Dukeminster Court

Dukeminster Court is a residential care home providing personal care for to up to 75 people. The home is purpose built and consists of 5 units, each with separate adapted facilities. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 67 people using the service.

There was an increased risk of people's oral health needs not being met. Incident reports had not always been completed by staff. People's care plans did not always contain current information on managing risks. Environmental risks were not always identified and managed in line with guidance. People did not always receive their medicines safely. However, infection control measures were robustly followed, and staff had access to sufficient PPE. People told us they felt safe and there were enough staff. Relatives told us they felt free to visit without restrictions.

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.

Systems and processes were not always operated effectively to ensure safety and quality risks were well managed. There was evidence that people's preferences around who supported them were not always met. The provider was working through action plans to improve quality concerns they had identified and took action in response to the concerns we found during this inspection. People and their relatives informed us there was a positive culture in the service, and our observations of how staff interacted with people confirmed this.

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 5 January 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained an injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of people's individual risks. This inspection examined those risks. As a result, 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 has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to safety and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dukeminster Court is a care home providing personal care to 43 people aged 65 and over at the time of the inspection. The service can support up to 75 people.

Dukeminster Court accommodates people in five separate units across three floors. At the time of the inspection, one floor and one unit was closed due to vacancies. Each bedroom had ensuite facilities. There were also shared indoor and outdoor spaces in each unit such as a garden area, onsite hairdressing salon, lounge, kitchen and dining area. There was an office at the front entrance of the building. Two units specialised in supporting people living with dementia.

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

People told us they felt safe living at Dukeminster Court. They liked the staff and told us staff treated them well, were kind and knew them very well. Staff knew how to keep people safe and what to do if they had any concerns.

People were supported by trained staff in all aspects of their daily life. This included going into the town, maintaining contact with friends and relatives, having meals and drinks out, socialising and meeting their health needs.

People told us the management had improved since the recent start of the new registered manager and this had a positive impact on the quality of care they received. This included things such as no longer having to wait for help when they called, complaints being resolved quickly and feeling listened to.

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 made sure all staff and visitors followed the latest government guidance for reducing risks about COVID-19 and the spread of infection. Staff had received additional training on this topic to ensure they could keep people as safe as possible.

People were supported to safely administer their medicines and agreed with staff and medical professionals what time they would like to take them. Where there were signs that a new medicine was having an adverse effect, the staff referred the person back to their doctor for review and advice.

People had access to health professionals who worked closely with the staff and management team to ensure all health concerns were looked into straight away. The senior staff had been trained to observe and record basic health observations such as blood pressure and oxygen levels to help professionals get the right information and monitor people’s well-being quicker.

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 2021) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 22 January 2021. Breaches of legal requirements were found. There were concerns identified in safe, caring responsive and well-led.

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, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 Dukeminster Court 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Dukeminster Court is a residential care home providing personal care to people aged 65 and over, some of whom live with dementia. At the time of the inspection 53 people were living in the home. The service can support up to 75 people. The home is purpose-built over five units accommodating three floors. Some units specialise in providing care to people living with dementia.

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

The individual risks to some people had not been identified, assessed or fully managed. This had resulted in harm to some people and put others at risk of harm. The service’s current quality monitoring systems had failed to identify and rectify this although a new system was being introduced at the time of this inspection. Not everyone we spoke with felt there were consistently enough staff to meet people’s needs promptly which meant there was sometimes a delay in people receiving assistance.

People received their medicines as prescribed and good processes were in place to help protect them against the risk of infection. Safe recruitment practices were followed and regular maintenance and servicing meant the environment and equipment remained safe.

People told us they were happy living in the service and relatives spoke positively about the home, it’s management and staff. There was a positive culture amongst the staff and team work was effective and supportive. People were involved in their care and support and relatives were kept updated in relation to the health and wellbeing of their family members. People told us they would recommend the home. One person who used the service told us, “I like living here. Everyone is so nice to me.”

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 (report published on 18 February 2020) 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 has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of falls. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service remains as requires improvement.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe care and treatment of people and governance at this inspection.

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

Follow up

We will request an action plan from, and meet with, the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dukeminster Court is a residential care home providing personal care to 71 people aged 65 and over at the time of the inspection. The service can support up to 75 people. Dukeminster Court is purpose built over three floors with separate wings.

