Dunwood Manor Nursing Home

Updated 5 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection team on the first day included a lead inspector, a second inspector, a specialist nurse advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who has used this type of care service. One inspector returned on the second day to complete the inspection.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. The provider had not been asked to complete a provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We instead discussed this information with the registered manager during the inspection.

During the inspection

We spoke with six people who used the service and with nine relatives. Not all the people living at the service were able to fully express their views about their care. Therefore, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, registered provider, director of care / nominated individual. We spoke with three registered nurses and four care workers. We also spoke with a chef, a member of the housekeeping team and a staff member responsible for planning activities. We reviewed the care records of eight people in detail. We also looked at the records for four staff that had been recruited since our last inspection and other records relating to the management of the service such as medicines administration records, audits and staff rotas.

After the inspection

Following the inspection, we obtained feedback from three health and social care professionals who worked closely with the home.

Updated 5 December 2019

About the service

Dunwood Manor Nursing Home is an extended and renovated country house set in large grounds. It provides personal and nursing care to up to 55 people. There were 43 people using the service when we inspected. There are two units. The Willows supports people who are physically frail or have complex health care needs. The Beeches cares for people living with dementia, some of whom also had frail physical health. Both units are nurse led and are arranged over two floors.

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

People told us they felt safe. Whilst most risks had been assessed and planned for, there were some areas where risk reduction measures needed to be more robust. There were sufficient numbers of staff to ensure that people were cared for safely, although some concerns were raised about the timeliness of support, the regular use of agency staff and the impact of this on the continuity and quality of care provided. Medicines were administered safely by staff who had received training and had been assessed as competent. There were some areas where staff could further embed best practice frameworks in relation to the management of medicines. There were systems in place to learn from safety events. However, there were a number of incident reports relating to unexplained bruising which although investigated had not been escalated to the local authority. The service was visibly clean throughout and no malodours were noted. Staff received training in safeguarding adults from harm and had a positive attitude to reporting concerns.

People needs were assessed and planned for. Staff were suitably trained, well supported and had the necessary skills and knowledge to perform their roles and meet their responsibilities. People’s nutritional needs were met, although there was room to improve the mealtime experience for some people. The design and layout of the building could be further improved to support those living with dementia. 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.

People had developed caring and meaningful relationships with staff. Where people could make decisions about their care, they were encouraged to do so, and this helped them to feel that they had control over their lives. Staff understood the importance of providing dignified care and supporting people to maintain their independence.

Overall people received person centred care that met their individual needs. People's communication needs were identified and planned for. People expressed confidence that they could raise any issues or concerns with any member of staff or the management team and that these would be addressed. The registered manager was passionate about providing people with a dignified and pain free death and the systems within the service supported this.

Feedback about the registered manager was positive and demonstrated that people, their relatives and health care professionals had confidence in their ability to lead the service and drive ongoing improvements. People and their relatives were consulted and involved on an ongoing basis about their care and wider issues within the home. The registered manager was open and collaborative and worked in partnership with local organisations and agencies to strengthen local relationships and improve care.

Rating at last inspection

The last rating for this service was ‘Good’ (April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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