Dundoran Nursing and Residential Home

Dundoran Nursing and Residential Home provides accommodation for up to 39 people who need help with nursing or personal care. At the time of the inspection 21 people were using the service. The majority of people living in the home, lived with dementia or other mental health needs.

People’s experience of using this service and what we found

During the previous inspection we identified serious concerns with the safety and quality of the service being provided for people.

During this inspection the provider had made improvements, however more time was required for these improvements to be sustained over a longer period of time.

Monitoring records were not always up to date and did not show people received the care they needed with regards diet and fluids. We have made a recommendation about this.

Monitoring to mitigate risks had improved . Care records were individualised and reflected each person's needs and preferences. Risks were assessed and identified, and staff had guidance to help reduce the risk of avoidable harm to people they were supporting.

Medicines management had improved and people had their medicines as prescribed. Staff had received training on administering medicines and their competence was regularly checked.

The principles of the Mental Capacity Act (2005) were now being consistently followed when providing care and treatment for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were knowledgeable about people's health needs and the provider worked in partnership with other health professionals as a measure of providing the appropriate level of support.

The provider had addressed issues identified from the last inspection and internal quality assurance audits relating to the medicine's, environment, care records and consent had improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 29 June 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found that the provider had made some improvements to the service and they were no longer in breach of regulations.

Exiting special measures

This service has been in Special Measures since 29 June 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Recommendations

We have made recommendations about the systems in place for the monitoring of peoples diet and fluids.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last inspections, by selecting the 'all reports' link for Dundoran Nursing and Residential Home 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.

Dundoran Nursing and Residential Home provides accommodation for up to 39 people who need help with nursing or personal care. At the time of the inspection 26 people lived in the home. The majority of people living in the home, lived with dementia or other mental health needs.

People’s experience of using this service and what we found

People’s needs and risks were not properly assessed, monitored or managed placing people's health, safety and welfare at risk. A lack of adequate information on how to manage and monitor risk meant staff did not have sufficient guidance on how to meet people’s needs safely or in a person centred way.

People’s health and medical needs were not properly described, and some people’s medical appointments and reviews had not been followed up by nursing staff. Information about some people’s clinical needs and the care they required was contradictory. Clarification from relevant medical professionals had not been sought.

Records in relation to the care people received were poorly maintained, not always accurate or easy to follow. They did not show that people received the care they needed with regards to skin integrity, personal hygiene, diet and fluids or medicines.

There was a lack of care planning or provision for people living with dementia or other mental health needs to promote their independence and well-being. The home did not always promote a therapeutic or relaxing environment for people living with dementia or other mental health needs. The loud and noisy environment increased the risk of people becoming distressed and agitated or disorientated.

The cleanliness, hygiene and condition of the premises and equipment were poorly maintained increasing the risk of the spread of infection. There were several fire doors across the service which did not close properly which meant they would not be effective in the event of a fire. There was no hot water in some people’s bedrooms or in some communal bathrooms to promote good hand and personal hygiene.

There were insufficient numbers of suitably skilled and experienced staff deployed across the service to meet people's needs and keep them safe. Staff recruitment was not robust and failed to ensure people employed were safe and suitable to work with vulnerable people. Staff were not properly supported in their job role and some staff had not completed appropriate training to ensure they had the skills and knowledge to support people effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The use of physical restraint had been used without robust processes in place to identify, agree and monitor its use.

The service lacked clear leadership and governance. The systems and processes used to assess, monitor and improve the quality and safety of the service were not robust and not used effectively to mitigate risks. Audits and checks carried out at the service were inconsistent and not regularly completed. Where actions had been identified these had not always been acted upon in a timely manner. Provider oversight of the management of the service was poor and it was clear they had not fully identified or, recognised the seriousness of the concerns found during our inspection. This exposed people to unnecessary risk.

At the time of our inspection, there was no registered manager in post and the previous manager had left. An interim manager and a clinical lead were supporting the service, both of whom were open and transparent during our visit. After the inspection, the provider submitted an urgent action plan of improvements to CQC. The Local Authority were also notified of our concerns and have taken action to support the service.

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 01 July 2022).

Why we inspected

This inspection was an urgent responsive inspection prompted by information shared by the Local Authority and members of the public. A decision was made for us to inspect and examine those risks in a focused inspection of the domains of safe and well-led. During the inspection however, significant concerns were identified in other areas of service and a decision was made to open up the inspection to a full comprehensive inspection covering all five domains.

We found evidence during the inspection that people were at serious risk of harm. Following the inspection, the provider was asked to, and submitted an urgent action plan for improvement. The Local Authority were also informed of our concerns and took action to mitigate risks and ensure the safety of people living in the home.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dundoran Nursing and residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to Regulation 9 (Person Centred Care); Regulation 11 (Need for Consent); Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing) and Regulation 19 (Fit and Proper Persons) at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work alongside the provider and local authority to monitor progress against the provider’s action plan for improvement.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Dundoran Nursing and Residential Home is a care home providing personal and nursing care for up to 39 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 31 people using the service.

The service was provided in one adapted building suitable for meeting the needs of people who use the service.

People's experience of using this service and what we found

People's care plans and risk assessments were not always as detailed or reviewed regularly as required. The registered manager explained this was because paper records were in the process of being transferred onto an electronic recording system and some shortfalls had been identified. The registered manager had taken immediate action to resolve this.

Staff were caring and treated people with kindness and respect. There was enough staff on duty to meet people's needs. Incidents and accidents were managed safely, the managers took necessary actions to keep people safe and minimise the risk of reoccurrence.

Feedback regarding the management and quality of service people received was very positive. Staff said they enjoyed their jobs and were well supported. The registered manager was clear about their role and responsibilities and worked closely with other health and social care professionals to help ensure people's needs were met and the service ran smoothly.

