About the service:

Dumpton Lodge is a residential care home that accommodates up to 29 older people who may be living with dementia. At the time of the inspection 25 people were living at the service.

What life was like for people using the service:

People continued to feel safe and that staff met their needs and preferences. Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to follow to reduce the risks. However, checks on the environment to keep people safe had not been recorded and there was no record of how shortfalls were rectified.

People told us they were happy with the way they received their medicines. However, medicines were not always managed safely and people had not always received their medicines as prescribed. People felt that they were listened to and any concerns they had were dealt with, but there was no system to formally gain people’s opinions and suggestions to improve the service.

Staff understood people’s needs, choices and preferences. People told us that staff provided their care as they wanted and respected the decisions they made about their care. People were encouraged to be as independent as possible and be involved in decisions about their care.

People were supported to take part in activities that they enjoyed. People were encouraged to maintain relationships that were important to them, visitors were welcome at any time.

More information is in the detailed findings below.

Rating at the last inspection:

Good (report published 22 July 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service no longer met the characteristics of Good in all areas. The domains of safe and well led are now rated as Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

Care service description

Dumpton Lodge is a detached home overlooking the sea in Broadstairs. The service is registered to provide accommodation and personal care for up to 29 people, some of whom may be living with dementia.

Accommodation is set over two floors. There are bedrooms on the ground and first floor and a shaft lift that connects the upper and lower floors. There are large communal areas. The home was clean, tidy and well decorated with good light. Corridors were uncluttered and wide with plenty of room for wheelchairs and hoists to be manoeuvred.

Rating at last inspection

At the last inspection, the service was rated Good and Requires Improvement in the ‘Safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 May 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dumpton Lodge on our website at www.cqc.org.uk

At this inspection we found the service remained Good and is now rated Good in the Safe domain.

Why the service is rated Good

The service had improved since the last inspection. Medicines were now stored safely and at the correct temperature. There were no out of date medicines. People received their medicines when they needed them.

Staff knew how to recognise and respond to abuse. There had been no safeguarding incidents since our last inspection.

Risks relating to people’s health and mobility had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

The inspection visit was carried out on 24 May 2016 and was unannounced.

Dumpton Lodge is a detached home overlooking the sea in Broadstairs. The service is registered to provide accommodation and personal care for up to 29 people, some of whom may be living with dementia. Accommodation is set over two floors. There are bedrooms on the ground and first floor. There are large communal areas. The home is suitable for people with mobility difficulties.

The home was clean, tidy and well decorated with good light. Corridors were uncluttered and wide with plenty of room for wheelchairs and hoists to be manoeuvred. There were grab rails throughout and gates at the top and bottom of both staircases and a shaft lift connecting the upper and lower floors.

There is a registered manager in post and two deputy managers. 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 two deputy managers were present at the time of the inspection and we spoke with the registered manager after our visit.

We last inspected the service in February 2015 and found breaches with two of the regulations with regard to staff recruitment and making sure care plan records were up to date. The provider sent us an action plan outlining how they would meet these regulations. We found at this inspection that improvements had been made to meet both breaches from the last inspection.

At this inspection medicines storage needed improvement as some medicines had been stored at the wrong temperature in the fridge and the stock of non-prescription medicines had been kept in the cupboard too long and were out of date. Some of the medicines administration records were not completely accurate. The medicines checks that were carried out by the registered manager had not picked up some of these mistakes. This was a breach of the regulations and the provider was given a requirement notice to put this right.

The controlled prescription medicines (medicines which are at higher risk of misuse and therefore need closer monitoring) were stored safely, given appropriately and recorded accurately. People received their medicines safely and when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

People told us that they felt safe living at Dumpton Lodge. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. Two visitors of a person spoke about their experiences. They said "We couldn't be happier, [person] is kept safe, looks well and is dressed nicely". They went on to say that their relative had been very frightened living at home and imagined all sorts of things which scared them. Since being at the home "[person] is so happy, the carers can't do enough for her". "It is such a relief that [person] is so settled"

Staff reported accidents and incidents to the registered manager who made sure appropriate action had been taken to reduce the risk of accidents happening again. The registered manager checked for patterns and trends with accidents and incidents in the home overall and made sure that lessons had been learned and changes were made if needed.

There was a thorough system to recruit new staff and to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. A variety of training courses were provided to make sure s

Not all the people living at Dumpton Lodge were able to talk to us directly to tell us about their experiences. We spent time with people and observed interactions between the people and the staff. We saw that staff were attentive and supported people to make choices. People looked comfortable and at ease in the home and with staff.

People who used the service and their relatives, told us that they liked the home and the staff were polite, respectful and caring. They said they were confident and satisfied with the service and were able to visit at any time. One relative said, “It is very welcoming here. The staff are friendly and work hard.”

