We carried out a review of the data available to us about Dunraven House and Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Dunraven House and Lodge, you can give feedback on this service.
Dunraven House and Lodge is a residential care home providing accommodation and personal care for up to 43 people. The service provides support to people with mental health needs. At the time of our inspection there were 39 people using the service. People are supported in two adapted buildings on the same site.
People’s experience of using this service and what we found
People said they felt safe living at Dunraven.
The registered manager had identified people who were at risk of choking and there were clear plans in place to manage the risks. The plans had been developed with input from a speech and language therapist where relevant.
Staff demonstrated a good understanding of people’s needs in relation to eating and the risk of choking.
The service had introduced measures to prevent visitors from catching and spreading infections. Visitors were screened for symptoms of COVID-19 and were provided with personal protective equipment (PPE).
Staff had received training on infection prevention and control measures and how to use PPE safely. PPE was available to staff throughout the service and staff were seen using it safely.
Additional cleaning measures had been introduced in the home. All areas of the home were clean, and records demonstrated the additional cleaning had been completed.
COVID-19 testing was being carried out for people using the service and staff in line with the latest guidance.
The provider had effective systems in place to check staff and professional visitors were vaccinated against COVID-19.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 15 May 2019)
Why we inspected
We undertook this targeted inspection to check on a specific concern we had about management of choking risks. The overall rating for the service has not changed following this targeted inspection and remains good.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dunraven House and Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Dunraven House and Lodge is a care home for people living with mental health needs. 40 people were living in the home at the time of the inspection.
What life is like for people using this service:
• People felt safe living at Dunraven House and Lodge. People were confident staff would listen to them and take action if they had any concerns.
• People were complimentary about the care and support they received. They said staff understood their needs and provided the care they needed in a kind way.
• People were supported make choices and have as much control and independence as possible.
• People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date.
• Staff respected people’s privacy and dignity.
• People received support to take their medicines safely.
• Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively.
• People’s rights to make their own decisions were respected.
• People were supported to maintain a good diet and access the health services they needed.
• The registered manager provided good support for staff to be able to do their job effectively.
• The provider’s quality assurance processes were effective and resulted in improvements to the service.
More information is in Detailed Findings below.
Rating at last inspection:
Requires Improvement. Report published 1 May 2018.
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
The provider has made all the improvements we said they needed to following the last inspection. We will monitor all intelligence we receive about the service to inform when the next inspection should take place.
This was an unannounced inspection. At the time of our inspection 40 people were receiving accommodation and personal care from the service.
There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.
Staff did not always recognise when people were raising allegations of abuse and action was not always taken promptly to report concerns and ensure people were safe.
Most people said they felt safe living at Dunraven House and Lodge. However, we also received feedback from some people who were concerned at the way they were treated. One person raised concerns with us about the way a member of staff had spoken to them. We also received feedback from a social worker that a person who was in hospital at the time of the inspection had said they did not want to return to the service because they did not like the way they were treated. This was being investigated by Wiltshire Council through the safeguarding processes.
The provider did not always ensure the principles of the Mental Capacity Act were followed. The service had supported one person to move from Dunraven House and Lodge to another service provided by the registered manager. The move had happened without consultation with the person’s relatives or their social worker. The person had been assessed to lack capacity to make a decision about where to live. The person had been supported to move from the home without a thorough process to ensure the move was in their best interest.
Most people told us they were treated well and staff were caring. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and spoke with people in ways they could understand. Despite the positive comments, we also received feedback from two people who did not feel they were treated well. An incident raised through the safeguarding processes demonstrated that people were not always treated with dignity and respect. Although these incidents had been addressed by the registered manager, this had not resulted in sustained improvements in the experiences of some people who used the service. Following the visit, Wiltshire Council’s mental health commissioning team informed the service they had been placed on an ‘amber alert.’ This was due to the number of concerns that had been raised about the service. The council said they would seek additional assurances from the provider before supporting new people to move into the home.
The registered manager did not always ensure notifications were made to the Care Quality Commission when required. Following this inspection visit, we were informed of an incident in which a relative informed staff that money and other personal possessions were missing from a person who used the service. The registered manager had not submitted a notification to us about this allegation. The registered manager had made other notifications to us when required, including other allegations of abuse, injuries to people who used the service and to report incidents which were reported to or investigated by the police.
The management team completed regular audits of the service. However, these systems were not fully effective and had not identified shortfalls in the way staff followed the safeguarding procedures, the failure to work within the principles of the Mental Capacity Act or that we had not been notified of specific events in the service.
Medicines were managed safely and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.
There were sufficient staff available to provide the care and support people needed. Staff received a thorough induction when they started working at the service and had completed regular training about their role.
People had regular meetings to provide feedback about their care and there was a clear complaints procedure.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
Dunraven House and Lodge is a care home which provides accommodation and personal care for up to 43 people with mental health needs. At the time of our inspection 40 people were living at the service.
This inspection took place on 4 November 2015 and was unannounced. We returned on 5 November 2015 to complete the inspection.
There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.
The systems to manage property the service was holding for people did not always ensure people were protected. Where the service was holding cigarettes for one person, there were not clear procedures to account for the number of cigarettes held. This meant it would not be possible to tell whether cigarettes had gone missing and the systems in place did not protect the person from material abuse. We have made a recommendation about the management of property the service holds for people.
