Archived: Dumpton Lodge

Dumpton Lodge is a residential care home providing personal care to up to 28 older people who may be living with dementia. At the time of our inspection there were 27 people being supported in one large adapted building.

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

People told us they felt safe living at the service. However, the provider and registered manager had not acted to mitigate risks to people to keep them as safe as possible. There was a new registered manager since the last inspection; the service had not improved.

Potential risks to people’s health and welfare had been assessed but when people’s needs changed risk assessments had not been changed to reflect this. Information in people’s care plans was not always consistent or accurate. Staff knew people well and were able to explain how they supported people.

There had been a large number of falls recorded in the year before the inspection, these had not been analysed for patterns or trends and this put people at risk of further falls. Though some action had been taken on an individual level, this had not been reviewed to check if the action had been effective.

Staff had not always been recruited safely. There was not always enough staff to support people when needed. People complained they had to wait to be assisted at night.

Checks and audits had not been effective in identifying the shortfalls found at this inspection. The provider visited the service regularly but had limited oversight of the quality of the service. People, relatives and staff had been given the opportunity to express their opinion of the quality of the service. The responses to quality assurance surveys had not been analysed to identify patterns and trends.

Opinions on the culture within the service varied. Some relatives were not comfortable to raise concerns and felt staff were defensive in their attitude when concerns were raised.

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.

Medicines were managed safely. The service worked with other health professionals to support people to access the support they need. The registered manager and staff understood their responsibilities to report concerns to the local safeguarding authority.

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 requires improvement (published 8 February 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

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

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.

We carried out an unannounced comprehensive inspection of this service on 9 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 has remained requires improvement. 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 Dumpton Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The management team were following advice and guidance from other agencies about infection control and prevention and had updated staff practice accordingly, for example changing the cleaning products used within the service.

¿ Alternative forms of maintaining social contact were used for friends and relatives for example, using video calls.

¿ There were designated, separate areas for donning/doffing personal protective equipment.

Further information is in the detailed findings below.

Dumpton Lodge is a residential care home providing personal to 27 older people at the time of the inspection. The service can support up to 28 people in one large adapted building.

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

People told us they were happy living at the service and they felt safe. However, the provider and registered manager had not acted to improve the involvement of people, relatives, staff and professionals in the service. At this inspection, people, relatives and staff had not been asked for their feedback about the service. Resident meetings were held monthly but were only attended by a small number of people, other people were not asked their views.

Potential risks to people’s health, welfare and safety had been assessed and there was guidance for staff to reduce the risk. Accidents had been recorded and analysed to identify patterns and trends. However, action taken to reduce risks and incidents had not been recorded and this was an area for improvement.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff had received training appropriate training for their role. Staff received supervisions and appraisals to discuss their practice.

Staff monitored people’s health and referred people to appropriate healthcare professionals. Staff followed their guidance to keep people as healthy as possible. Medicines were managed safely, and people received them as prescribed.

People had access to activities they enjoyed and were supported to stay as healthy as possible. People were supported to eat a healthy diet.

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.

People met with the registered manager before they moved into the service to make sure staff were able to meet their needs. Each person had a care plan containing details of their choices and preferences. Where possible people or their relatives were involved in developing their care. People were given information in the way they preferred.

Checks and audits had been completed on the all elements of the service and action taken when shortfalls were found. The registered manager attended local forums and was developing plans to make improvements to the service.

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 Requires Improvement (published 18 February 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains Requires Improvement. This is the second time the service has been rated Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements in safe and well led domains. We found no evidence during this inspection that people were at risk of harm from this concern.

Enforcement

We have identified breaches in relation to obtaining feedback from people, relatives and staff to improve the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Dumpton Lodge is a residential care home that accommodates up to 29 older people who may be living with dementia. At the time of the inspection 25 people were living at the service.

What life was like for people using the service:

People continued to feel safe and that staff met their needs and preferences. Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to follow to reduce the risks. However, checks on the environment to keep people safe had not been recorded and there was no record of how shortfalls were rectified.

People told us they were happy with the way they received their medicines. However, medicines were not always managed safely and people had not always received their medicines as prescribed. People felt that they were listened to and any concerns they had were dealt with, but there was no system to formally gain people’s opinions and suggestions to improve the service.

Staff understood people’s needs, choices and preferences. People told us that staff provided their care as they wanted and respected the decisions they made about their care. People were encouraged to be as independent as possible and be involved in decisions about their care.

People were supported to take part in activities that they enjoyed. People were encouraged to maintain relationships that were important to them, visitors were welcome at any time.

More information is in the detailed findings below.

Rating at the last inspection:

Good (report published 22 July 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service no longer met the characteristics of Good in all areas. The domains of safe and well led are now rated as Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

Dumpton Lodge is a detached home overlooking the sea in Broadstairs. The service is registered to provide accommodation and personal care for up to 29 people, some of whom may be living with dementia.

Accommodation is set over two floors. There are bedrooms on the ground and first floor and a shaft lift that connects the upper and lower floors. There are large communal areas. The home was clean, tidy and well decorated with good light. Corridors were uncluttered and wide with plenty of room for wheelchairs and hoists to be manoeuvred.

Rating at last inspection

At the last inspection, the service was rated Good and Requires Improvement in the ‘Safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 May 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dumpton Lodge on our website at www.cqc.org.uk

At this inspection we found the service remained Good and is now rated Good in the Safe domain.

Why the service is rated Good

The service had improved since the last inspection. Medicines were now stored safely and at the correct temperature. There were no out of date medicines. People received their medicines when they needed them.

Staff knew how to recognise and respond to abuse. There had been no safeguarding incidents since our last inspection.

