Dorking Manor

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated Good

This meant people were safe and protected from avoidable harm.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service used an electronic recording system to record accidents and incidents, root cause and lessons learn and daily huddles were held to discuss lessons learnt and to share information to the wider team.

Following several incidents involving 1 person, the registered manager reviewed and changed their practice regarding the use of sensor mats. They now ensured, where appropriate, that a sensor mat was positioned on either side of a person’s bed where the person had a history of falls. A staff member told us, “In the mornings we have briefings and we go through the situations and any learning from that. We discuss falls, weights and I think this is really good and prepares me for my shift. Every day is something new and its very important to have briefings in the morning.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager had access to the GP practice systems and had a trusted assessor within the hospital. This helped ensure that people did not have to provide the same information to several people and in turn helped make their move into the service run smoothly. A relative told us, “Her experience, and ours, has been very positive, the staff made her feel very welcome, they helped her to settle in smoothly, they accommodated personalised items in her room.”

When information was shared which indicated a person’s potential higher need, the service worked with external partners to check it was safe for the person to move in. This included liaison with external health professionals when 1 person was on a medical trial.

Once living in Dorking Manor, people and their families could access support from the in-house dementia group who gave them moral support as well as guidance.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The registered manager worked with the local authority safeguarding team to record, refer and investigate any potential safeguarding concerns or allegations of abuse.

Staff received training in how to recognise safeguarding concerns and understood their role in supporting people to stay safe and free from intentional harm. A staff member told, “If I saw or suspected anything I would report it immediately to my line manager or the deputy manager.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The service had made appropriate DoLS applications for people whose liberty was being restricted.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff supported people to remain safe. One person said, “I’ve had no falls since being here. That’s why I came here because I had falls at home.” Another told us, “It does feel safe. If you have a fall, they (staff) appear from all directions.”
When people were sitting in the lounge or dining areas they had essential equipment to hand which included their walkers, walking sticks or mobility aids. When 1 person was being transferred between a chair and wheelchair, staff spoke with them throughout informing the person what was going to happen. When the person was sitting in the wheelchair staff ensured their feet were on the foot plates before moving them.

We observed staff supporting people to move about the service and checking in on people to make sure they were okay and yet there was a sense of positive risk taking as some people were also seen to be walking independently without staff support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People lived in an environment that was appropriate for people’s needs and checked for its safety. The corridors were wide and people had no problems accessing all areas of the floor with their mobility aids and there were handrails around the corridors to aid safe movement.

Numerous checks were regularly completed in the service which included fire safety checks, general maintenance and flushing water systems to reduce the risk of Legionella. This helped to ensure that any actions were identified and resolved quickly.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We observed staff around the service throughout our visit and people and relatives told us they felt on the whole, there were sufficient staff, although we did receive some mixed views. People told us, “There is a call bell, but I don’t need to use it”, “They do come along promptly when you call them, but I’m not sure if they have enough staff”, “I don’t use a call bell but there always seems to be someone around to help if you need them” and “When I use the call bell they get here quickly.” Relatives said, “I don't think they have enough staff to manage the needs on the floor” and “We were a little concerned about staffing levels following an influx of residents earlier this summer but are reassured that many more were recruited.”

Staff had similar mixed views telling us, “Yes and no, some days when staff call in sick, but we cope” and “It’s enough. We do everything. We take care of the residents, serve their meals, going outside, activities we help. Support in the laundry and if team leader busy we help with medication. Every day the residents have their own routine. It’s fine.”

We did not see people having to wait for support. When 1 person wished to go for a walk in the garden staff immediately supported them to do this, inviting another person along at the same time. When people were moving between the lounge and dining room for lunch, 1 staff member always remained in the lounge so people were not left alone.

Staff received the necessary induction and training to support them in their role. Staff told us, “From my point, I joined with my colleague, it was good. We had a lot of experience, I came from nursing home and I learned everything. It was very good at that moment”, “I am doing a level 2 (qualification) in dementia” and “We do refresher training and online and face to face.”

The registered manager told us, “In a short time have promoted 2 staff to leads. They have showed in their appraisals a willingness to take further training and tell us they would like to be considered. We make sure they have the same opportunities too.”

Staff were recruited through safe practices which included them providing a full employment history, evidence of performance in previous roles and their right to work in the UK. All prospective staff underwent a Disclosure Barring Service check prior to commencing work. This helped ensure they were suitable to work at this type of service.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We received positive feedback about the cleanliness of the service. People told us, “It’s always kept spotless”, “I can tell if they’ve been in to clean my room just by using my nose”, “I’m definitely happy with the cleaning. They do it top to toe” and “They change the bed sheets and clean the room regularly.”

People also told us staff used appropriate personal protective equipment saying, “They do wear gloves and aprons” and “The wear gloves when doing personal care.”

The environment in which people lived was extremely clean and well-presented. Although we saw housekeeping staff working throughout the day we found 1 area of carpet with a malodour. However this was addressed before the end of the day. The laundry room within the service was well organised, spacious and followed good practice with dirty and clean areas. This helped reduce the risk of any cross-contamination when people’s clothes were being laundered.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People told us they got the medicines they needed. One person said, “The medications are good. All done on time. Everyone has a box with their name on it. They’re very hot on that.” Another told us, “The medication is all done well.”

People’s medicines were stored securely and in a clean, orderly manner, with appropriate arrangements in place to maintain the required storage conditions and protect medicines from unauthorised access. Staff were recording the temperature of the room and the fridges to help ensure that medicines were stored in line with the manufacturers requirements.

There were processes for ordering, receiving, administering, recording, and disposing of medicines and stock levels were monitored to reduce the risk of missed doses.

Each person had a medicine administration record (MAR) which included a clear photograph of them, details of how they preferred to take their medicines and information about their GP and any allergies they may have.

Staff used an electronic MAR system which helped ensure people received the medicines they were prescribed in line with the prescription. This included where people were on medicines that had to be given at specific times.

Medicines were only given by trained and competency assessed staff. A staff member told us,

“At the moment, our competency is done by one of my colleagues but the deputy manager registered manager will do them too.”