The Dene Lodge - Minehead

The Dene Lodge is a residential care home. It is registered to provide care and accommodation to up to 39 people. The home provides support to older people including people living with dementia. At the time of our inspection there were 19 people living at the home.

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

People lived in a home where there was no registered manager in post and there were no effective systems to monitor quality or drive improvements. Records had not been updated to make sure they fully reflected people’s needs. This placed people at risk of receiving inconsistent or inappropriate care.

There was a task centred approach and culture within the home. This meant that people did not always receive person-centred care which promoted their well-being and independence.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

People were helped with personal tasks by kind and patient staff. However, there was very limited social interaction for people when staff were not helping them with physical care. New staff had not received training or guidance on how to promote well-being for people living with dementia. This all resulted in people not receiving social stimulation. We have recommended that staff receive training in supporting people living with dementia.

People felt safe with staff who supported them and looked relaxed when staff helped them. Staff said they were confident that any concerns raised would be fully investigated to make sure people were protected.

People lived in a home which was well maintained and provided a pleasant environment. Several people commented how much they enjoyed spending time in the garden.

People were happy with the food provided although improvements were needed to meals served to people who required a specialist diet.

Staff worked well with other professionals to make sure people’s medical needs were monitored and met. People said that staff arranged for them to see a doctor or nurse if they were unwell.

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 2 August 2021) and there was a breach of regulations. 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 in infection prevention and control practices and the provider was no longer in breach of regulation 12. However other breaches were identified at this inspection.

At our last inspection we recommended that the provider ensured that all staff were familiar with the Mental Capacity Act 2005 and the practicalities of making decisions in respect of a person who lacks capacity to consent to their medicines being administered. At this inspection we found that although staff had received training in the mental capacity act no learning from this had been put into practice.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out an unannounced focussed inspection of this service on 7 July 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective 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 not changed from Requires Improvement based on the findings of this 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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report.

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 The Dene Lodge – Minehead on our website at www.cqc.org.uk.

The Dene Lodge is a residential care home providing personal care to up to 39 people. The home is made up of two buildings. The main house provides care to up to 33 people living with dementia. There is a six bedded bungalow in the grounds called Rachel’s House. This provides short-term rehabilitative care for people who do not need to receive this care in hospital. At the time of the inspection there were 31 people living at the home.

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

Improvements were needed to ensure people received safe care. We found that the registered manager was not always following government guidance about how to keep people safe during the COVID-19 pandemic. This included staff not wearing personal protective equipment correctly.

Risks to people were minimised because staff knew them well. However, risk assessment records were not always robust and up to date.

People lived in a home where quality monitoring systems were not always effective in identifying shortfalls in the service and planning improvements.

The building was well maintained and provided a safe environment for people to live in. All equipment was regularly serviced to make sure it was safe for people and staff to use.

People looked comfortable and relaxed with staff. Staff were seen to be kind and caring towards people.

People were supported by adequate numbers of staff to keep them safe and respond to their needs promptly.

People received their medicines safely. However we have recommended that the provider makes sure decisions made about medicine administration are in accordance with current legislation.

People lived in a home where the registered manager was open and approachable. The registered manager knew people well and was able to tell us about their individual needs.

Staff worked with other professionals to make sure people received the healthcare support and treatment they needed.

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 (report published 25 November 2017)

Why we inspected

We received concerns in relation to Infection prevention and control, staffing and the management of the home. 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 COVID-19 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

We have identified a breach of regulation in relation to safe care and treatment at 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 The Dene Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in November 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. Where concerns had been raised the registered manager had worked in partnership with relevant organisations to make sure people were safe. One person who lived at the home said “I feel safer here than I did in my own home.” Some people who were living with dementia were unable to tell us whether they felt safe. However, people looked relaxed and comfortable in their surroundings.

People continued to receive effective care and support because staff had the skills and knowledge to meet their needs. When required, staff assisted people to access health and social care professionals to ensure they received the care and treatment they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home continued to provide a caring service to people. Staff were kind and respectful when they interacted with people. One person who lived at the home said “This is my home and [name of registered manager] and the staff are more like my family. It is wonderful; excellent.” Systems were in place to make sure people’s wishes and preferences during their final days and following death were understood and respected.

The home continued to be responsive to people’s needs and preferences. People were assessed before they made the decision to move to the home. This helped to ensure the home was able to meet a person’s needs and preferences. Care plans contained important information about a person’s social history which helped staff to get to know people. People were able to make choices about their day to day lives and there were plenty of opportunities for social stimulation.

The home continued to be well-led. The registered manager had managed the home for many years and was well respected by the people who lived in the home, staff and people’s relatives. A person who lived at the home said “She’s amazing. One of a kind. So caring and committed.” 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 2008 and associated Regulations about how the service is run. There were systems in place to monitor the quality of the service provided and to seek people’s views.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People were safe because the service had an effective system to manager accidents and incidents and learn from them so they were less likely to happen again. This reduced the risks to people and helped the service to continually improve.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.

People received their medicines as prescribed. Prescribed medicines (including controlled drugs) were stored and administered safely in line with current and relevant regulations and guidance.

The staffing levels were sufficient to meet people's identified needs. People were safe because the service considered skill mix and experience when arranging staffing.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people's diverse care, cultural and support needs.

Staff had effective support, induction, supervision and appraisal.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be. People we spoke with said, 'I couldn't be in a better place' and 'I couldn't have better care.' Staff we spoke with said, 'Everyone's so friendly.'

Is the service responsive?

We found the service responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation. Staff told us, 'They say what they want and we respect this.' People told us, 'If you ask for something and it's not available, as soon as it is, they remember' and 'It's brilliant here.'

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met.

The service generally worked well with other agencies and services to make sure people received their care in a joined up way. However, we saw that one person had not been referred to a dietician although this had been identified as a need in the person's care plan.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Concerns and complaints were used as an opportunity for learning or improvement.

Staff were knowledgable about people's support needs and treated people respectfully. They were supportive and patient. They explained and reassured people where necessary.

People we spoke with told us that they were happy living at the service and felt safe. One person told us they 'like it here' and 'I can't really find fault'. One person told us they 'love the view from my room' and 'I get on with all the staff'.

People and their families were encouraged in developing their care plans. We saw that all care plans described each person's individual needs and preferences in clear language.

Complaints and concerns were listened to and acted upon immediately.

People we spoke with were very happy with the support they had from staff and the home. One person said, 'Glad I came here.' Another said they felt 'looked after.' Visitor's told us that the care provided at the home had had a big impact on the person they came to visit. They said,' looks well and is doing wonderfully.'

We saw people had been supported to be dressed appropriately in clean and cared for clothing. We saw that people had had assistance if needed to brush their hair and maintain their nails. Staff ensured that where people chose to or needed to, they were wearing their glasses, hearing aids and jewellery. This showed that staff maintained peoples welfare and promoted their well-being.

People we spoke with expressed that they felt safe living in the home. They told us they were able to speak to staff if they had any concerns or worries. People said the staff were 'lovely',' friendly' and 'helpful.' Visitors told us that staff 'always made us feel welcome.'