Durnsford Lodge Residential Home

Durnsford Lodge is a 'care home' that provides care and support for a maximum of 28 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 24 people were living at the service.

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

People told us they were happy; they felt safe and the staff were kind and caring. However, we received mixed feedback from relatives about the care provided.

We found whilst the provider and new registered manager had made a number of positive changes since the last inspection, more work was needed to ensure the service was operating in accordance with the regulations and best practice guidance.

People were not always protected from the risk of harm associated with their complex care needs or the environment. We asked the provider to take immediate action to address those concerns. Following the inspection the provider confirmed they had taken action to address concerns identified in relation to people’s living environment and fire safety.

People were not always supported to have maximum choice and control of their lives and staff were not always supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

People’s medicines were administered and disposed of safely. However, medicines needing extra security were not being stored safely or securely.

Staff were recruited and employed in sufficient numbers to meet people's needs. However, we have made recommendations about the use of agency, students, and the deployment of staff.

Poor judgements and decision making did not always demonstrate a culture where people were valued and respected consistently.

Governance systems were either not embedded into practice or not undertaken robustly enough to identify and monitor the quality of the service and effectively drive improvements.

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 17 March 2022). 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.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We have found evidence that the provider needs to make improvements. Please see the Safe Effective and Well-led sections of this full report. 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 not changed.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent, dignity and respect, premises and equipment and good governance at this inspection. We have also made recommendations in relation to recruitment and the deployment of staff at this inspection.

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

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.

Durnsford Lodge is a 'care home' that provides care and support for a maximum of 28 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 21 people were living at the service.

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

People who were able to share their views with us were happy living at Durnsford Lodge, told us they felt safe and liked the staff that supported them. We received mixed feedback from relatives about people safety.

We found the service was not always operating in accordance with the regulations and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, sufficient action had not always been taken to mitigate those risks and keep people safe. Key pieces of information relating to people's care and support needs were not always being recorded or followed up. Other risks were well managed.

People were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests.

People’s medicines were not always managed or stored safely.

People were not always protected from the risk and spread of infection. Following the inspection, the provider confirmed action had been taken to resolve the concerns in relation to infection prevention and control.

People were not always protected by safe recruitment procedures.

Systems and processes to monitor the service were not undertaken robustly. This meant they were not always effective; did not drive improvement; did not identify the issues we found at this inspection and could not be relied upon as a source to measure quality and risk.

The provider was investing in the home. They had developed a service improvement plan and had made several positive changes to the home’s environment, improved facilities and increased people’s opportunities to get involved in activities.

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 March 2019). Since this rating was awarded Durnsford Lodge Limited had been purchased by a new provider. Whilst there had been no change to the legal entity there had been a complete change in the ownership and management of the service.

Why we inspected

The inspection was prompted in part due to concerns we received about the management of risk, safeguarding, infection prevention and control and use of personal protective equipment (PPE). A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only

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 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, safe care and treatment, need for consent, recruitment and governance at this inspection. We have also made recommendations in relation duty of candour and quality assurance. Please see the action we have told the provider to take at the end of this report.

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:

Durnsford Lodge had appropriate arrangements in place for visitors. This included, temperature checks on arrival at the home and personal protective equipment (PPE) such as gloves and masks for visitors to wear. There was clear signage detailing visiting procedures, which included information on pre-booking visits. The home had a designated room for visiting people who lived in the care home, which was cleaned between each visitor. When the weather was good, the garden could be used to facilitate visits. Social media, telephone calls and virtual meetings were organised to enable people who lived in the care home residents to maintain contact with family and friends.

The care home had tried to social distance people who lived in the care home in communal areas, but some people chose to sit near to each other, there were supplies of PPE and regular cleaning of these areas to minimise the risk of cross infection.

Durnsford Lodge had not experienced any outbreaks of COVID-19, but suitable arrangements were in place should this occur. (An outbreak consists of two or more members of staff or people who live in the care home at the same time.)

People were only admitted to the home following a negative COVID-19 test and were isolated in accordance with current guidance on admission.

Consideration was given to isolating people who lived in the care home, with their agreement if a new admission was not able to isolate due to their condition, such as when a person was living with dementia needed to walk with purpose in communal areas.

All staff worked solely at Durnsford Lodge and when bank staff were used, they were included in the home's COVID-19 testing programme. All residents and staff were tested in line with current guidance and if needed isolated following a positive test. There were designated areas for staff to put on and take off PPE. All staff were required to change into their uniforms at work and to change in to their own clothes once their shift had finished. All staff had received training on infection control, including COVID-19.

