The inspection took place on 10 December 2014 and was unannounced.
Dunwood Manor Nursing Home provides accommodation and nursing care for up to 55 older people, some of whom may also be living with dementia or have a physical disability. The home is in a rural location in Sherfield English, near Romsey. There is access to gardens and a hydrotherapy centre. Hydrotherapy is the use of water in the treatment of different conditions, including arthritis and related rheumatic complaints.
Dunwood Manor has a registered manager in post. 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.
At the last inspection on 10 February 2014, we asked the provider to take action to make improvements in respect of acting in accordance with the Mental Capacity Act 2005. This was because staff had a lack of understanding of the principles of the Act and because mental capacity assessments and best interest decisions had not been correctly documented. The registered manager submitted an action plan which stated that the home would be compliant by 30 April 2014. This action has now been completed.
People told us they felt safe in the home. Staff had completed safeguarding training and were able to explain to us how they protected people from abuse. Staff told us they were aware that they could report safeguarding concerns to outside agencies such as the police, the local authority and the Care Quality Commission.
Specific risk assessments were in place for each person in relation to falls, bed rails, safeguarding and mental wellbeing. Support plans were written in relation to each identified risk. Staff described how they learnt about people’s individual risks from handovers and care plans. The daily handover sheet included information about people’s individual risks in relation to their health, risk of falls, dietary needs and behaviours.
There were sufficient staff on duty in the home to meet people’s needs. Staff commented on how well the permanent staff worked together but stated that agency staff were usually less effective. Sometimes permanent staff felt pressured but did not feel there were not enough staff to meet people’s needs. On the day of the inspection, it was clear that staff were busy all day; however we noticed that call bells were answered within a reasonable time (approximately two minutes).
Recruitment and induction practices were safe.
Medicines were stored and administered safely. We checked records in relation to controlled drugs and found them to be accurate. Medication administration records (MAR) were kept for each person. We reviewed a sample of the records from the day of the inspection, which showed that medicines had been administered as prescribed.
Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and health and safety.
Training had taken place and some had been booked for nurses in respect of clinical competencies.
Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with residents appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.
Mental capacity assessments had been undertaken which were decision specific, where relevant. Where a care plan was required in relation to mental capacity, this was reviewed on a monthly basis to ensure the most up to date assessment was in place. This was important because people’s capacity can fluctuate. People made their own decisions where it was established, they had the capacity to do this, and their decision was respected.
We found that the registered manager had made appropriate Deprivation of Liberty (DoLS) applications and staff were aware of which people were subject to a DoLS and the restrictions these authorised. Handover notes included information on whether a DoLS was in place or whether an application had been submitted.
People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day. A tea trolley came round during the morning serving tea, coffee, fruit squash, biscuits and yogurts. The meals offered were home cooked, freshly prepared and nicely presented.
People were supported to maintain good health through access to ongoing health support. Following the inspection we received feedback from several health professionals who regularly visited the service. A dental officer told us they were always contacted appropriately and in a timely fashion. Two GPs and a pharmacist told us they regularly visited the home and were complimentary about the care. People using the service had access to an onsite hydrotherapy pool. Health needs were closely monitored within the home.
Staff were cheerful and attentive and had taken time to get to know people individually. One person told us about their interest in garden birds. Staff had ensured they were sat by a window so they could see the birds. One person said “The cleaner watered my plants for me this morning; I never asked for this, I thought it was considerate.” Relatives were complimentary about the home; one relative said “They’re so wonderful here.”
People were involved in decisions about their care and were offered choices in all aspects of their daily life. Privacy and dignity was protected and staff were able to respond appropriately to people’s needs due to the detailed and accurate care plans, risk assessments, daily records and handovers. Care plans contained information about people’s abilities, their desired outcomes and the support they required to achieve them, including any identified risks. People were encouraged to join in activities as much as they would like to. Detailed records were kept of activities with a sheet for each person recording the activity they had partaken, how much they had been involved and whether they had enjoyed it.
The provider had a complaints procedure which detailed how informal and formal complaints should be dealt with including. Complaints had been appropriately responded to, in a timely way.
There was a positive and open culture within the home. Staff said they felt able to raise concerns at any level of management, and were confident they would be responded to. Staff said they were actively encouraged through meetings and appraisal to give feedback about the service.
Improvements since the last inspection included the recruitment of a new registered manager, new care plans, a training pack for care workers and a clinical training booklet for care workers. Policies and management arrangements meant there was a clear structure within the home which ensured the service was effectively run and closely monitored. The quality of the service was closely monitored through a series of audits. A business continuity plan was in place to ensure the continuing care to people in the event of an emergency.