, including infection prevention and control, and it checked both the premises and the care provided. This explanation was written from the published report of 2 September 2022 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 Dovecote Residential Care Home
8 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Dovecote Residential Care Home →
- September 2022Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Dovecote Residential Care Home →
- February 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2020
Registered with the Care Quality Commission on 20 July 2020.
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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Most charge £950 to £1,240 a week. 42 can care for a couple. 10 years' experience on average.
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