Dungate Manor provides residential care for up to 39 older people, who may also be living with dementia.

The inspection took place on 18 September 2017 and was unannounced. There were 30 people living at the service at the time of our inspection.

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. The registered manager had been in post since November 2015.

We last inspected the service on 17 August 2016 where the service was rated as Requires Improvement overall and four breaches of regulations, relating to staffing, consent, infection control and governance were found. Following that inspection, the provider wrote to us and outlined an action plan that detailed how the service would improve. This inspection identified that the provider had taken the action they told us they would and as such the quality of service had significantly improved.

Increased provider presence and investment within the service had secured better outcomes for the people who lived at Dungate Manor. Renovations that improved the safety and suitability of the premises had been positively received.

Staffing levels were now sufficient to meet people’s needs. People told us that staff now had more time to support them in a way that made them feel valued. Appropriate checks were undertaken to ensure suitable staff were employed. Greater emphasis on staff training and mentoring support ensured care staff undertook their roles and responsibilities in line with best practice.

People were safeguarded from the risk of harm because staff understood their roles in protecting them and risks were better identified and managed. New champion positions for infection control and moving and handling were introduced which ensured people received their support in a much safer way.

Staff worked in partnership with other health care professionals to help keep people healthy and well. There were systems in place to ensure people received their medicines as prescribed. People had choice and control over their meals and were supported to maintain good hydration and a balanced diet.

People received personalised care that was responsive to their changing needs. Staff routinely sought people’s consent and now understood the importance of providing care in the least restrictive way. People had regular opportunities to engage in activities that were meaningful to them.

The atmosphere was friendly and welcoming. People had good relationships with the staff that supported them and were actively involved in making decisions about their care. Staff respected people’s privacy staff and dignity and supported them to live their lives as they wished.

The culture within the service was open and positive and people, relatives and professionals respected the management and leadership of the service. People were confident about expressing their feelings and the management team ensured that if people raised issues that they were listened to and acted upon.

Dungate Manor provides residential care for up to 39 older people, who may also be living with dementia.

The inspection took place on 17 August 2016 and was unannounced. There were 36 people living at the service at the time of our inspection.

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. The registered manager had been in post since November 2015.

We previously carried out an unannounced comprehensive inspection of this service on 16 July 2015. At that inspection three breaches of legal requirements were found in respect of staffing levels, the provision of safe care and person centred support. As a result the service was rated Requires Improvement and three requirement actions for the service to improve were set. Following that inspection, the provider sent us an action plan which identified the steps they intended to take to make the required improvements. Despite telling us that all the requirement actions would be addressed, we found that staffing levels had not increased and as such we found this to be a continued breach of regulations at this inspection.

In addition to the continued breach relating to staffing, at this inspection we also found three new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were insufficient staff to both meet people’s needs and maintain adequate levels of cleanliness across the service. As a consequence of staffing shortages, people experienced care that was too often rushed and task focussed. People had accepted a lifestyle of waiting for their support rather than receiving it when they wanted. For example, people either did not have access to or did not use their call bells because they understood that “Staff were very busy” and would “Come as soon as they could.”

Recently, just one member of domestic staff was responsible for the laundry for 36 people and the cleaning of the entire three-storey service. As a result of insufficient housekeeping staff, the levels of cleanliness across of the service were unacceptable. People’s rooms were dusty and communal toilets were unclean.

Some staff demonstrated a poor understanding of infection control and placed people at risk by their practices of leaving used continence items unprotected in communal areas and walking round the service wearing gloves used during personal care.

Changes at provider level had meant that monitoring of the service had not been consistent or sufficiently regular so as to ensure effective oversight of the service. Where development plans had been devised at provider level, these had not been shared with the registered manager.

Staff routinely involved people in their care and understood the importance of consent. However, they lacked a good understanding about what processes should be followed where a person lacked the capacity to make a decision for themselves.

People enjoyed their meals had there was a plentiful supply of homemade meals and snacks throughout the day. Staff recognised the importance of supporting people to maintain adequate hydration and nutrition, but did not always ensure records for people at risk were contemporaneously maintained.

There were systems in place to recruit suitable staff and ensure they appropriately vetted before they started to work. Staff had access to a range of relevant training and were effectively supported to deliver their roles.

People were supported to maintain their health and systems were in place to manage their medicines safely. The management team had good links with other health

Dungate Manor is a care home providing accommodation and personal care for up to 39 older people, who may also be living with dementia. There were thirty people living in the home at the time of our inspection.

