Archived: Dunmore Residential Home

Updated 5 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

On 24 November 2021 two inspectors, an assistant inspector and a medicines inspector began the inspection. On 30 November 2021 and 1 December 2021 there were two inspectors on both days. The medicines inspector was also present on 1 December 2021.

Service and service type

Dunmore Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. The provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

An Expert by Experience spoke with nine relatives on 30 November 2021 to gain their feedback on the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We also used the Short Observational Framework for inspection (SOFI) on 30 November 2021. SOFI is a way of observing care to help us understand the experience of people who were not able to comment specifically on the service. The inspection concluded on 10 December 2021 and written feedback was provided via e-mail on the same day.

During the inspection, we looked at seven people’s care records including assessments of people’s personal care, emotional and social needs. We also ensured we met everyone living at the home; we spoke with 12 staff, including agency staff.

We reviewed a range of records. This included people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with health and social care professionals who are either in contact with the service or regularly visit the service.

Updated 5 November 2022

About the service

Dunmore Care Home is registered for 32 older people, including people living with dementia. There were 20 people at the service at the time of the inspection. Bedrooms are located over four floors. There is a small passenger lift to access all floors. There is some accessible outside space.

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

Due to poor management of risk, people were at risk of harm. We found multiple examples of poor care and inadequate monitoring of risk in relation to malnutrition, dehydration, personal care, oral care, weight loss, incontinence, fire safety, infection control and pressure care. Some people looked unkempt. People were restless; some expressed sadness and worry at the changes in the home, and the lack of social activities. People told us they were bored and there was nothing to occupy them. We observed people sitting for long periods of time in their wheelchair with nothing to do and no interaction with others.

People’s dignity was not maintained; people’s clothes and belongings were lost. Complaints were poorly managed and long-standing issues were not effectively addressed. People told us they did not feel listened to, and relative’s expressed frustration that their concerns were not addressed. They did not feel confident in the new management structure.

There had been many staff changes, including in care, catering, administration, housekeeping, maintenance and management. There had been changes in the running of the home and this had impacted on staff confidence and morale. The changes had not been explained to people. People told us they were not kept informed of changes; they said, “We would like to know more, to be kept in the loop.”

People were unhappy with the food. People told us their lunch was lukewarm, and meals were very rarely hot. Another person sent their meal away complaining to a staff member it was cold. This was an on-going problem according to minutes from a residents’ meeting.

Infection control was poorly managed, particularly in the laundry.

Medicines were administered safely, but audits did not pick up on concerns we identified during the inspection. This included action not being taken when medicines were not stored appropriately, for example not being stored at the appropriate temperature.

Records of care tasks were not always completed. We found gaps in the recording relating to the repositioning people which should have been carried out to help prevent skin damage. Fluid and food intake were poorly monitored putting people at risk of weight loss, malnutrition and dehydration. Care plans did not consistently have the required information to support staff in understanding a person's individual needs.

Staff were recruited safely. However, staff training and induction were not effectively managed. Supervisions did not routinely take place and staff competency checks were poorly completed.

During our inspection, we saw actions and heard conversations that showed us some staff were compassionate and kind. People responded to their kindness and smiled or laughed with them. However, relatives said the atmosphere at the home seemed rushed and staff had less time to interact with people.

People were not routinely supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible or in their best interests. This included people living with dementia; improvements were needed to ensure they had equal choices to those people who were not living with dementia.

Systems and processes were not effective in ensuring the safety of people or the environment. Systems in place to monitor and review the quality of care had not been effective in improving standards, and ensuring the service, and staff, were meeting people's needs safely and effectively.

During the inspection, we raised individual safeguarding concerns for some people living at the home. This was to ensure risks to their health and well-being were assessed and reviewed by health and social care professionals.

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 12 November 2020) with breaches in Safe Care and Treatment and Good Governance.

The provider completed an action plan after the last inspection to show what they would do to improve. This included timescales. At this inspection not enough improvement had been made, and standards had deteriorated further. The provider was still in breach of the two regulations identified at the inspection in September 2020, with an additional seven breaches. This service has been rated Requires Improvement for the last three consecutive inspections which all took place in 2020.

Why we inspected:

This was a planned inspection based on the previous rating. 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. We were not assured infection control was being managed appropriately.

We have found evidence that the provider needs to make a number of improvements; some of which were urgent. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

During the inspection, the provider was given short timescales to rectify environmental risks. We checked these had been addressed during our inspection.

Follow up:

We have met with the provider, so they have a clear understanding at the level of our concerns. During the inspection, and afterwards, the provider was required to complete action plans to show us how they would address the risks to people’s 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.

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 of 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.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection, we identified nine breaches in relation to environmental and individual risks to people’s safety, infection control, person-centred care, maintaining people’s dignity, safeguarding, nutrition and hydration, staff training and deployment, complaints, consent and the running and oversight of the service.

CQC took enforcement action against the provider. The provider made the decision to close the service. People living at Dunmore Residential Home were supported to move to alternative homes by the local authority