Dunkirk Memorial House

The main house is divided into two main areas. One area provides care to people who require nursing care and the other provides care to people who need support with personal care. A separate 30 bedded unit called The Mews, provides care to people who are living with dementia.

At the time of the inspection there were 75 people living at the home.

We found the following examples of good practice.

Staff were following good infection prevention and control practices which helped to minimise risks to people. The home was taking part in an extensive testing programme which included rapid on site and home testing, and lab tests.

People were being supported to safely keep in touch with friends and family in accordance with their needs and wishes. This included phone calls, video calls, letter writing, pod visits and face to face meetings.

People continued to receive social stimulation within safe boundaries. Adjustments had been made to enable people to socialise and take part in activities. This had included rearranging seating in the dining rooms to enable people to eat together.

Staff felt well supported by the management in the home and the provider. They told us they were being kept up to date with guidance, had opportunities to discuss any concerns and felt safe in their work.

Staff worked as a team and all said morale was good. This helped to create a positive atmosphere for people to live in.

The main house is divided into two main areas. One area provides care to people who require nursing care and the other provides care to people who need support with personal care. A separate 30 bedded unit called The Mews provides care to up to 30 people who are living with dementia.

At the time of the inspection there were 83 people living at the home.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Outstanding.

Why the service is rated Outstanding

Since the last inspection the provider had maintained the high standards of care and support people received and constantly looked for ways to introduce further improvements. This had included taking part in innovative projects and addressing issues raised by people and staff.

Compliments received by the home described Dunkirk Memorial House as being “Such an exceptional place” and “A unique and very special home.” The local Member of Parliament had also praised the standard of care given at the home during a discussion in the House of Commons. One person said, “I just don’t think you could find anywhere better.”

There was a sense of pride in the home with people proud of their home and staff proud of the work they did. People were at the centre of everything at the home and consulted on all changes. People had freedom to follow their own routines and staff were respectful of people’s religions, cultures, backgrounds and lifestyle choices.

People’s military backgrounds were respected and staff understood the preference of some people to follow routines. There was a memorial garden at the home and a remembrance service was held each year.

The staff were very responsive to people’s needs and preferences providing different care for people’s different needs and wishes. This was demonstrated in the varied décor styles and atmospheres of different areas of the home.

People were supported by staff who had the skills and experience to meet their needs. Staff training was provided to make sure staff could effectively support people with specialist needs such as people who were living with dementia or people with specific medical needs.

There was a wide range of social activities and events for people to take part in. One person told us activities ranged from “Scrabble to Buckingham Palace garden parties.”

People’s health was monitored and the staff were creative in supporting people to stay active. There were regular exercise classes and dance was being introduced to hopefully reduce people’s risk of falls. There were extensive grounds were people could walk or access in wheelchairs or mobility scooters.

Throughout the inspection we saw numerous examples of kindness and compassion. We heard and read how staff went the extra mile to support people. Records showed the combination of physical care, stimulation and kindness had greatly improved a person’s quality of life. People told us staff “Will do anything for you.”

People were involved and consulted on their care and support and the running of the home. People’s needs were assessed and care was provided to people in accordance with their wishes and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The buildings were designed and maintained to promote people’s independence. The Mews had been designed specifically for people living with dementia and had several design features which assisted people to orientate themselves and remain independent. There was a range of social and quiet spaces. Everyone had unrestricted access to safe garden areas and these were well used.

Further information is in the detailed findings below

Dunkirk Memorial House is registered to provide accommodation and nursing care to up to 90 people. The home specialises in the care of older people including people living with dementia. The main house is divided into two main areas. One area provides care to people who require nursing care and the other provides care to people who need support with personal care. A separate 30 bedded unit called The Mews provides care to up to 30 people who are living with dementia. At the time of this inspection there were 80 people receiving a service at Dunkirk Memorial House.

The home provides care to ex-service people and their dependents.

The last inspection of the home was carried out in July 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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.

Feedback from people about all aspects of the service was positive. One person said “If you have to live somewhere like this you couldn’t be anywhere better.” Another person said “The general atmosphere is very good which makes it a very pleasant place to live.” One letter written to the staff team stated ‘Dunkirk House is truly a very special and exceptional place.’

The staff morale at the home was high which led to a happy vibrant place for people to live. Staff were proud to work for the British Legion and had great respect for the people they cared for.

The was an excellent activities programme and a number of ad hoc activities which ensured people were fully occupied and received on-going social stimulation. Activities were arranged in accordance with people’s interests and abilities.

The buildings were designed and maintained to promote people’s independence. The Mews had been designed specifically for people living with dementia and had several design features which assisted people to orientate themselves and remain independent. There was a range of social and quiet spaces. Everyone had unrestricted access to safe garden areas and these were well used.

There were sufficient numbers of well trained and experienced staff to support people safely and ensure they were not rushed with their care. Staff told us there was good team work and support from senior staff and management. The staff were taking part in a year-long project aimed to promote the well-being of people living with dementia. Staff spoke passionately about the project and felt people were already benefitting from the changes which had been made.

People’s nutritional needs were assessed and met and mealtimes were considered important social occasions. Where people were identified as requiring support and encouragement to have a good diet, activities were provided to stimulate people’s appetites.

People received effective care and treatment which took account of their preferences and needs. Care plans gave staff clear information about how people wished to be supported. Staff demonstrated an good knowledge of people and their previous lifestyles which enabled them to provide very individualised care to people.

