Dunraven House and Lodge

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

The service was previously in breach of legal regulations in relation to person centred care. At this assessment we found the service was no longer in breach of this regulation.

This service scored 71 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always decide, in partnership with people, how to respond to any relevant changes in people’s needs.

During our previous assessment we found shortfalls in relation to person-centred care. During this assessment, we found the provider had taken action against these shortfalls. Although improvements were found, the service still needed time to embed these actions and consistently deliver person centred care to all people.

During this assessment, we found that although the provider had made some improvements there were still some shortfalls. People were not always being supported in a person-centred way or in a way that met the expectations of Right Support, Right Care, Right Culture.

People told us if they wanted to socialise while drinking alcohol, they were required to leave the house and grounds, as per the provider’s policy. However, comments we received included, “I would like to have somewhere in the grounds to smoke and drink with my friends,” and “It’s an inconvenience going around the corner to the bench especially in winter time”. Managers confirmed this was the case and were looking into developing a social space within the grounds of the home. This meant some people currently had some restrictions for socialising within their own home.

In addition, we observed there were three TVs within a main lounge that were all on playing different programmes. This meant people could not watch or have conversations in peace. One person was watching a wildlife programme and commented “I cannot hear because of the other televisions”. Other people wanted to talk to us and found this difficult asking us to speak louder.

Since the last assessment, some areas of the home had undergone modernisation and refurbishment. There was a newly built kitchenette and a re‑decorated lounge area which provided a light, bright and functional space for people.

However, the layout in some parts of the home did not support a homely and welcoming environment where people were able to interact or where people were offered choice and control. In one of the lounges, the seats were arranged against the walls and spaced apart, instead of in a comfortable layout where people could sit together and chat. This made the room feel more like a waiting area than a living room, and it did not encourage people to spend time together, communicate freely or feel at home. We discussed this with the provider who told us they were aware that some areas of the home required change and were in the process of reviewing this, they took action in the moment by moving some items to enable people to be more comfortable.

People and relatives told us they were happy with the service provided, which met their specific needs. Staff told us providing a service to meet people’s specific needs was something that made them proud. This approach was reflected in the care records we reviewed. Comments from people included, “Staff have helped me with my recovery”, and “I have been wanting to do more for a while and staff have helped me get into employment”. Relatives provided written feedback about how the service was positively impacting their relatives.

Where people’s needs changed, staff escalated concerns to the provider who ensured referrals to partnership organisations were made. For example, a person’s mental health had declined, and the provider had proactively organised a new assessment of needs. They had supported a referral to an external stakeholder team by including recommendations and proactive steps they had already taken to support someone.

We were told, “It’s great that staff know me and know my needs, and they report this back to managers, it means I do not have to worry about explaining why my needs are changing”. This enabled people to feel safe, respected and empowered in their own homes.

We saw people wanting to actively talk to us about the activities they had been doing in the community, several people were proud to tell us about the jobs the provider had supported them to get.

The provider understood the diverse health and care needs of people and their local communities. Care was joined-up, flexible and supported choice and continuity.

The provider demonstrated a clear understanding of people’s diverse health and care needs and worked collaboratively with professionals to ensure continuity and flexibility in care.

Leaders and staff maintained open communication channels with GPs, occupational therapists, social workers and pharmacies, enabling timely interventions and coordinated support. Comments included, “Without the support from the staff I would not be where I am today,” and “Now that I have a job I feel I am part of the community”. Managers confirmed this and told us they had ensured continuity of care for a person who had purchased a car and was driving again.

Relatives were given regular updates through emails and scheduled calls from managers ensured where appropriate that relatives received care information. This was especially useful for relatives who did not see people regularly.

This integrated approach meant people received joined-up care that supported continuity and improved wellbeing.

The provider ensured people and their relatives had access to clear, timely and accessible information about their care and support.

Reviews were routinely completed with people, giving them opportunities to discuss their support and raise any concerns. The registered manager liaised with commissioners and stakeholders to ensure people received regular service reviews, and that any changes were communicated promptly.

The provider had a complaints policy available for people. This explained how to raise concerns if people were not happy with the service they were receiving. We saw regularly reviewed care documents and staff confirmed that they explained any changes in care plans to people and their families, ensuring transparency and involvement in decision-making. People told us, “Staff have sat down with me and helped me prioritise what I want to do”.

We saw staff sitting with people in advance to help them prepare for appointments. Staff asked open questions to ensure people had the knowledge and knew what to expect from their appointments. Staff confirmed this, telling us, “I’ll always check to make sure people know what to expect when they are due to go and see their GP”. Managers confirmed staff were supported through supervision and reflective practice to make sure communication was individual to people’s needs.

This meant people experienced a service that communicated clearly and which routinely checked for understanding and adapted to individual preferences. As a result, people felt informed, involved in decisions about their care and more confident in managing their wellbeing.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider completed reviews with people to give them opportunity to discuss their support. Managers liaised with commissioners and stakeholders to ensure people were receiving regular service reviews. Comments included: “[Manager] listens and helps me plan goals in a way I understand and that I can achieve in order to help with my recovery,” and, “[Manager] is great, I know I can give them a hard time sometimes depending on my mood but they always listen to me”.

Relatives told us they were approached for feedback from the provider. Relatives praised leaders for being open and for making improvements to the service. Managers told us, “We have a duty to listen to people and to ensure they are receiving the support that they want and need”.

We saw some staff engaging well while others. However, we did observe some staff not responding when people spoke to them or not engaging people in positive interactions. People told us, “Some staff are great at checking in and asking what I want, but it depends who’s on.” We spoke to the registered manager about this who told us they were developing this area with staff.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Assessments covering the accessibility of the home and whether any adaptations, equipment or referrals to occupational therapists were needed, had been completed.

People could choose who they wanted to support them for their care from the staff available that day. If additional support was needed, the provider ensured staff were made available for this. For example, when a person’s needs increased, the provider had ensured additional staffing was available. Likewise, when a person’s needs had decreased, the provider had shared this with the local authority. Managers confirmed this: “Over the months, we have worked hard with [person] and they will soon be ready to leave the home and move to a supported living environment”. These adjustments meant the provider was ensuring an individual approach to ensure all people received a service that was holistic in its style. Staffing was arranged flexibly to support people’s needs.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff had completed equality and diversity training and respected each person as an individual. People and relatives were involved in developing care planning documents and risk assessments and could make changes at any time they wished.

People who wished to do so, were supported to access the community to apply for jobs and were supported to access the community to undertake a range of activities.

People were supported to apply for benefits they were entitled to and if required, to attend the job centre with their staff. This meant people received support to enable them to experience equality in their outcomes.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

For example, staff told us, “We looked after [person] and supported them when they were in hospital so well that [person] had a great quality of life, had support and comfort from staff that knew them well”. Relatives confirmed this by writing to the provider and thanking them for their support.

Where appropriate, decisions were recorded in ReSPECT (Recommended Summary Plan for Emergency Care and Treatment forms). The ReSPECT form ensure people’s wishes are followed should they become ill or have to go to hospital. This information was also recorded in people’s care plans.

For people who were needed support and treatment for their mental health needs , the provider had enabled people to speak to their GP about further and ongoing support.

Once consent from people had been sought, where appropriate, future planning documents had been shared with relatives and chosen family members. This meant care was consistent, person-centred, dignified and helped to reduce uncertainty during critical situations.