Dawson Lodge

Dawson Lodge is a residential care home providing personal care and accommodation to up to 43 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 42 people using the service.

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

Medicines management systems and processes were not always effective, and we found the provider’s medicines policy had not always been followed. The provider took action to address this shortfall during the inspection.

We found risks to people were not always managed effectively. Care plans and risk assessments did not always contain enough detail to ensure people were supported safely. The provider took action to address this during the inspection.

There were systems and processes in place to manage accidents and incidents. However, these were not always robust. The provider took action to address this during the inspection.

We received mixed feedback about the level of engagement and activities available to people. Although the registered manager and staff spoke positively about the activities available to people and the level of engagement provided to people, some of the feedback, the records we reviewed, and our observations did not reflect this. The registered manager took action to address this.

Quality assurance processes had not identified all of the concerns in the service. Records were not always complete or completed accurately or with enough detail. The registered manager took action to address this.

People and their relatives told us they felt safe and liked living at the home. Most people and their relatives felt there were enough staff. However, some people told us they had to wait at times to receive care and support. We observed safe staffing levels with staff being responsive and unhurried in their interactions with people throughout the inspection.

People's needs were assessed, regularly reviewed and included their physical, mental health and social needs. We saw evidence of people's and relative's involvement in care assessments and reviews. People were positive about the food at Dawson Lodge and confirmed they were offered choices in what they ate and drank.

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 relatives’ views were considered by the service and were sought to make decisions about care.

The registered manager was passionate about ensuring everyone had full access to the communal spaces and creating a relaxed and homely atmosphere. People were supported to be involved in decorating the home.

Staff respected people's privacy and dignity. People told us staff were kind to them. Relatives spoke positively about how staff supported people. People were supported by staff who had the skills and knowledge to carry out their roles and responsibilities. The provider ensured staff completed specialised training courses to enable them to provide safe care and support.

The registered manager was passionate about ensuring people received responsive and empathic care at the end of their life. They completed and recorded discussions with people to help ensure their care reflected their wishes and preferences.

The registered manager and provider were responsive to our feedback and took prompt action. The registered manager was committed and passionate about their role. People, relatives and staff were able to share feedback and felt listened to.

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 outstanding (published 31 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and people’s needs not being met. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified a breach in relation to 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 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.

The inspection was unannounced and was carried out on 29 August 2018 by a lead inspector, a second inspector and an expert by experience. An expert by experience is someone who has experience of using, or has cared for someone who uses this type of service. The lead inspector returned on 31 August 2018 to complete the inspection.

Dawson 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.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their relatives consistently told us they thought the home was extremely well run. The registered manager was visible and approachable and was interested in what people had to say. Reviews and surveys included exceptional feedback and the home was highly rated in the most recent survey.

The provider and registered manager had a positive vision for the home which promoted person centred care within a happy environment. The registered manager promoted an open culture where feedback was welcomed to help drive continuous improvement within the home which was supported by the senior management team. The provider had received many awards for delivering high standards in care.

The registered manager worked pro-actively with the local community to provide innovative opportunities to enhance people’s quality of life. Intergenerational programmes encouraged fun interaction between children and people living at Dawson Lodge which developed learning and reduced stigma around dementia.

There was a strong person-centred culture within the home. Staff took time to listen to people and their relatives to help understand their life stories and what was important to them, and to develop individual plans of care.

There was a vibrant, homely and relaxed atmosphere at Dawson Lodge. People and their relatives told us consistently that the staff were exceptionally kind, caring and helpful and went the extra mile to ensure their needs were met. Staff took time to offer calm and gentle reassurance if people became upset or anxious.

All staff shared responsibility for providing a wide range of fun and meaningful activities which met people’s preferences, and responded spontaneously to ‘golden moments’ when people showed an interest in something. People were empowered and encouraged to share their ideas and contribute to the running of the home.

Staff had completed an end of life care programme at a local college to develop skills and knowledge which supported them to deliver sensitive and compassionate palliative care. This was confirmed by health care professionals. Relatives appreciated the practical and emotional support they received when their loved ones were nearing the end of their lives.

Staff spoke very highly of the registered manager. They felt extremely well supported, listened to and valued by the management team. There were a number of initiatives to help develop team working and to reward staff and recognise their contributions to the home.

Relatives told us they felt welcomed, valued and respected by staff. They could visit at any time and staff always had time to talk to them about their loved ones.

The provider was working towards the Accessible Information Standards. Staff employed a range of communication methods to assist people with their understanding such as picture menus, talking books and electronic devices for video communication.