Risks relating to people’s health and mobility had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

Dumpton Lodge is a detached home overlooking the sea in Broadstairs. The service is registered to provide accommodation and personal care for up to 29 people, some of whom may be living with dementia. Accommodation is set over two floors. There are bedrooms on the ground and first floor. There are large communal areas. The home is suitable for people with mobility difficulties.

The home was clean, tidy and well decorated with good light. Corridors were uncluttered and wide with plenty of room for wheelchairs and hoists to be manoeuvred. There were grab rails throughout and gates at the top and bottom of both staircases and a shaft lift connecting the upper and lower floors.

There is a registered manager in post and two deputy managers. 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 two deputy managers were present at the time of the inspection and we spoke with the registered manager after our visit.

We last inspected the service in February 2015 and found breaches with two of the regulations with regard to staff recruitment and making sure care plan records were up to date. The provider sent us an action plan outlining how they would meet these regulations. We found at this inspection that improvements had been made to meet both breaches from the last inspection.

At this inspection medicines storage needed improvement as some medicines had been stored at the wrong temperature in the fridge and the stock of non-prescription medicines had been kept in the cupboard too long and were out of date. Some of the medicines administration records were not completely accurate. The medicines checks that were carried out by the registered manager had not picked up some of these mistakes. This was a breach of the regulations and the provider was given a requirement notice to put this right.

The controlled prescription medicines (medicines which are at higher risk of misuse and therefore need closer monitoring) were stored safely, given appropriately and recorded accurately. People received their medicines safely and when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

People told us that they felt safe living at Dumpton Lodge. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. Two visitors of a person spoke about their experiences. They said "We couldn't be happier, [person] is kept safe, looks well and is dressed nicely". They went on to say that their relative had been very frightened living at home and imagined all sorts of things which scared them. Since being at the home "[person] is so happy, the carers can't do enough for her". "It is such a relief that [person] is so settled"

Staff reported accidents and incidents to the registered manager who made sure appropriate action had been taken to reduce the risk of accidents happening again. The registered manager checked for patterns and trends with accidents and incidents in the home overall and made sure that lessons had been learned and changes were made if needed.

There was a thorough system to recruit new staff and to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. A variety of training courses were provided to make sure staff had the skills and knowledge they needed for their role. Staff were clear about their roles and responsibilities and felt confident to approach the registered manager or deputies if they needed advice or guidance. They told us they were listened to and their opinions counted.

People were treated with respect and their preferences were taken into account when receiving their care. People said staff were considerate and took their time when supporting them so that they felt comfortable and unrushed. A person said, "I like living here, it's my home and I have everything around me". She went on to say that she did not need help with washing and dressing nor needed medicine or a zimmer frame to get around. "I can do my own thing all day" she said "I am very happy here".

People were supported to keep well and healthy and if they became unwell the staff responded in a timely way and made sure that people accessed the appropriate services. Visiting health professionals including district nurses and doctors were involved in supporting people’s health and wellbeing as needed.

Dumpton Lodge had been selected by the local district nurses to have specific health care beds commissioned by the doctor’s surgery to reduce unnecessary hospital admissions and were signed up to the Hydration Charter to improve people’s wellbeing and prevent infections.

People were complimentary of the food in the home and visitors were offered refreshments when they were in the home too. People said they were able to choose what they ate and there was always plenty. People were supported to have a nutritious diet. If people were not eating or drinking enough their food and fluid intake was monitored. Referrals were made to health care professionals, such as dieticians, when required. Mealtimes were social occasions and staff made sure that people had enough time to enjoy their meals and received the support and attention they needed. The deputy managers spoke enthusiastically about the new healthcare project to increase people’s hydration that they were involved in.

Staff behaved respectfully and were accommodating if people wanted drinks and snacks at different times. If people wanted to go to the toilet staff responded straight away. Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed.

A visiting relative told us, "I could get upset that she is here but it is so lovely and she feels so at home".

The registered manager and team had worked hard to update and review the care planning system. Each person had a care plan that included their preferences and all the information necessary to meet their individual needs. Risks to people were assessed and managed without restricting people.

There were two lounges and a dining room area where people could spend time and there were activities held in these spaces at different times. Some people preferred to stay in their room and this was respected.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance and had been approved.

People, staff and relatives told us that the service was well led and that the registered manager and staff team were supportive and approachable and that there was a culture of openness within the service. People and their visitors told us that if they had a concern they would speak to the registered manager or any of the staff. There was a clear complaints procedure and opportunities for people to share their views and experiences of the service.

Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

There was no overall development plan for the home to structure the projects they were focusing on or address any aspects of the service that needed to be improved on. This was an area for improvement.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

We found a breach of Regulation 12 regarding the safe handling of medicines. You can see what action we have taken at the back of this report.

People who used the service and their relatives, told us that they liked the home and the staff were polite, respectful and caring. They said they were confident and satisfied with the service and were able to visit at any time. One relative said, 'It is very welcoming here. The staff are friendly and work hard.'

We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. People were provided with appropriate equipment that was regularly serviced and well maintained.

There were less staff during the afternoon and evening so at times the staff were rushed and we found that people had to fit into the routines of the home. There were times when people were unsupervised so we have asked the provider to review the staffing.

Relatives and people using the service told us they did not have any complaints and would talk to the manager and staff if they had concerns. People told us they had meetings with the staff to say what they thought of the home.

At the time of our inspection the provider did not have a registered manager in post.

People said that they were very happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One lady said 'It's lovely here' another said 'I'm quite happy here. Staff treat me well'. Other people were complimentary of the food and had no concerns with regard to the quality of care. Another said 'Staff are very good. They respect us and treat us well'.