Dunraven House and Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The provider was not ensuring people were supported effectively. People’s needs were not always identified. When people’s needs were known, the provider was not always taking appropriate action to support them. The registered manager stated because people had capacity there was nothing they should do to support people with decisions, for example, making healthy eating choices. However people’s mental capacity assessments were not in accordance with the Mental Capacity Act code of practice. Neither had the provider ensured comprehensive risk assessments were in place to evidence they had worked with people to understand risks they were taking. This left people at risk of poor support.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke to told us they were not engaged with about their needs and that needs assessments were recorded by staff on care plans without their involvement.

The registered manager told us they assessed people’s needs before accepting referrals to ensure people were a good fit for the house. People’s ongoing needs were recorded by staff on their electronic care plans however we found these were not always comprehensive or up to date.

The provider had a clear process on how to assess people prior to admission into the service. However, once people had moved in, they were not regularly included in a review of their needs with the provider completing assessments which were then signed off by managers. This meant people were not always involved in planning support needs. A manager within the service had signed care plans on behalf of people which meant the provider could not demonstrate people had been involved with their own assessments. This was addressed with the registered manager at the assessment, and they confirmed they had started to engage with people to get them to sign their care plans after this issue had been raised with them by the local authority shortly before the inspection.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were not always supported appropriately with their choices of food. There were several people in the service who had diabetes, but little consideration was given to ensuring there were appropriate food options available to help people manage their diabetic needs. A partner we spoke to said when they were supporting a person with weight-loss as per their preference, they had been told by the service they could not ask for smaller portions when being served their food. Instead the person could just leave what they did not want to eat.

When we asked the registered manager and other managers about the food choices offered they expressed that because people were capacitated there was nothing they could do about the choices people made. However, no consideration had been given to the promotion of health needs or people’s preferences. When the chef was asked about offering alternative food options they said they offered vegetarian sausages or burgers. After asking about other vegetarian options such as a vegetarian lasagne the chef stated he would “make that with meat”.

Systems were not in place to support people to live healthier lives. There was limited consideration of people’s needs when planning menus at the service which was completed without the any involvement of people eating the food. Managers had not ensured alternative options, other than salad, were available for people, nor had they ensured the cook was adequately trained in supporting people’s needs and choices.

The provider did not have a system for monitoring and improving outcomes so people could not be involved in this.

The provider told us people’s outcomes were not identified, nor goals set. The registered manger told us they were planning to introduce long-term and short-term goals for people in the service, however we noted they spoke about people in a derogatory manner in relation to goals and appeared to have minimal aspirations for people. The registered manager told inspectors “People can’t or don’t want to do anything”.

Systems were not in place to ensure goals were set for people nor was there a system for monitoring and reviewing people’s support needs and subsequent outcomes.

People told us they were not always asked about or involved in decisions in relation to the care provided to them. Some people expressed they wanted to be listened to more, however, others were happy to not be involved in some decisions, for example about menu planning.

The provider could not demonstrate they were gaining consent from people in relation to their care. One of the managers was signing records of consent on behalf of people without any formal agreement being in place. This has been raised with the provider who said they would seek agreement from people in the future.

There was no clear system in place to demonstrate people had given consent for care and support practices. For example, during a review of people’s daily notes we noted most people at the service had received at least one nightly check when they were in bed. There was no clear rationale for these nightly checks on people and the provider could not demonstrate they had sought consent for this. When we asked why these checks took place, we were told this was about the provider’s need for accountability to other authorities should a death occur overnight. This action demonstrates blanket restrictive practices were occurring within the service as no consideration had been made about people’s privacy and whether or not people needed to be checked every night in response to their assessed needs. The registered manager was asked to review the practice and ensure they gained consent from anyone they were planning to check overnight.