Dunraven House and Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager assessed people’s needs before they started using the service to ensure needs could be met. They met with GPs, psychiatrists and social workers to get a good understanding of people’s needs before joining the service. Staff told us they received good information about people’s needs. Comments included, “People have positive behaviour support plans and this means we can support people to be the best version of themselves”. Managers confirmed this by telling us, “We undertake a thorough assessment of people’s needs, but it doesn’t stop there, we review these needs regularly and feed back to the local authority where relevant”. There were detailed care plans and staff developed risk assessments in partnership with people, so they could take positive risks.

There were frequently updated and reviewed care plans which changed in line with people’s needs. For example, one person was supported through dynamic care planning that adapted responsively to their changing needs. The provider supported them to purchase and maintain a vehicle. This meant people’s needs were continually and effectively assessed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People told us staff provided good support for them to undertake their daily lives. One person told us, “I now have a job and I love this, staff have supported me to do this.” Managers told us, “Since starting work, [person’s anxiety] has reduced”. We triangulated this by viewing incident sheets which showed a reduction in anxious behaviours for that person.

The principles of Stopping over medication of people (STOMP) were delivered by the provider. These principles included the reduction of psychotropic medicines by regularly reviewing prescriptions, ensuring medicines were only used when clinically appropriate, and working with people and healthcare professionals to explore non‑medicinal, person‑centred alternatives. For example, one person went walking regularly throughout the day which reduced the person’s reliance on PRN medicines. Managers told us they supported people to access their mental health teams regularly.

Care staff completed regular training in nutrition, moving and handling, dementia and positive behaviour support to ensure their knowledge was up to date. This meant staff could deliver care in line with national guidance.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people joined the service. The provider worked closely with relatives. Feedback from relatives was requested by the provider as a form of quality assurance. Feedback comments included: “[Provider] is great, I do not understand where this recent negativity has come from” and “[provider] has always provided all aspects of care for my relative to a great standard. I know they are safe there”.

Where support from external agencies was required, we saw evidence of good communication and partnership working. Speech and language therapists (SALT), behaviour teams, and the mental health team had engaged with the service to ensure people’s changing needs were assessed. For example, a delegated nursing task had been identified by the provider who took steps to ensure this was organised collaboratively.

People told us, “Staff work well together here in the home” and “teamwork helps ensure people’s needs are understood and met without delays”. Managers confirmed they had regular systems in place—such as multidisciplinary meetings with external stakeholders, handovers and team meetings—to promote collaborative working and to address any issues promptly, contributing to a cohesive and joined‑up approach to care. This meant staff worked consistently across different teams and shared information effectively to support safe and coordinated care for people.

The provider informed us they had recently moved their paper-based systems over to a digital based platform in order to manage training, policies and procedures. The registered manager was in the process of transferring all documentation across to the new platform.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were diabetic menu options available for people who were pre-diabetic and vegetarian options available for those who wanted a meat-free alternative. People told us about the options available to them. One person told us: “I’m going for the vegetarian option today because I feel like it”.

Another person told us they were supported to manage their health needs. They commented, “[Manager] is great really, he takes time and I know he’s busy, but he takes time to go with me to my appointments”. A manager confirmed this “I feel it’s important that I go with [person] as this represents consistency in support for him”. This meant people experienced consistent, person‑centred support that helped them engage with services and maintain progress in managing their addiction and were given the support and advice to make healthier living choices

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes for people were positive and consistent and that they met both clinical expectations and the expectations of people themselves.

Staff recorded observations and noted changes in a person’s health, which were reviewed by the registered manager. When a person showed signs of reduced engagement, staff escalated concerns promptly, leading to a GP referral and adjustments to their care plan. Relatives commented: “They monitored [person’s] mood, they noticed [person] was spending more time on their own, staff called the mental health team and arranged a check-in with them”.

Staff regularly monitored people’s progress using tools such as wellbeing check‑ins and risk reviews. We saw up‑to‑date records showing staff tracked changes in people’s mental health and adapted support accordingly. Staff worked alongside external professionals, including community mental health teams and GPs to ensure people received support when their needs changed. We saw examples where health needs led to a swift review and improved stability for the person.

People told us staff helped them understand their goals and what progress looked like. Comments included: “They always check in with me and ask what’s working and what isn’t. It makes me feel involved in my own recovery.” Another person said, “The staff that do know me well can notice when I’m struggling before I say anything, and they change things to help me cope better.” People said they felt able to talk openly and that staff responded quickly when they raised concerns about their mental health.

Managers confirmed they reviewed outcomes data regularly, including incidents, safeguarding concerns, and progress against recovery goals. They told us this helped identify trends and ensure people were receiving effective support. Managers described how staff were encouraged to reflect on practice and use feedback to drive improvements. They gave examples of changes made, such as adjusting someone’s route to work so that they could be deterred from stopping at the pub on the way.

This meant people’s outcomes were monitored and changed in-line with their achievements and wishes.

The provider carefully explained to people what their rights around consent were, made sure they fully understood them and respected these when delivering person-centred care and treatment.

All staff we spoke to all demonstrated an understanding of the Mental Capacity Act and what consent meant. People told us staff asked for consent. Staff understood the need to follow the best interest decision making process if people were assessed to lack capacity to consent to a specific decision.

Mangers told us about people’s fluctuating capacity, and this was listed on capacity assessments. Three people told us staff would always ask to gain their consent, but staff knew when not to ask them questions if it was a time when their capacity was at risk of fluctuating. One person told us, “When I have a drink staff know they will not get the best answers out of me, so they wait until they know I have not been drinking if they want to talk to me about my support”. Staff told us, “It is okay to make unwise decisions. I would not try to change a person’s view or insist. I always try to value their decision” and “I make sure decisions and options are discussed with people and are for people’s best care outcomes”.

This meant people were supported in a way that recognised the differences of their decision‑making abilities and respected their rights under the Mental Capacity Act.