About the service:

Dunraven House and Lodge is a care home for people living with mental health needs. 40 people were living in the home at the time of the inspection.

What life is like for people using this service:

• People felt safe living at Dunraven House and Lodge. People were confident staff would listen to them and take action if they had any concerns.

• People were complimentary about the care and support they received. They said staff understood their needs and provided the care they needed in a kind way.

• People were supported make choices and have as much control and independence as possible.

• People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date.

• Staff respected people’s privacy and dignity.

• People received support to take their medicines safely.

• Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively.

• People’s rights to make their own decisions were respected.

• People were supported to maintain a good diet and access the health services they needed.

• The registered manager provided good support for staff to be able to do their job effectively.

• The provider’s quality assurance processes were effective and resulted in improvements to the service.

More information is in Detailed Findings below.

Rating at last inspection:

Requires Improvement. Report published 1 May 2018.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

The provider has made all the improvements we said they needed to following the last inspection. We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

Dunraven House and Lodge 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.

This was an unannounced inspection. At the time of our inspection 40 people were receiving accommodation and personal care from the service.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

Staff did not always recognise when people were raising allegations of abuse and action was not always taken promptly to report concerns and ensure people were safe.

Most people said they felt safe living at Dunraven House and Lodge. However, we also received feedback from some people who were concerned at the way they were treated. One person raised concerns with us about the way a member of staff had spoken to them. We also received feedback from a social worker that a person who was in hospital at the time of the inspection had said they did not want to return to the service because they did not like the way they were treated. This was being investigated by Wiltshire Council through the safeguarding processes.

The provider did not always ensure the principles of the Mental Capacity Act were followed. The service had supported one person to move from Dunraven House and Lodge to another service provided by the registered manager. The move had happened without consultation with the person’s relatives or their social worker. The person had been assessed to lack capacity to make a decision about where to live. The person had been supported to move from the home without a thorough process to ensure the move was in their best interest.

Most people told us they were treated well and staff were caring. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and spoke with people in ways they could understand. Despite the positive comments, we also received feedback from two people who did not feel they were treated well. An incident raised through the safeguarding processes demonstrated that people were not always treated with dignity and respect. Although these incidents had been addressed by the registered manager, this had not resulted in sustained improvements in the experiences of some people who used the service. Following the visit, Wiltshire Council’s mental health commissioning team informed the service they had been placed on an ‘amber alert.’ This was due to the number of concerns that had been raised about the service. The council said they would seek additional assurances from the provider before supporting new people to move into the home.

The registered manager did not always ensure notifications were made to the Care Quality Commission when required. Following this inspection visit, we were informed of an incident in which a relative informed staff that money and other personal possessions were missing from a person who used the service. The registered manager had not submitted a notification to us about this allegation. The registered manager had made other notifications to us when required, including other allegations of abuse, injuries to people who used the service and to report incidents which were reported to or investigated by the police.

The management team completed regular audits of the service. However, these systems were not fully effective and had not identified shortfalls in the way staff followed the safeguarding procedures, the failure to work within the principles of the Mental Capacity Act or that we had not been notified of specific events in the service.

People who used the service were able to make decisions in their daily lives. They told us that they did a lot of things independently and they felt their decisions were being respected.

We saw detailed information for four people who had diabetes and this included protocols written by their GP’s that enabled them to manage this condition. There was individual photograph’s of their respective medication to show them which was the correct one to use.

All the people living in the home who we spoke with confirmed there was always enough staff on duty to support them and take them out. For example people's comments included; "staff are there to take me shopping or for an appointment”, “they are all really kind and helpful”, “ there is always someone here to help me”.

People we spoke with confirmed they thought the houses were well looked after and they enjoyed living there. One person told us “I am really happy here, it’s a nice clean home and I like my bedroom”, another person told us “I can go places here if I want peace and quiet, but I can also join in with others in the lounge, it has everything I need”.

People we spoke with who used the service said they could talk to their key worker if they had any concerns. People also told us that they knew how to follow up a concern more formally by making a complaint.

We used a number of different methods to help us understand the experiences of people living at Dunraven House and Lodge.

We observed staff treating people with kindness and patience. Staff demonstrated how well they knew people’s needs and ensured people were treated with privacy and dignity.

Everyone we spoke was complimentary of the staff and were very satisfied with the care and support provided. Comments included: “The staff are caring and experienced and know me very well.” Another person said "there are always plenty of staff on duty.”

Two people told us they had plenty of opportunities to get involved in having their say about how the service was run. They also told us they were confident if they reported any problems, they would be dealt with promptly and effectively.

Staff told us they received training on a regular basis which enabled them to carry out their job. They said they had opportunities to express views and opinions about how the service was run.

Shortly after our visit we spoke with a healthcare professional who told us the staff were very good at communicating with them, and reported any problems promptly. They had provided training to the staff to enable them to understand people’s specific healthcare needs. Staff training records showed that had receiving training in specific health conditions such as dementia.

People told us they received care from staff who maintained their dignity and privacy and encouraged them to do as much for themselves as they could.

People told us that they were asked what activities they would like to do and encouraged to take part, but said “we don’t have to go, if we don’t want to.” People told us they had plenty of activities to get involved in if they wished.