The inspection took place on 16 July 2015 and was unannounced.

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 2008 and associated Regulations about how the service is run.

Staffing levels were not sufficient to meet people’s needs. We saw throughout the day that people had to wait to receive care. For some people this meant that they had to wait to use the toilet, for others they were woken for lunch because staffing constraints meant that they could not delay the serving. A vacancy for senior staff meant that there was only one senior staff member working in the home. There were a lot of tasks that the senior staff member was responsible for and they did not have time to do everything allocated to them. There were not always sufficient housekeeping staff on duty which meant that in some areas, cleanliness of the home could be improved.

People told us that they felt safe and relatives said they felt confident that their family members were well looked after. We identified however that people were not always properly protected from risks of avoidable harm. Some parts of the home that were not safe for people living with dementia to access were left unsecured. Appropriate measures to reduce the risk of people falling had not always been followed.

Whilst each person had an individualised plan of care, the information recorded was not always reflective of people’s current needs. For example there was conflicting information about how one person mobilised. For another person, the risk assessment for falls had not been updated to reflect their increased level of risk. For a person receiving respite care, the home had not taken the same time to get to know them as they had with people living permanently at the home.

There were a range of activities for people to participate in, but due to the vacancy for a full-time co-ordinator, the current programme did not meet people’s diverse needs. Several people commented that they were sometimes bored at the home. Activities available didn’t always reflect people’s individual hobbies and interests.

People described staff as “Lovely”, “Friendly” and “Kind”. We saw lots of positive interaction between staff and people and people were supported in a caring way.

Medicines were managed well and senior staff took the time to explain to people about their medicines and where it was safe, gave them choice about when to take them.

Appropriate recruitment checks were undertaken when new staff were employed to ensure they were suitable to work with people living with dementia. Staff received necessary training and support to enable them to do their jobs. People’s legal rights were protected and they were safeguarded from the risk of abuse because staff understood their roles and responsibilities in protecting them.

People told us that the quality of food was good and that they were given choices at every meal. We saw that people were supported to maintain a healthy diet. Where people required support to eat this was provided in a dignified and unhurried way.

People were supported to maintain good health and had regular access to a range of healthcare professionals who told us that they worked collaboratively to keep people well.

People and their relatives spoke highly of the management team which was described as “Friendly and efficient.” We saw that the home had an open culture in which people were encouraged to share their experiences and feedback was used to continually improve the home. With one exception, people’s complaints were listened to and thoroughly investigated. The registered manager was competent in her role and had a good knowledge of the home and the people who lived there.

We found a number of breaches of regulations. You can see what action we asked the provider to take at the back of the full version of this report.

This inspection was to follow up on the findings from our previous inspection of 10 June 2013 to assess if action had been taken with regards to the concerns we identified.

We found that the provider had taken action to address concerns around assessing and monitoring the quality of service that people received. We also found that appropriate action had been taken to ensure that people's records were up to date and accurate.

During our visit we conducted a short observation (SOFI) of the people who used the service participating in an activity and being supported by staff. We saw that staff facilitated peoples’ engagement in the activity through positive verbal encouragement and worked at a suitable pace for individuals.

We spoke with three members of staff about their understanding of protection of vulnerable people, called safeguarding. They all demonstrated a clear understanding of the signs and behaviours associated with potential abuse.

We spoke with people who used the service about their experiences. One person we spoke with told us “I have to be hoisted and helped into the bath. Staff are very good and know what they are doing so I never feel uncomfortable. They are always professional and I never feel embarrassed” and “Staff are very good and competent”.

We saw that the service had not regularly gained the views and experiences of people who used the service in the way the service was provided and delivered. When we spoke with the care manager about this and they told us that new feedback surveys were due to be sent out to people who used services and staff by the end of July 2013.

Staff told us that daily records were kept for each person who used the service. We looked at the daily record sheets for four people who used the service and found that they had been completed however the information recorded was not always accurate and did not always reflect the needs and choices of the individual.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

We spoke to four people who live in the home who told us that they were happy living there. Comments included that they were “very happy”, that “I wouldn’t want to live anywhere else” and “they’re all very kind and attentive, if you need anything dealt with it is dealt with”.

We asked people about mealtimes and they told us that “the food’s pretty good”. Everyone we spoke to said that the food provided was “good.”

We also spoke to two visitors about the service, both told us that they were very happy with the care that was given to the people who used the service with one describing it as “phenomenal”.

However we found that the service did not always complete accurate records in respect of peoples nutritional needs.