Archived: Durnsford Lodge Residential Home

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 assessment of this key question in February 2019 we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care and staffing.

This service scored 46 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People were not truly involved, valued, or seen as partners in their care. There was limited information to demonstrate how staff were engaging with people in understanding their rights, supporting them to have increased opportunities, or enabling them to make informed decisions. For example, senior staff and the registered manager were reviewing people’s care plans and risk assessment monthly. There was no information to indicate how people were supported to take part in these reviews or show their views/wishes had been sought or used to inform their ongoing care and support.

Some care plans were not sufficiently detailed and contained minimal guidance for staff on how to care for people safely, according to their preferences and wishes. Others contained a good level of detail, but we found people were not receiving person-centred care in line with their preferences and emotional needs. For example, one person’s care plan stated they enjoyed all sorts of activities and really enjoyed visiting entertainment. We found there was no evidence of this person participating in any activities for 28 days. The lack of social stimulation had not been highlighted when this section of the person’s care plan was reviewed. This indicated reviews were not a person-centred meaningful exercise.

Staff did not maintain high-quality person-centred care records. Information recorded about service users was not person-centred and did not provide an accurate view of their lived experience. This contributed to a breach of regulation in relation to person-centred care.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Care plans we viewed reflected people’s needs in relation to their social, cultural and religious needs. However, it was not clear how these were being met. There were limited opportunities for people to use community services, visit places of interest, or sit in the garden. Following the inspection, the registered manager told us the people were offered to sit outside if they wished. There was no information about social gatherings or local events displayed within the service, and there was limited information to show how people’s religious or spiritual needs were being met.

The service did hold events to recognise national celebrations such as VE Day, but this was not consistent. For example, on the first day of the assessment, the activities programme indicated there would be a St George’s Day celebration; however, nothing had been planned, and nothing took place.

Where the provider had taken time to understand what was important to people in terms of their social activity [wishes], we saw many of these had not been achieved. This contributed to a breach of regulation in relation to person-centred care.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were not involved in a meaningful way in the development of their care and support, and information was not provided in a way which met service users’ individual communication needs.

When we arrived at the service on 23 April the orientation board in the main hallway was set to 16 April and had not been updated for 8 days. Living with dementia can mean it is easy for people to become confused or disoriented. Orientation boards support people by providing a prompt.

The registered manager told us they were fully aware of the Accessible Information Standard. Since 2016, all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

However, we found there was limited information to demonstrate how this was being used in a meaningful way to support and empower people. For example, people’s care plans were not accessible, notices around the service were in a normal font and at a height which may be difficult to read. Where the service had developed visual communication aids, such as the menu guides, these were not being used. This contributed to a breach of regulation in relation to person-centred care.

People's communication needs were identified, recorded, and highlighted in care plans. We noted one person had communication cards to aid their understanding, which were attached to their walking frame.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider did have systems in place for people and their relatives to share feedback or raise concerns. For example, complaint procedure, residents’ surveys and a suggestion box. The provider regularly engaged with people’s relatives through emails and social media platforms.

However, we found people’s views were not always important or valued. For example, whilst the provider had provided feedback to relatives about ongoing changes in the service. There was no evidence this information was being shared with people living at the service, for example, through meetings or newsletters, etc. Nor were people consulted about changes to their home. For example, when CCTV was installed. This contributed to a breach of regulation in relation to person-centred care and the need for consent.

The provider did not always make sure people could access the care, support and treatment they needed when they needed it.

People were at risk of harm because they were not always able to summon care staff in an emergency. For example, there was no call bell in communal areas for people to use, and there was no ongoing oversight of these areas as care staff were busy in other areas of the service. Call bells were not always in reach for people in their bedrooms, which restricted their ability to summon help when needed.

People’s emotional, social needs and personal care needs were not always being met as staff were task-focused and told us they did not have time to meet people’s needs in an unhurried manner. As detailed in the safe and caring sections of this report. This contributed to a breach of regulation in relation to person-centred care.

Referrals to specialist health services were made through the GP practice for services such as speech and language therapy to help support the service in meeting people’s needs.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People did not experience poor outcomes as a result of being discriminated against due to any protected characteristics. However, the service had not been developed in a way which truly valued or empowered people. There was a lack of understanding of how to provide good dementia care in practice. There was a poor culture where there were low expectations and a lack of purposefulness to people's day where people were not seen or valued as partners in their care. This contributed to a breach of regulation relating to person-centred care.

People were not always 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.

The service did not have good systems and processes in place to help ensure people’s wishes and needs were known and respected in relation to end-of-life care. For example, we reviewed 14 care plans and found most people did not have personalised end-of-life care plans.

Staff had not been provided with end-of-life / palliative care training. This training aims to equip care staff with the knowledge and skills to provide compassionate and competent care to people nearing the end of their lives and would cover subjects such as communication, pain management and emotional support for the person and their families.

The failure to develop and support people to plan for important life changes and ensure staff had received appropriate training meant people could not be assured their wishes would be respected, or that staff had the skills to support people and their families during this time. This contributed to a breach of regulation in relation to person-centred care, staffing and good governance.

Treatment escalation plans (TEP) were in place. This meant people's preferences were known in advance, so they were not subjected to unwanted interventions or admission to hospital at the end of their life, unless this was their choice. Senior staff told us how they worked with GPs to ensure ‘Just in Case’ end-of-life, pain relief medicines were readily available to healthcare professionals as required.