The environment supported the needs of people with dementia, providing memory boxes, familiar objects, photographs, pictures and themed walkways to help people with their orientation.

The management of people’s medicines was robust. Medicines were ordered, stored and disposed of appropriately. People received their medicines as prescribed.

Recruitment procedures were safe and ensured only suitable staff were employed to work at the home. People were encouraged to be involved with the interview process and have their say in who was employed. There were sufficient staff deployed to meet people’s needs and keep them safe.

People were protected from abuse. The provider had robust safeguarding policies in place and staff understood how to identify and report abuse if they suspected abuse was taking place.

Risks associated with people’s health, safety and welfare had been identified and assessed, and guidance was in place to help staff to reduce those risks. Health and safety checks, including fire safety were carried out regularly. Emergency evacuation procedures were in place and staff understood what to do in the event of an emergency.

Staff followed infection prevention and control procedures which minimised risks of cross infection. Effective cleaning routines ensured the home was clean and tidy.

People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005 and consent. Deprivation of Liberty Safeguards had been submitted to the local authority for authorisation when required.

People were offered a choice of food and drink that met their preferences and dietary needs at any time of the day or night. People were supported by staff to maintain their health and wellbeing and had access to health care services when required.

Staff received training, supervision and appraisal to support them in their roles and to provide them with the required skills, knowledge and competencies.

Complaints procedures were available and displayed throughout the home. People and relatives had no complaints and knew who to speak to if they wanted to complain.

The registered manager understood their responsibilities under the Health and Social Care Act 2008, including submitting notifications of events as required to the commission.

We last inspected the service in November 2015 when we found no concerns and rated the service as good. At this inspection we found the service to be outstanding.

Thirty three people were accommodated. We spoke with, ten people who used the service, four relatives, a health professional, nine staff and the manager. We found improvements had been made which was reflected in comments from people and relatives. We had comments such as staff were 'very good', 'I love it here. I go with the flow, my family pop in and out, the staff are wonderful'. 'I am happy to be living here the staff treat me kindly'. Another relative told us the service had improved, baths and showers were offered more regularly, the home was cleaner and staff knew the help that was needed.

We found work had taken place to establish a process to obtain people's views and agreements about their care. Staff had received training and guidance to more effectively carry out their tasks and provide the care people wanted. The service had improved their organisation, and monitoring of staff practices had increased. Further work however was required to ensure people's personal records were accurately maintained.

We found the home was clean and hygienic with processes in place to monitor this and ensure it continued. Other management quality monitoring was in place to consult, assess the effectiveness of the service and identify and plan improvements.

Action had been taken and improvements made to the recording of staff recruitment and safeguarding procedures were in place. However not all staff had received sufficient training and support to carry out all of the tasks required of them.

Procedures for infection control were not robust to ensure the risks of cross infection were minimised. Medicine administration records were inaccurate. The quality assurance system was not comprehensive enough to ensure that standards required in the home were maintained.

We refer to two managers in this report. The 'new manager' who had started in post on Monday 2 September 2013 and the 'acting manager' who had been in post for the previous six months and remained in post during a handover period at the time of our visit.

This planned inspection included a review of action taken regarding food and nutrition following our report of an inspection on 15 October 2012. We assessed the action taken to improve arrangements for the provision and monitoring of food and fluid intake of people living in the home. We saw that people were supported in a friendly and supportive manner with attention to individual hydration and nutritional needs. We found that improvements had been made to ensure that people requiring support with food and fluid intake had been identified and plans were in place to meet those needs.

We also received information from seven care staff and team leaders, two senior staff and the manager about systems and procedures in place to meet people's needs. We found that the four staff spoken with were aware of the types of abuse that could occur and what to do if they had concerns. Recruitment processes were not sufficiently robust to ensure that new staff had been properly vetted. Staffing levels were sufficient to meet people's needs.

People told us about food choices and were satisfied with the quality. Dietary needs of people at risk were being monitored. However, records did not demonstrate that adequate action was taken to ensure that some people were supported to eat and drink enough.

Work was taking place to improve the information available to staff about 'as required ' prescribed creams. However we have continued concerns that records of their application remained inconsistent. Records indicated that twenty one people had not regularly received all of their topical medicines.

We found sufficient staffing which was kept under review taking people's dependency levels into account. We found that people were able to influence the service and many had chosen to join in with a day trip on the day we visited. Questionnaires, residents' meetings and comment cards were used to obtain feedback about the service. Auditing systems were in place and demonstrated that the service had a quality assurance system and action was planned to address issues that arose.