CQC report explained · a nursing home
What the CQC found at Dovedale Court
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found medicine errors, incomplete records, missing instructions and problems with expiry dates and refrigerated medicines. Other safety arrangements, including staffing, safeguarding, infection control and risk assessments, were generally satisfactory.
- Effective?
- Good
- People's needs were assessed before care began and staff had suitable training and support. The home had improved its pre-assessment process so equipment and medicines could be identified before admission.
- Caring?
- Good
- Staff were caring, compassionate and respectful. People were involved in decisions, supported to keep their independence and helped to maintain relationships.
- Responsive?
- Good
- Care plans were personalised and staff understood people's preferences and changing needs. People could take part in activities, maintain relationships and raise complaints.
- Well-led?
- Requires improvement
- Managers and staff communicated well and people felt positive about the management. However, management audits repeatedly failed to identify the medicine problems found during the inspection.
What inspectors found, November 2019
Dovedale Court was rated Requires Improvement overall; inspectors found caring support but serious medicine safety problems and weak checks.
Inspectors made an unannounced visit on 30 September 2019. They reviewed care, medicine and staff records, spoke with people, relatives and staff, and observed care.
The main concern was medicines. Some doses did not match prescriptions, some records were incomplete, and staff did not always have the right instructions for medicines given as needed, through feeding tubes or hidden in food or drink. Some medicines were out of date or stored without reliable temperature checks.
People were generally treated with kindness and respect. Care was personalised, staff were trained, health needs were supported, and people had activities and contact with relatives. The overall rating fell from Good at the previous inspection to Requires Improvement because the home was not always safe or well-led.
Kind and respectful staff
People and relatives described staff as caring and respectful. Inspectors saw staff supporting privacy, dignity and independence.
“People were supported by staff that were caring, compassionate and treated with dignity and respect.” from the report
Personalised care
Care plans recorded people's individual needs, preferences and life histories. Staff knew this information and used it to build relationships.
“Care plans were personalised to the individual and recorded details about each person's specific needs and how they liked to be supported.” from the report
Staffing and training
Inspectors found enough staff to meet people's needs and safe recruitment checks had been completed. Staff received induction, training and supervision.
“There were sufficient numbers of staff to meet people's needs.” from the report
Health support
Staff worked with health professionals and monitored changes in people's health. People could access a range of healthcare services.
“Staff worked alongside other agencies to provide person centred and effective care.” from the report
Medicine errors and missing safeguards
seriousSome medicines were not given as prescribed. Inspectors found a warfarin dosing error, regular use of some medicines meant to be given only when needed, incomplete patch records and missing instructions for medicines given through tubes or hidden in food and drink.
“some people's medicines were not managed to ensure people received them safely and in accordance with their health needs and the prescriber's instructions.” from the report
Medicines were not always stored safely
seriousSome medicines were out of date or had not been dated when opened. Refrigerator temperature checks did not show reliably that temperature-sensitive medicines were stored correctly.
“There was the potential that people may receive some of these medicines when they have passed their expiry date.” from the report
Audits missed problems
needs fixingManagement checks did not identify the medicine discrepancies, missing documentation, expiry issues or refrigeration monitoring problems found by inspectors.
“Medication audits undertaken by the management team had not identified issues we discovered during the inspection.” from the report
Missing decision records
needs fixingTwo care records for people receiving medicines covertly did not contain a mental capacity assessment or best-interest decision.
“two care records we looked at for people receiving their medication covertly contained no records of a mental capacity assessment or best interest decision made.” from the report
- 01What changes have you made to prevent medicine doses and administration records from being wrong?
- 02How do you now check medicines given as needed, including sedatives, are only given when clinically needed?
- 03What written protocols are in place for medicines given through feeding tubes or hidden in food and drink?
- 04How do you check expiry dates and refrigerator temperatures for medicines, and what happens when a check fails?
- 05What evidence can you show that the action plan following this inspection has been completed?
This was an unannounced inspection that considered all five key questions, prompted in part by concerns about pre-assessment and medicine management. This explanation was written from the published report of 13 November 2019 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, November 2018
Rated Good; inspectors found kind, safe care and clear improvements, but nursing workloads and some staff practice needed attention.
Inspectors visited on 25 and 28 September 2018. The first visit was unannounced and the second was announced. They spoke with people, relatives and staff, observed care, and reviewed care, medicine, staff and management records.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were generally safe, treated with kindness and respect, supported to make choices, and given care that reflected their needs and preferences.
The report says the home had improved since the previous inspection, when it was rated Requires improvement overall. A registered manager was now in place, risk records and audits had improved, and earlier concerns about safeguarding and medicines had been addressed.
There were still some areas to watch. Nursing work could be difficult at times, some staff needed further training, and inspectors saw isolated occasions where staff responses or practice could have been better.
Safe medicines support
The medicines records reviewed were complete, medicines were stored securely, and staff administering medicines had training and competency checks.
“We observed staff giving medicines to people and found they were administered safely.” from the report
Personalised care and activities
Care plans included people's needs, likes and preferences. People could choose from leisure activities and inspectors saw people enjoying music and social activities.
“People had access to leisure opportunities and activities they enjoyed.” from the report
Management monitoring
The provider used audits, meetings and risk monitoring to identify actions and track improvements. People's and relatives' views were sought.
“We saw there were numerous audits in place, these completed by staff at various levels and the providers quality monitoring team.” from the report
Nursing workload
needs fixingThe report says the nursing workload was sometimes difficult because of the number of clinical tasks. The provider was recruiting and planning to train nursing assistants, but nursing assistants were not a substitute for another nurse.
“There were some concerns that the nurse workload was at time difficult but the provider was pro-actively exploring ways to manage this.” from the report
Further clinical training
needs fixingNurses had mixed views about the clinical training available. Further training for nurses and nursing assistants was planned.
“Nurses we spoke with had mixed views on the clinical training available” from the report
Some inconsistent staff practice
needs fixingInspectors saw isolated occasions where staff responses or practice could have been better. A senior corrected one unsafe transfer immediately, and another staff member did not initially replace a meal when requested.
“We did see one occasion where a member of staff commenced supporting a person to transfer in an inappropriate way” from the report
Teamwork and supervision
minorA few staff described barriers to teamwork, and nurses said clinical supervision could be improved. The manager knew about these issues and described plans to address them.
“Nurses did tell us whilst they had clinical discussions, there was scope for improvement of their clinical supervision.” from the report
- 01How many nurses and nursing assistants are usually on duty during the day and night, and how do you manage busy nursing periods?
- 02What clinical training has been completed by nurses and nursing assistants since this inspection?
- 03How do you check that new staff use safe moving and handling techniques after their induction?
- 04What action has been taken to improve teamwork and clinical supervision for nurses?
- 05How do you make sure staff consistently support people's meal choices and encourage people with drinks and other daily care?
This was a scheduled comprehensive inspection covering all five key questions, with the first day unannounced and the second day announced. This explanation was written from the published report of 10 November 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 Dovedale Court
4 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- November 2019Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 31 October 2011.
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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