Dunniwood Lodge

Dunniwood Lodge is a residential care home providing personal and nursing care for up to 44 people. Some people using the service were living with dementia. At the time of our inspection there were 32 people living at the home.

People's experience of using this service and what we found

People were safeguarded from the risks of abuse. Staff received training in this area and knew how to recognise and report abuse.

Risks associated with people's care were identified and risk assessments were in place to minimise the risk.

Staff were knowledgeable about risks associated with people's care.

Accidents and incidents were monitored, and trends and patterns identified. Lessons were learned when thinks went wrong.

People received their medicines as prescribed. Competency checks were carried out and staff were knowledgeable about medicine management.

The provider had a robust recruitment procedure which ensured new starters were recruited safely.

We observed staff interacting with people and socially engaging with them. Staff we spoke with felt there were enough staff. They also told us that the management team was supportive and assisted them when needed.

The provider made sure infection control processes helped keep people safe during the COVID-19 pandemic. The home was clean and there were PPE stations situated at several points throughout the home.

The provider had managed the current pandemic well and implemented effective procedures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 March 2018).

Why we inspected

We received concerns in relation to poor management, staffing and infection control standards. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Prior to the inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from the reported concerns. Please see the safe, caring and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dunniwood Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We found the following examples of good practice.

The service was accessing the government testing scheme which had assisted them to identify an outbreak quickly. The service worked with the local authority infection, prevention and control (IPC) team and other health professionals in managing the outbreak.

The home was clean and had regular cleaning regimes in place. Clear infection prevention signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

Clear communication with staff reinforced hygiene practices, such as shift handovers and daily meetings.

Hand sanitising points were readily accessible throughout the home and staff used these frequently.

Staff ensured people using the service could maintain links with family members and friends.

Appropriate risk assessments were carried out to assess the impact of COVID- 19 on people and staff.

People isolating in their rooms had regular contact with staff who wore personal protective equipment (PPE) appropriately. Staff told us they had a plentiful supply of PPE.

Further information is in the detailed findings below.

There was 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 our last inspection on 5 December 2016, we asked the provider to make improvements to ensure that care staff were deployed effectively. In addition, we asked the provider to make improvements to the level of detail contained in people’s care plans.

The findings from our inspection on 22 February 201 confirmed that appropriate action had been taken and improvements had been made.

There were arrangements in place to keep people safe and to help safeguard people from the risk of abuse. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policy and procedure. Potential risks associated with people, the environment and equipment had been identified and managed. People continued to receive their medicines safely. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed regularly. People were protected by the prevention and control of infection where possible. Accidents and incidents were monitored and recorded.

People's needs and choices continued to be assessed when they started using the service. People received care that was personalised to their needs. People were supported to take part in meaningful activities which they enjoyed. People were encouraged to raise concerns or complaints and were asked for feedback about the service they received.

People continued to have access to food that they enjoyed and were able to access drinks and snacks throughout the day. People's nutrition and hydration needs had been assessed and recorded. Staff and the kitchen team met people's specific dietary needs and support. Staff ensured people remained as healthy as possible with support from health care professionals, if required.

Staff were seen to be kind and caring towards people. People and their relatives were involved with making decisions about care and support. People were treated with privacy and dignity.

There continued to be enough staff on duty with the right skills to meet people's needs. Staff received the training and support that they needed to carry out their responsibilities in delivering care and support that was effective and responsive. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People and others were encouraged to express their views and had completed surveys. Systems were in place to monitor the quality of the service being provided to people. They were a range of checks and audits carried out to ensure the safety and quality of the service that was provided to people.

Dunniwood Lodge is a care home which provides care and support for up to 44 older people. It is situated in Bessacarr, near Doncaster within easy reach of bus stops, shops and other amenities. At the time of our inspection there were 36 people using the service.

The service had a registered manager in post at the time of our inspection. 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.

Throughout our inspection we observed staff interacting with people who used the service and found there were enough staff on duty to meet people’s needs. However, there were times throughout the day that staff were not deployed appropriately and could have been more organised. For example, we observed breakfast taking place and saw that some people who required assistance were not supported. We also observed people ringing the call system and it taking staff quite a while to respond to them.