All areas of the service were clean and well maintained. Safety checks of the premises and equipment had been undertaken. People had personal emergency evacuation plans (PEEPs) in place.

The registered manager provided clear direction and good leadership. Feedback about the service was consistently positive. All the relatives we spoke with would recommend the home to others. Staff felt valued and supported, and were confident people received good care. Systems and processes for monitoring quality and safety were effective.

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 28 November 2020)

Why we inspected

The inspection was prompted in part due to concerns received about unsafe environment and the safety of people. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dundoran Nursing and Residential Home on our website at www.cqc.org.uk

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dundoran Nursing and Residential Home is a care home providing personal or nursing care to up to 39 people living with dementia. At the time of the inspection, there were 26 people living in the home.

People’s experience of using this service and what we found

Staff had received training and their competence had been assessed to ensure people received their medicines safely. Staff were aware of the procedures to administer medicines covertly (hidden in food or drinks). However, the records did not always clearly reflect the process followed and lacked detail.

People’s relatives told us their family members received safe care. There were sufficient numbers of safely recruited staff available to support people in a timely way and staff were knowledgeable about safeguarding procedures. Risks to people had been assessed and measures were taken to reduce any identified risks. Infection control arrangements were in place to prevent and mitigate the risk of Covid-19. Appropriate personal protective equipment (PPE) was available and staff used this appropriately in the day to day delivery of care.

Effective systems were in place to monitor the quality and safety of the service. When areas for improvement were identified, actions were taken to address them. The registered manager was working through an action plan to drive improvement.

Feedback regarding the management and quality of service people received was very positive. Staff said they enjoyed their jobs and were well supported. The registered manager was clear about their responsibilities and worked closely with other health and social care professionals to help ensure people's needs were met and the service ran smoothly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 May 2019) and a breach of regulation was identified regarding unsafe moving and handling practices. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and moving and handling procedures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dundoran Nursing and Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were supported to move and transfer in ways that could put them at risk of harm. The registered manager took appropriate action when this concern was raised with them.

Medicines were not always managed and recorded as required. We made a recommendation regarding this in the main body of the report.

The systems in place to monitor the quality and safety of the service were not always effective as they had not highlighted the concerns we identified during the inspection. When areas for improvement were identified through the checks, actions taken were not always clearly recorded. We made a recommendation regarding this in the main body of the report.

People told us they felt safe living in the home. Risks to people had been assessed and care plans guided staff on how to minimise identified risks. Staff were aware of safeguarding procedures and how to raise concerns.

Safe recruitment practices had been adhered to. Staff felt well supported and received ongoing support through regular training and supervision.

There were usually enough staff on duty to meet people’s needs. Feedback regarding staffing levels was mixed, but most was positive and rotas showed that staffing numbers were consistently maintained with the support of agency staff.

People had enough to eat and drink and feedback regarding the meals available was positive. When people were at risk of malnutritional steps had been taken to address the risks, such as referrals to the dietician.

Adaptations had been made to the building to ensure it was suitable for people living with dementia.

People’s consent had been sought and recorded in line with the principles of the Mental Capacity Act 2005 and people had their rights respected.

People and their relatives staff told us staff were kind and caring and treated people with compassion. Staff knew people well, including their needs and preferences and these were recorded within their plans of care. People were supported to be as independent as they could be.

The registered manager took responsive action based on the feedback from the inspection.

Rating at last inspection: Good (Last report published September 2016).

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The home had a manager who was registered with the Care Quality Commission. 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 people accommodated at Dundoran were living with dementia-related conditions. We observed that they were treated with dignity and respect and supported to make everyday choices. People had a choice of meals and received the support they needed to eat and drink. Staff we spoke with had a good understanding and knowledge of people`s individual care needs and there was good communication between staff and people’s families. Family members visited during the day with no restrictions.

The home was clean, tidy, comfortable and safe. Adaptations had been made to support people with mobility difficulties and to help people to find their way around.

During the day of our visit there were enough staff on duty and people did not have to wait for staff to attend to them. The rotas we looked at confirmed that these staffing levels were maintained by some use of agency staff.

Care records we looked at showed that people’s care and support needs were assessed and planned for and the plans were reviewed regularly. Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately and some of these were awaiting authorisation by the local authority.

The home employed a social activities organiser and a wide range of age-appropriate activities was provided.

We saw evidence of regular staff meetings and meetings for people who lived at the home. A series of quality monitoring audits was carried out.

We saw that people's needs were assessed and regularly reviewed. Care records were personalised, contained information about a person's individual needs and preferences and promoted the person's independence where possible.

Where people had limited mental capacity, care plans detailed how to communicate with people so they were able to be involved in decisions about their day to day care. Staff we spoke with were knowledgeable about a person's needs and understood the person's right to refuse consent.

People were offered a balanced diet and a choice of menu options. People's dietary requirements were assessed and adequate nutrition and hydration provided.

We reviewed three staff records and saw the provider had undertaken appropriate checks in the employment of staff to ensure they were suitable to work with vulnerable people.

The provider undertook a range of quality audits to check and monitor the quality of the service provided. We examined the provider's recent satisfaction survey. Feedback received about the service was positive. Where suggestions for improvement had been made the provider had acted upon them.

There was a care plan for each person and the documentation was tidy and easy to follow. The care plans contained assessments of people's needs, plans for their care, detailed daily records, monthly records of weight, pulse and blood pressure, and a record of any visits from medical professionals. The care plans had been reviewed monthly to take account of people's changing care needs.

Redecoration and upgrading of the buidling were ongoing at the time of our visit. Most areas had been refurbished providing all single bedrooms, most with en suite facilities.