We found that people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing. People were provided with appropriate equipment that was regularly serviced and well maintained.

There were less staff during the afternoon and evening so at times the staff were rushed and we found that people had to fit into the routines of the home. There were times when people were unsupervised so we have asked the provider to review the staffing.

Relatives and people using the service told us they did not have any complaints and would talk to the manager and staff if they had concerns. People told us they had meetings with the staff to say what they thought of the home.

At the time of our inspection the provider did not have a registered manager in post.

People who use the service told us what it was like to live at this service and described how they were treated by staff and their involvement in making choices about their care.

People said that they were very happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One lady said “It’s lovely here” another said “I’m quite happy here. Staff treat me well”. Other people were complimentary of the food and had no concerns with regard to the quality of care. Another said “Staff are very good. They respect us and treat us well”.

People said they were happy with the home. They said the staff were kind and very good at their jobs. Overall most people said they felt there was enough entertainment and occupational activities in the home. Two people said they would prefer more entertainment.

People said they were able to get up and go to bed when they wanted to. They said they could have a bath or shower when they wished. People said that mealtimes were flexible, they could have them in the dining room or in their bedroom.

Everyone said the food was good and they had enough to eat and drink when they wanted it. There was one comment that some of the food was a bit repetitive.

They said that the staff were attentive and they were able to contact them if they were in their bedrooms.

People said they were happy to talk to the manager or the staff if they had any concerns.

Not all the people living in the home were able to tell us about their experiences so we observed the interactions between the people living in the home and the staff.

People were supported with what they needed at their own pace. People were given the opportunity to express what they wanted. Staff respected people's dignity.

This was an unannounced inspection that took place on 23 and 26 February 2015.

Dumpton Lodge is located overlooking the sea in Broadstairs. The service is registered to provide accommodation for up to 29 people. Accommodation is set over two floors. There are bedrooms on the ground and first floor. There are large communal areas.

The service was managed by a registered manager who was present on both days of the inspection. 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.

Some of the care plans were not up to date and were not personalised with information about people’s preferences. Risk assessments were not reviewed consistently, although any significant changes in people’s needs were identified and updated into the care plans and risk assessments. The care plan audit had not identified the shortfalls in the care plans. Staff knew the support people needed and what people’s likes, dislikes and preferences were. Handovers and effective communication meant staff knew about changes in people’s needs.

People had mixed views about the activities. Some people enjoyed some of the activities that were on offer. Other people felt there could be more variety. Relatives told us that activities were, ‘limited’. One relative said, “They don’t always include everyone and Dad doesn’t like what they do”.

Most of the time there were enough staff on duty to meet people’s needs. The registered manager planned to increase staff cover for the weekend mornings to help staff so they did not have to rush people. Checks were carried out on new members of staff, but references were not always obtained from the last place of employment.

Staff felt they received good support and were confident that the registered manager listened to what they had to say. Staff had received training and told us they felt the training supported them to meet the people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the service was currently subject to a DoLS, the manager was seeking further support to ensure that no one was at risk of having their liberty deprived. Where people lacked the mental capacity to make decisions staff were not always guided by the principles of the Mental Capacity Act to ensure any decisions were made in the person’s best interests, as there were no individual capacity assessments.

People spoke positively about the care and support they received. They thought staff knew and understood them. One person said, “The carers are very competent and always do their best for me”. Staff treated people with dignity and respect. People told us they felt safe and that staff gave them the support they needed.

People were protected from the risk of abuse. Staff knew how to keep people safe and who to report any concerns to. Risk assessments supported people to receive safe care and staff knew how to assist people to keep them safe. The environment was safely maintained and free from obvious risks. There was a lack of appropriate signage and colour schemes in the extension to help people find their way around on their own as advocated by dementia care good practice guidelines.

Medicines were stored safely and people received their medicines when they needed them. All medicines, apart from the application of creams, were recorded properly.

People were supported to have a healthy diet and choose what they wanted to eat and drink. People’s healthcare needs were monitored and appropriate advice sought from health care professionals to make sure people’s needs were met. People said they didn’t need to worry about their health. One person told us, “They always make sure I feel well”. A visitor told us that their relative had, “Taken on a new lease of life since moving in”.

There was an accessible complaints procedure. People and their relatives were confident that any concerns they raised would be acted on and resolved. One person told us, “I wanted to get up later and I told staff and now I can have a lie in when I want”.

People’s views were asked for through questionnaires and conversations with staff. Staff responded when people made specific requests. Relatives felt that the registered manager and staff were supportive and listened to what they had to say.

There was an open and transparent culture where staff supported an ethos of promoting a family orientated atmosphere. People told us that the service felt like a, ‘home’. One person said, “I would prefer to be at home but I am happy here”.

We have made some recommendations to the provider so that they can make improvements to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulations 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 this report.