Dinsdale Lodge Care Home

Dinsdale Lodge Care Home is a care home providing personal care to up to 26 people. The service provides support to older people. At the time of our inspection there were 23 people living at the home.

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

People told us they were happy living at Dinsdale Lodge Care Home. The provider ensured people had a safe environment. Health and safety checks were regularly conducted. Staff were trained to support people in the event of an emergency. Medicines were managed safely. Risks were identified and managed.

Staff had completed safeguarding training. Information gathered from safeguarding concerns, accidents and incidents was analysed to identify trends or patterns with actions put in place to minimise risk of further incidents.

Staff had completed training in infection control and followed protocols to reduce the risk of infection. A robust recruitment process was in place. Enough staff were deployed to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager promoted an open culture. The provider and registered manager understood their duty of candour. Staff were knowledgeable about their roles and worked well together. The home had developed strong partnerships with health and social care professionals to ensure people received joined up care.

Effective systems were in place to monitor the quality and safety of the home. The home regularly sought feedback from people, their relatives and staff.

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

Rating at last inspection and update

The last rating for this service was good (published 29 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dinsdale Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dinsdale Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dinsdale Lodge Care Home accommodates 26 people in one adapted building across two separate floors. Both floors accommodate people with residential care needs, some of whom have a dementia type illness. On the day of our inspection there were 23 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Dinsdale Lodge Care Home was last inspected by CQC on 29 September 2016 and was rated Requires improvement. No breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified at the previous inspection but some improvements were required in the Responsive and Well-led key questions.

At this inspection we checked to see whether improvements had been made and we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out. A refurbishment programme was ongoing at the home, which included incorporating design that was dementia friendly.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals.

People’s needs were assessed before they started using the service and continually evaluated to develop support plans.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Dinsdale Lodge Care Home. Staff treated people with dignity and respect and helped to maintain their independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint and the provider had an effective complaints process in place.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys. People told us the management were approachable and accommodating.

We identified multiple concerns in respect of the safe care and treatment of people using the service. The registered provider failed to follow instructions and advice from other health care professionals. People’s health and nutritional needs were not being met in a safe manner. The registered provider did not ensure staff received appropriate training and development to enable them to carry out the duties they were employed to perform. The registered manager failed to ensure people were protected from the risk of financial abuse. Care records did not reflect people’s needs and preferences. People were not treated with dignity and respect. People’s confidential information was not held securely. Health and safety requirements in relation to water temperatures had not been addressed. The registered provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and failed to ensure that people received appropriate care and support.

We undertook this comprehensive inspection to check that the registered provider now met legal requirements. During this inspection we found the registered provider had implemented actions and some improvements had been made.

Dinsdale Lodge is a care home with accommodation for up to 28 people who require personal care, some of whom are living with dementia. At the time of our inspection 16 people were receiving a service. The service was no longer providing accommodation for people who required nursing care.

The service did not have 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.’

The registered provider had employed a manager who had submitted an application to be the registered manager for Dinsdale Lodge. The application was being processed at the time of the inspection. Staff gave positive feedback about the manager and the improvements in the home.

We reviewed the development plan introduced by the registered provider to ensure all the concerns we found in the previous inspection were addressed and quality was monitored. We found the registered provider had made progress against the development plan to ensure people were safe, but it was too early to assess the effectiveness of the audit process in driving continuous improvement.

Systems and processes were in place to manage safeguarding alerts, accidents and incidents. The registered provider had records of monthly analysis, investigations and lessons learnt. Statutory notifications had been submitted to the Care Quality Commission (CQC) appropriately. People’s monies were being kept in a locked safe with measures to audit monies coming in and out of the home. We found financial records had been completed accurately. Office doors were secure and had been fitted with key pads for entry.

We found people’s medicines were being managed safely. The registered provider ensured competency checks were completed for staff who had responsibility for administering medicines. Care workers had completed training in safeguarding, moving and handling, fire safety, food safety and care plan training. Some staff had not completed training for epilepsy and medicine management however this had been booked.

Care plans and risk assessments contained information about people’s care needs, these were reviewed on a regular basis. We found two care plans which required updating. We found advice and recommendations from health care professionals were being acted on. For example, speech and language and district nurses. Due to care plans being recently amended and in some cases rewritten following review, it was too early to assess how responsive the service would be regarding changes in need and the impact on people.

Health and safety certificates and risk assessments were in place. For example, testing of water temperature, gas safety certificate and fire checks. People had up to date personal emergency evacuation plans (PEEPs) in place to support safe evacuation in the event of an emergency.

We found the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and any conditions on authorisations to deprive a person of their liberty were being met. Staff had an understanding of the MCA and how this applied to the people they supported.

Information on advocacy and how to complain was available for people and visitors. The registered provider had developed a specific document to enable people with communication needs to complain.

The registered provider had a robust and thorough recruitment system. We found checks had been made with the disclosure and barring service, (DBS) these were carried out before they were employed to confirm whether applicants had a criminal record and were barred from working with vulnerable people.

We observed caring interactions between staff and people. People were given time and were not hurried in any way. We found staff respected people’s privacy and dignity.

People’s nutritional needs were assessed and met. We observed meals were appetising and well presented. The service provided a varied and health menu choice for people.

We found the registered provider had updated some areas in the home, radiator covers were being replaced and some bedrooms had been deep cleaned. The stair carpet was worn and in need of attention. Some bedrooms were in need of redecoration along with paintwork requiring repainting.

We completed an unannounced inspection of this service 25 June and 15 July 2015. The provider received a rating as Requires Improvement at that time.