Staff and people who lived in the home had received vaccines in line with guidance and if someone declined a vaccine a risk assessment was completed, for example staff members in high risk groups, such as pregnancy. One of the GP practices that provided a service to the home had lead the programme on vaccination for all residents. They had liaised with other practices that residents were registered with and ensured that all people who lived in the home were vaccinated at the same time.

One member of kitchen staff was furloughed as they were exempt from wearing a mask and a face shield was not practical. Some people who lived in the care home were hard of hearing had issues with reading facial expressions, so staff removed their masks and social distanced from these people when speaking with them.

The premises were visibly clean and hygienic and suitable laundry facilities and processes were in place. Infection control policies and procedures were up to date and regularly reviewed. Audits were carried out, these included hand hygiene and premises checks. When needed appropriate action was taken.

People’s experience of using this service: The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were taken seriously and responded to. Records showed the registered manager arranged to meet with people, and their relatives, privately to discuss any worries they might have.

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 and relatives said the service was safe. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. The environment was safe and people had access to appropriate mobility and moving and handling equipment as needed. There was enough staff on duty at the right time to enable people to receive care in a timely way.

Staff had the knowledge and skills to administer people’s medicines safely. The registered manager and senior staff had good oversight of relevant procedures through monitoring and auditing. This ensured people received medicines safely.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role.

People's health was well managed, and staff had positive links with professionals which promoted wellbeing for them.

The registered manager used the same safe recruitment procedures we found at our last inspection.

Staff were well supported by a system of induction, training, supervisions, appraisals and staff meetings. They had opportunities to raise concerns or suggestions and be involved in the development of the service. Quality audits were carried out to identify any areas for improvement.

Rating at last inspection: Good (Report published 18 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

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

Durnsford Lodge Residential Care Home provides care and accommodation for up to 28 older people. Durnsford Lodge Residential Care Home provides care who may also have mental health needs, including people living with dementia. On the day of the inspection 24 people were using the service.

The service had 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.

There was a calm, friendly and homely atmosphere. Friendly conversation and gentle background music helped create a relaxed and homely atmosphere. People and their relatives all spoke highly of the care and support Durnsford Residential Home provided. One person said, "I am very happy here; all the staff are kind and caring".

Staff interacted with people in a caring and compassionate way. For example, staff spent time

sitting with people and checked they were comfortable and happy. One staff member walked slowly alongside a person as they mobilised around the home. They chatted about the day and made the person feel unrushed and relaxed.

The design and décor of the building had been carefully thought out and took account of people's needs. People were able to move safely around the building and had sufficient space to enjoy time on their own or in the company of others. The garden area had been developed to include an area specifically designed for people living with dementia.

People told us the staff were caring and they felt they mattered. They said staff listened to them and respected their wishes. Staff we spoke with were clear about the importance of respecting people. They consistently spoke about people being individuals and treating people as they would like to be treated. A Comment from onestaff was that, “All the staff are here for the right reason,we are passionate about the work we do”.

A range of activities were available to meet people's needs and particular interests. Staff had considered ideas to evoke memories and trigger reminiscent thoughts and conversation. For example, memory frames had been put together and included pictures and objects relevant to the person concerned.

The service had an open door policy, relatives and friends were welcomed and people were supported to maintain relationships with those who mattered to them.

Staff were supported through induction, supervision and on-going training. Staff were encouraged to enhance their skills and professional development was promoted. Staff told us they were supported and encouraged to question practice. Staff said they were aware of the

values of the service and these were regularly discussed and promoted. Staff were inspired and motivated to provide a good quality service and had a clear understanding of their role and what was expected of them.

People medicines were managed safely. People received their medicines on time and in a way they preferred. The practice was reviewed through regular audits and the staff traing and competency were up to date.

People were fully involved in planning and reviewing their care. This meant their care was personalised and reflected the person’s current wishes and needs. Care and support focussed on each person's individual needs, their likes, dislikes and routines important to them. Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made and advice sought to help safeguard people and protect their human rights. When people were unable to consent to their care or support discussions took place to ensure decisions were made in their best interests. When people's needs changed staff reacted promptly involving other social and healthcare professionals if needed. The food in the home was of a good quality and catered for people's specific dietary needs and preferences.

People told us they felt safe living at the home. All staff had undertaken training on safeguarding adults from abuse, and felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. A staff member said: “The training is really good, the dementia training was really excellent”.

A range of activities were available to meet people's needs and particular interests. A new garden area with seating and a water feature had been added to support the needs of people living with dementia.

The registered manager and registered provider took an active role within the running of the home and had good knowledge of the staff and the people who used the service. There were clear lines of accountability within the management structure. People, friends and family and staff described the management of the home as approachable, open and supportive. People told us, "The manager is always around, she will come into my room to say hello and check I am ok with everything".

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised had been used to help drive continuous improvement across the service.