We inspected Dukeminster Court on 8 October 2019. When we visited that day there was a chest infection outbreak on two floors of the home which meant we could not visit these parts of the service. We intended to return on an unannounced visit on 7 November 2019, but the home had an outbreak of a diarrhoea and vomiting virus, so we could not attend. We returned to the service on 20 December as an unannounced visit to complete the inspection.

We found positive elements to the service, however we also found some shortfalls with how the provider and the registered manager were monitoring the quality of the service. At times there potentially were not enough staff to meet people’s social needs. Some staff practice was not person centred. There were missed opportunities in terms of staff chatting to people and checking they were comfortable. The provider had not identified this shortfall. Staff tried to spend time with people but this was largely seen as an addition to their work rather than part of their role.

Some people did not have completed risk assessments and care plans to support staff to promote their safety. Good and safe practices was not always followed when administering people their medicines. These issues had not been identified by the provider or registered manager.

Staff we spoke with had a good understanding about how to respond if they had concerns about a person being harmed in some way. Various safety checks were taking place to promote people’s safety when they were in the building and using any equipment.

Staff felt supported and believed they could access advice from senior staff if they needed to. Staff spoke well of their inductions and training. The provider ensured all training was face to face because they believed this led to effective learning, staff also agreed with this approach.

Systems were in place to monitor people who fell and who were a low weight. Action was taken to promote people to gain weight. People and relatives spoke well of the food and drinks. There were choices and people ate their favourite foods.

When people were unwell health professionals like GP’s were called upon. People and relatives felt confident the staff knew what to do in these situations and knew people well enough to know if they were unwell and needed support.

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 and their relatives believed staff were caring and kind. Where possible people’s independence was encouraged by staff. There was a range of events which took place at the home. Thought was given at these times to what people found interesting and fun.

People had end of life plans in place and the staff had received compliments of how they had supported people at this time in people’s lives.

Relatives spoke well of the staff and the registered manager. They spoke about how the registered manager was out and about in the home and how they responded to issues when these happened.

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 on 8 April 2017).

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to how people's safety was managed and how the quality of the service was assessed. There were shortfalls in how the registered manager and the provider assessed and monitored the service. Some people's risk assessments were not complete. 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. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dukeminster Court provides accommodation and personal care with nursing for up to 75 elderly people, some of who are living with dementia. At the time of this inspection there were 70 people living at the home

The service has a registered manager in place. 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.

During our previous inspection undertaken on 16 June 2016, we identified concerns in relation to medication. The provider sent us an action plan and told us that they had taken immediate action to make the necessary improvements. During this inspection we found that the required action had been taken. The provider had created robust processes to ensure that peoples medication was always available in the home.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

There were enough staff available to support people to be safe in the home.

The provider had robust recruitment processes in place. Staff understood their roles and responsibilities and would seek people's consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people's individual needs.

People were supported by caring and respectful staff who knew them well. Staff were given the opportunity to get to know the people they supported through keyworker roles.

People's needs had been assessed, and care plans took account of their individual, preferences, and choices. Staff supported people to maintain their health and well-being.

Feedback was encouraged from people and the registered manager acted on the comments received to continually improve the quality of the service. The provider had effective quality monitoring processes in place to ensure that they were meeting the required standards of care. There was a formal process for handling complaints and concerns which were investigated and resolved in a timely manner.

Dukeminster Court provides care and accommodation for up to 75 people, some of whom are living with dementia. At the time of our inspection there were 68 people living at the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 processes in place to manage people’s medicines were not always effective. Although most medicines were provided by the pharmacy in pods on a monthly cycle, where this was not the case people’s medicines had run out on a number of occasions. This could have had a detrimental effect on their health and well-being.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. People who lived at the home took part in the selection process for new staff. Staff received training to ensure they had the necessary skills to care for and support the people who lived at the home. They were supported to develop additional skills that would enable them to deliver a higher quality of care. Staff had regular supervisions and appraisals during which they could discuss their training and development needs.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People enjoyed the food that was available to them and had a variety of nutritious food and drink. If they did not like what they were offered at meal times they were provided with alternative food. People at risk of malnutrition or dehydration were monitored and where appropriate fortified food and drink was given to them.

Staff were kind and caring and protected people’s dignity. Staff treated people with respect and supported them in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to about the services provided at the home. People were assisted to access other healthcare professionals and services to maintain their health and well-being.

People and staff were encouraged to attend meetings with the manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place.

During this inspection we identified that there had been a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people’s medicines were not always managed appropriately. You can see what action we told the provider to take at the back of the full version of the report.