Dinsdale Lodge Care Home is registered to provide nursing or personal care for up to 28 people. At the time of our inspection there were 20 people living at the home, some of whom were living with dementia.

The home had a registered manager. 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 2008and associated Regulations about how the service is run.

We concluded people were not being protected against the risks of receiving care that was unsafe or inappropriate. People were not fully protected against the risks associated with unsafe administration of medicines because the provider failed to ensure staff administering medicines were competent to do so.

Clinical staff and non-clinical staff had not received appropriate training to meet the needs of the people using the service. Staff had not completed the courses identified as being required on the training matrix. We found no refresher training booked for staff. Staff had not received regular supervision and appraisals appropriate to their role. The provider did not have effective systems in place to enable people using services to complain.

We found the registered manager had failed to make safeguarding referrals despite incidents falling within the threshold of safeguarding. The registered manager had not conducted their own enquiries into safeguarding incidents.

Mental Capacity Act 2005 (MCA) was not understood by the registered manager. We found the provider had not completed capacity assessments in relation to the Mental Capacity Act 2005.

Risk assessments for the building were ineffective and did not identify risks or control measures to keep people safe. The provider had failed to act on advice from their own contractor responsible for the management of legionella.

Care plans and risk assessments contained inaccurate information about people’s care needs. We found that recommendations from other health care professionals were not captured in people’s care plans. Recording practices in the service were poor.

There were not enough staff to meet people’s needs as detailed in care plans. A number of people required two staff to support them with moving and handling which meant people spent time waiting to be supported.

We saw people were not being supported to eat and drink safely. People were left unattended for long periods, with no ability to summon assistance.

There was no effective quality assurance system in place. The registered manager did not have any development plans to drive improvement, or act upon areas whereby changes had been identified.

People’s choices in relation to their care were not respected

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider had not made sufficient progress with the action plan they had submitted following our last inspection in April 2014. During this inspection we found gaps in signatures on medication administration records (MARs) for 13 people and in other essential care records for three people. We also found that systems to check the quality of care records, including medication records, were still ineffective in identifying and investigating concerns with record keeping.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The provider had developed systems to ensure potential risks were assessed and managed. Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe. We also found the provider assessed people, using recognised tools, against a range of potential risks. For example, the risks of poor nutrition, skin damage and falls.

The provider had effective systems in place to ensure that people received their medication safely and in a timely manner.

A range of health and safety related checks were in place to ensure the premises were safe. For example, weekly hot water checks, night-time security checks and a building safety audit. Most people had a personal emergency evacuation plan (PEEP), which provided staff with information about each person's needs should there be an emergency.

We viewed records that confirmed that the provider had implemented a range of checks of the equipment used by people in the home. For example, wheelchair safety checks and checks of specialist equipment, such as hoists,slings and specialist mattresses.

Staff had access to accurate and up to date records to enable them to provide appropriate care for each person.

Is the service effective?

Family members told us staff had spent time sitting and chatting with their relative about their life history. One family member commented, 'The staff made a tremendous effort to get to know my relative and find out what they like', and, 'Staff have time to spend with residents.' This meant staff had access to detailed information to help them better understand people's needs.

Staff had completed a 'This is your life' booklet for each person. This included important information about them, such as their life history and personal preferences.

Information gathered during the initial assessment was used to develop detailed care plans. Care plans clearly identified the goal or expected outcome of the care plan and identified the interaction and support required to achieve the goal.

We spoke with three people who used the service. They told us that staff asked them for permission before delivering any care. One person said, 'I am asked for my opinion.' Family members we spoke with were happy with how staff communicated with their relative. One relative commented, 'The staff have worked out the best method of communication for my relative.' People who were able to sign had signed their care plans to give valid consent to their care.

Is the service caring?

People said they received good care. One person said, 'Excellent, the care is good. The staff are very professional, nothing I ask of them is too much trouble.' Another person said, "The staff treat me great, it is like home from home.'

Family members told us that staff treated their relative not only with dignity and respect but also with affection. Family members confirmed that they had seen and read their relative's care plans. "The care is absolutely brilliant"; "The staff are very caring, I have seen first hand how much they try and engage people in conversation"; "The staff are so well mannered. They take time to talk and explain things to you", and, "The care is very good, I like my relative being in there."

Our observations during our inspection confirmed that staff delivered care in line with people's care plans. We saw that staff were attentive, kind and gentle whilst delivering care and continually explained to people what they were doing.

Is the service responsive?

One family member commented, 'Staff pick up changes in my relative's physical condition and act on it.'

People's dependency levels were monitored each month, which allowed staff to quickly assess whether a person's needs were changing.

Care plans were evaluated each month to ensure they remained current. The record of the review included a summary about each person's current situation. We saw from viewing care records that staff had taken action to respond to people's changing needs. For example, one person's care plan had been changed as they needed more assistance with moving and handling.

Is the service well-led?

The provider did not have a robust system of quality audits in place to identify gaps in care records, including medication records, and take appropriate action to address these gaps.

The current systems of medication audits or checks were ineffective in identifying gaps in medication records. During our inspection we found gaps in MARs that had not previously been identified and investigated.

Although the provider logged relevant information, such as details of incidents, accidents and complaints, we did not find evidence that this was analysed to identify trends and patterns in order to improve the care that people received.

We found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. People were not protected from unsafe or unsuitable equipment.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

People we spoke with told us that they were very happy with the care they were provided with at the home. They said, "They are great' and "I would not want to be anywhere else".