People who use the service were positive about the care they received and praised the quality of the staff and management. People told us they felt safe when receiving care and were involved in developing and reviewing their support plans. Comments from people included, “Very safe, no problems here” and “Yes, I feel safe”. We observed people interacting with staff in a relaxed and confident manner.
Staff understood the needs of the people they were supporting. People told us staff provided support with kindness and compassion. Comments included, “I love it here, I’ve made lots of friends. They are nice people the carers” and “They are very nice, it’s a friendly atmosphere. The staff are all ok”. The health and social care professionals we received feedback from also told us people were treated well by staff. Comments made referred to how well staff knew people and how staff had developed good relationships with people.
Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people met their needs.
The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback and there were effective complaints procedures. One person said they would approach staff if they had any problems; but had not needed to do so. Other comments from people included, “I would speak to staff if I had any concerns” and a description of staff as “Very approachable”.
The provider assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.
We saw detailed information for four people who had diabetes and this included protocols written by their GP's that enabled them to manage this condition. There was individual photograph's of their respective medication to show them which was the correct one to use.
All the people living in the home who we spoke with confirmed there was always enough staff on duty to support them and take them out. For example people's comments included; "staff are there to take me shopping or for an appointment', 'they are all really kind and helpful', ' there is always someone here to help me'.
People we spoke with confirmed they thought the houses were well looked after and they enjoyed living there. One person told us 'I am really happy here, it's a nice clean home and I like my bedroom', another person told us 'I can go places here if I want peace and quiet, but I can also join in with others in the lounge, it has everything I need'.
People we spoke with who used the service said they could talk to their key worker if they had any concerns. People also told us that they knew how to follow up a concern more formally by making a complaint.
We observed staff treating people with kindness and patience. Staff demonstrated how well they knew people's needs and ensured people were treated with privacy and dignity.
Everyone we spoke was complimentary of the staff and were very satisfied with the care and support provided. Comments included: 'The staff are caring and experienced and know me very well.' Another person said "there are always plenty of staff on duty.'
Two people told us they had plenty of opportunities to get involved in having their say about how the service was run. They also told us they were confident if they reported any problems, they would be dealt with promptly and effectively.
Staff told us they received training on a regular basis which enabled them to carry out their job. They said they had opportunities to express views and opinions about how the service was run.
Shortly after our visit we spoke with a healthcare professional who told us the staff were very good at communicating with them, and reported any problems promptly. They had provided training to the staff to enable them to understand people's specific healthcare needs. Staff training records showed that had receiving training in specific health conditions such as dementia.
People told us that they were asked what activities they would like to do and encouraged to take part, but said 'we don't have to go, if we don't want to.' People told us they had plenty of activities to get involved in if they wished.
People told us their support plan accurately reflected the care and support that they received from staff. This was because they were fully involved in developing and agreeing to how their care and support was delivered. 'I've taken part in my care plans and everything is fine.'
People told us they received support from health care professionals outside the home and said they had recent contact with their care managers from social services. Two people told us they had recently had a review with their Community Psychiatric Nurse (CPN). We spoke to an external healthcare professional after our visit who told us they were concerned about peoples' ability to make choices and their capacity to make decisions.
We spoke to another external healthcare professional after our visit who told us they would expect the home to be seeking written protocols from relevant professionals where they take on looking after someone's medical condition and they were not sure Dunraven House and Lodge always did so. They told us that where people had been escorted by staff this had often been with a member of staff whose first language was not English. This had meant communicating information about ongoing health care needs was a problem.
Everyone we spoke with was very complementary about the staff. Examples of comments were, "the staff are very kind and caring cheerful and attentive."
Comments we received from people were: 'Can't fault this place' 'I like it now it's all been done up, so homely.' 'Certainly very peaceful here.' 'I don't ever want to leave this place'. 'The provider knows all about what's happening here.' 'I can tell the provider anything if I'm worried about it and she'll make sure I'm OK.'
The home needed to take action on a range of areas after we last visited and there remain some areas which need to be addressed. Further development of care plans and reviews were needed, including discussion with people living in the home, to ensure that information held verbally was also written down. Not all staff were taking on individual responsibility for reporting of matters in the home environment which could present risk to people, so that they were rectified in a timely manner.
People told us that they could make choices about their daily routines. Some people said they went out independently when they wanted to. They said they could go to bed when they were ready although they were woken in the morning at about 7.30am. Some people said they were unable to have a 'lie in' although the provider and staff disagreed with this. They said it was the person's choice when they wanted to get up. One person told us they felt 'programmed' to do things such as swimming and having to sit in the same place at meal times.
People told us they were able to give their opinions about the running of the home. They attended house meetings so they could do this more formally. One person told us about the rules of the home. They said these included no violence, no smoking in the house and no going into other people's bedrooms. One person spoke of the consequences of doing this. They said the provider ran a tight ship and would not have any 'messing.'
People told us they were very happy with their bedroom. They said they had everything they needed. People told us that the temperature of the home was satisfactory. One person told us that staff would turn the heating up, if they were cold. People said they could have a key to their bedroom if they wanted one. People had generally declined this offer yet said their privacy was not compromised, as a result. People told us that any repairs to the environment were made quickly, without delay.