People and/or their representatives felt involved in all aspects of their care and support. There were systems in place to make sure people had an active voice in the running of the home.

People told us they would be comfortable to make a complaint and were confident any concerns would be listened to. The registered manager told us they valued feedback from people and used it to continually improve the service offered.

People’s health needs were monitored and changes were made to people’s care in response to any changes in their needs. One person said “They just seem to cope with everything.” A visitor told us “They have adapted to all the changes in their needs and always keep us fully informed.”

People felt safe at the home and with the staff who supported them. A robust recruitment procedure for new staff and staff training on how to recognise and report abuse minimised the risks of abuse to people.

We considered all the evidence we had gathered under the outcomes we inspected. We used information to answer the five questions we always ask :

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is the summary of what we found:

On the day or our inspection at Dunkirk Memorial House 71 people were living there. We spoke to 10 people living at the home, one relative and 12 members of staff.

Is the service safe?

We observed people were cared for in an environment that was safe, clean and hygienic. Eight people were able to tell us they "felt safe" and "well cared for" living at the home. People told us how "kind" the staff were and how staff always respected their wishes and offered them choices of how to spend their time. We noted that appropriate safeguarding arrangements were in place in the form of safeguarding and whistleblowing policies. All staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberties. We saw evidence of this in staff files.

CQC monitors the operation of Deprivation of Liberties which applies to care homes. We noted no applications had needed to be submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. We observed that people living at Dunkirk Memorial House at the time of the inspection had the capacity to make their own decisions.

We observed there were sufficient staff on duty to meet the needs of people living at the home. The acting manager and the acting deputy manager were on call in case of emergencies. We noted staff records were accurate and complete. We saw evidence that staff had the experience and skills needed to support people in their care and support needs at the home. We observed emergency procedures were in place in the event of fire. We noted fire evacuation training was up to date and documented in staff files.

Is the service effective?

We found the service was effective in meeting people's needs. We observed staff at Dunkirk Memorial House interacted well with people who told us how kind and supportive the staff were to them. It was evident staff were well known to people at the home. One person said "I have only been here a few weeks and I am really happy here. I am able to choose how I spend my time which is really important to me". We spoke to a family member of a person at the home. The person said "The staff make every attempt to ensure that my relative is able to participate in the activities at the home when I am not here and this gives me great peace of mind. The staff are wonderful and do everything they can to help my relative live as full a life as possible at the home".

Is the service caring?

People told us "it is wonderful here". One person said "I kept falling over and losing my balance when I was at home. As I had visited here before and liked it I decided it would be a good place to come and I have not regretted it". We reviewed five care plans and noted each care plan contained a comprehensive assessment of each person's care and support needs. One person said "When I was admitted the nurse spent time with me explaining everything about the home and what care I would need while I was here. I felt I was involved in planning my own care".

Is the service responsive?

Staff told us it was essential to the care and wellbeing of people living at the home to be responsive to their care and support needs. We noted there was a wide range of activities to support people's independence. We observed staff always offered people the choice of joining in with the activities which were well advertised throughout the home. People told us how much they enjoyed the trips out and how much they were looking forward to going to Forde Abbey on the day of our visit. One person said "I really enjoy the trips out and the staff are wonderful about helping us to all get in and out of the minibus safely". The acting manager told us the home was supported by the local GP services who visited the home up to three times a week and had a dedicated telephone line for advice and support.

Is the service well-led?

The acting manager (temporary replacement for the registered manager) told us the home had experienced staffing difficulties in the past six months. The registered manager and head of department for the newly commissioned dementia wing had left the home. We observed there were robust acting up arrangements in place and recruitment for the vacant posts had been completed. The new post holders would take up post in September 2014. We noted the operational manager for the other British Legion Homes had provided support to the acting and deputy managers' and was currently based at the home for three days a week. Staff told us they were well supported by the acting and deputy managers' and the operational manager. We saw evidence that staff meetings, supervision and formal appraisal processes were in place. We noted the managers' had met with the people living at the home, relatives and staff to advise them about the changes and to provide reassurance on how the home would be run in the future. We reviewed feedback from the quality assurance surveys completed by people living at the home, their relatives and visiting professionals. We noted people had reported favourably on the care, support and management of the service. One person said "I have very good care and nothing is ever too much trouble whatever time of day it is ".

We spoke with 11 people who used the service, to the registered manager and other staff on duty. We spoke with a visiting GP. We observed how care and support was provided to people.

People told us about their lives at Dunkirk Memorial House. One person told us, 'The best decision I made, never regretted it.' Another said 'I have continued with my life as I wanted. I get the care and support I need.' People told us about how staff helped people to maintain their independence.

People were very complimentary about the staff working in the home. Comments included, 'Very helpful,' 'Lovely' and 'Wonderful.' We observed that people had good relationships with staff, communication was good and they did not hesitate to speak to staff if they had a comment or concern.

People were supported to access a wide range of social events. We observed that people were well supported with their needs being met with dignity and respect. We looked at people's care plans, risk assessments, daily recordings and found that they were comprehensive and encompassed the safety and well-being of people who use the service.

Both staff and residents said that they knew how to raise a concern or complaint and that they felt confident in doing so. All staff had received safeguarding training and there were policies and procedures in place for this. Residents had information on safeguarding on their notice board, together with telephone numbers and photographs of the local police officers.

Staff told us that they were well supported and they received regular training. We saw that staff were supervised and were appraised annually.

People who used the service, family and staff were provided with the opportunity to give feedback.