People told us their support plan accurately reflected the care and support that they received from staff. This was because they were fully involved in developing and agreeing to how their care and support was delivered. “I’ve taken part in my care plans and everything is fine.”

People told us they received support from health care professionals outside the home and said they had recent contact with their care managers from social services. Two people told us they had recently had a review with their Community Psychiatric Nurse (CPN). We spoke to an external healthcare professional after our visit who told us they were concerned about peoples’ ability to make choices and their capacity to make decisions.

We spoke to another external healthcare professional after our visit who told us they would expect the home to be seeking written protocols from relevant professionals where they take on looking after someone's medical condition and they were not sure Dunraven House and Lodge always did so. They told us that where people had been escorted by staff this had often been with a member of staff whose first language was not English. This had meant communicating information about ongoing health care needs was a problem.

Everyone we spoke with was very complementary about the staff. Examples of comments were, "the staff are very kind and caring cheerful and attentive."

Comments we received from people were: “Can’t fault this place” “I like it now it’s all been done up, so homely.” “Certainly very peaceful here.” “I don’t ever want to leave this place”. “The provider knows all about what’s happening here.” “I can tell the provider anything if I’m worried about it and she’ll make sure I’m OK.”

People told us they liked living in the home. One person said “I like it here, it’s very nice”. People told us they were able to spend their time as they chose. A person said “I do exactly as I want to, as far as I’m concerned”. People described the support given to them by the staff, one person saying “staff give you help when you need it”. We observed staff treated people in a non-judgemental way and this was reflected in people’s records. People said they felt safe in the home. Staff we met with were aware of how to support people where they could be at risk of abuse. Staff said they were supported in their role, one member of staff telling us that their supervisors “listen to you about your job”. The home has put much work into addressing improvements which were identified at our previous review. This included discussing improvements needed with people living there, as well as staff.

The home needed to take action on a range of areas after we last visited and there remain some areas which need to be addressed. Further development of care plans and reviews were needed, including discussion with people living in the home, to ensure that information held verbally was also written down. Not all staff were taking on individual responsibility for reporting of matters in the home environment which could present risk to people, so that they were rectified in a timely manner.

People told us that staff were polite and friendly and treated them with respect. One person however, said a particular staff member ‘shouts and swears.’ Another person said staff were a ‘bit rough.’ Three people told us that some of the staff could be bossy. In response to these issues, the providers told us that people with mental health issues required a structured routine. Due to this, they said that people might have misinterpreted being ‘bossy’ with being firm. They said they worked with staff on a day to day basis and had never heard a staff member ‘shout and swear.’ They did not believe it was an accurate portrayal of the staff member although confirmed such behaviour from staff would not be tolerated.

People told us that they could make choices about their daily routines. Some people said they went out independently when they wanted to. They said they could go to bed when they were ready although they were woken in the morning at about 7.30am. Some people said they were unable to have a ‘lie in’ although the provider and staff disagreed with this. They said it was the person’s choice when they wanted to get up. One person told us they felt ‘programmed’ to do things such as swimming and having to sit in the same place at meal times.

People told us they were able to give their opinions about the running of the home. They attended house meetings so they could do this more formally. One person told us about the rules of the home. They said these included no violence, no smoking in the house and no going into other people’s bedrooms. One person spoke of the consequences of doing this. They said the provider ran a tight ship and would not have any ‘messing.’

People told us they were very happy with their bedroom. They said they had everything they needed. People told us that the temperature of the home was satisfactory. One person told us that staff would turn the heating up, if they were cold. People said they could have a key to their bedroom if they wanted one. People had generally declined this offer yet said their privacy was not compromised, as a result. People told us that any repairs to the environment were made quickly, without delay.

Dunraven House and Lodge is a care home which provides accommodation and personal care for up to 43 people with mental health needs. At the time of our inspection 40 people were living at the service.

This inspection took place on 4 November 2015 and was unannounced. We returned on 5 November 2015 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

The systems to manage property the service was holding for people did not always ensure people were protected. Where the service was holding cigarettes for one person, there were not clear procedures to account for the number of cigarettes held. This meant it would not be possible to tell whether cigarettes had gone missing and the systems in place did not protect the person from material abuse. We have made a recommendation about the management of property the service holds for people.

People who use the service were positive about the care they received and praised the quality of the staff and management. People told us they felt safe when receiving care and were involved in developing and reviewing their support plans. Comments from people included, “Very safe, no problems here” and “Yes, I feel safe”. We observed people interacting with staff in a relaxed and confident manner.

Staff understood the needs of the people they were supporting. People told us staff provided support with kindness and compassion. Comments included, “I love it here, I’ve made lots of friends. They are nice people the carers” and “They are very nice, it’s a friendly atmosphere. The staff are all ok”. The health and social care professionals we received feedback from also told us people were treated well by staff. Comments made referred to how well staff knew people and how staff had developed good relationships with people.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people met their needs.

The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback and there were effective complaints procedures. One person said they would approach staff if they had any problems; but had not needed to do so. Other comments from people included, “I would speak to staff if I had any concerns” and a description of staff as “Very approachable”.

The provider assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.