We looked at records in relation to medicine management and found each person had a Medication Administration Record sheet in place. However, we found some gaps in recording medicines. Therefore this did not always evidence when people had been given their medicines. We spoke with the registered manager who had already commenced action to address this.

We saw risks associated with people’s care had been identified and risk assessments had been put in place to help reduce the risk from occurring.

We looked at three recruitment files and found the provider had a safe and effective system in place for employing new staff. The three files we looked at contained pre-employment checks and they were obtained prior to new staff commencing employment.

Staff were knowledgeable about protecting people from the risk of harm and knew what action to take if someone was at risk of abuse.

We looked at records in relation to training and saw that some training required updating to bring it in line with the providers policy. We spoke with the registered manager and were told that training was completed face to face by an outside training company. Staff felt supported by the registered manager.

People received a balanced diet based on their individual needs and choice. However, some people struggled to eat their food as they required more support. Drinks and snacks were provided at regular interval throughout the day.

Through our observations and from talking with staff we found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). We spoke with the registered manager who knew when to apply for DoLS for people and evidenced that some applications had been made to the supervisory body. Some had been approved and some were awaiting the outcome.

We observed staff interacting with people and we found they were mostly kind and caring in their approach. However, some interactions were task focused and were not personalised to individual people. Staff ensured that people’s privacy and dignity were maintained.

We looked at care plans belonging to people and found they did not always give a clear picture of the support people required and did not always give enough detail. We spoke with the registered manager about this and were told that all care plans were in the process of being updated as audits of care planning had revealed similar issues.

We spoke with people and were told that activities took place. However, the activity co-ordinator was not available on the day of the inspection and there was not much activity for people to get involved in.

The service had a complaints procedure and people felt able to raise concerns with the registered manager.

We spoke with people who used the service, their relatives and staff and they felt the registered manager was approachable, friendly and would address any concerns without delay.

We saw that audits had been completed to ensure the service was providing appropriate care and support. We also saw that actions were addressed and resolved.

We saw evidence that people were involved in the service and were asked for their feedback. People were able to contribute to new projects and offer ideas and suggestions to improve the service.

Dunniwood Lodge is a care home situated in Bessacarr, Doncaster. It provides personal care for up to 44 older people. At the time of our inspection the service was providing care and support to 37 people.

The service did not have a registered manager in post at the time of our inspection. 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. A home manager had been appointed and had been in post since 26 October 2015 and was in the process of applying to be registered with the CQC. The manager was currently identifying areas for development and devising management systems to assist her. However, these required embedding in to practice. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Medicine management was not always in line with the provider’s policy. Medicines prescribed on an ‘as and when’ basis (PRN) did not have an appropriate record of why the medicine had been given and what effect this had. We saw gaps in the recording of the temperature of the fridge and room used to store medicines.

The manager kept a log of safeguarding concerns and the outcomes. We saw evidence that safeguarding was taken seriously and reported appropriately.

We looked as care files and found plans were in place to manage any risks associated with people’s care.

We saw enough staff were available to meet people’s needs and they responded quickly when they were required to. However, we saw someone had to wait quite a while to be transferred from their wheelchair into a comfortable chair.

We saw training records and spoke with staff and found that training had not taken place for quite a while prior to the new manager starting work at the service. However, we saw that some training had been completed since this and their was a plan in place to address this issue.

People were supported to make decisions about their care and their choice was respected. Care plans included information about people’s likes and dislikes.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. However, we saw some lack of choice around the main meal.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. We saw care plans included guidance from other professionals.

Through our observations we found staff were supporting people in a friendly and caring manner.

Care plans we looked at included a lifestyle profile which indicated how the person would like to spend their day, what time they like to rise and retire. Care plans also included a map of life which gave information about the person’s life history.

We saw staff interacting with people, but found this was not always in line with their care plan. Care plans were reviewed on a monthly basis and we saw that where appropriate changes had been made to reflect the person’s current needs.

The provider had a complaints procedure displayed in the entrance are of the home. We spoke with people who used the service and their relatives and most told us they did not need to complain. They felt able to speak with the manager if they had a concern.

During our inspection we saw the registered manager interacted well with staff and people who used the service. People knew her well and she made time for people who used the service, relatives and staff.