Durnsford Lodge Residential Home

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• 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

We identified 1 breach of legal regulations. People were not always supported to have maximum choice and control of their lives and staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA) including Deprivation of Liberty Safeguards (DoLS). However, the provider had systems and processes in place to help ensure people were supported to understand their rights and staff had received training in MCA and DoLS. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People who were able to share their views with us told us the staff were kind and caring and offered them everyday choices. For example, one person said, “I like all the staff and they are kind, I have no concerns. Yes, I get choice and I usually have a boiled egg, today I had cereal instead, but I have what I want.” Another said, “I am happy to do whatever people want to do but I do tell them what I would like to do and that is what they agree to as well so that is good.” Relatives we spoke with told us they had not been asked to take part in capacity discussions or best interests decisions. Comments included, “We haven't had any discussions about [person’s name] capacity, but we all know he can't make his own decisions.” As the family we are involved in all discussions and decisions. We haven't discussed best interests’ decisions, well I haven’t.” “We haven't spoken about Mom's capacity or any future decisions, not that I remember.” And “Care plans, best interest decisions were not discussed with me.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The manager and staff told us they had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and whilst they described the importance of obtaining people's consent and following the principles of the mental capacity act. We found this knowledge and understanding was not applied consistently. For example, some people's care records did not always show their consent and/or views had been sought in relation to decisions being made on their behalf or that people were always being supported and empowered to have maximum choice and control over their lives.

At our last inspection we found the failure to properly assess, and record people's capacity and best interest decisions risked compromising people's rights. This was a continued breach of regulation 11, at this assessment we found not enough improvement had been made. The provider had a clear policy and developed systems and processes to help ensure people were supported to understand their rights. Records showed, and staff confirmed they had received training in safeguarding adults, the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, we found people were not always supported to have maximum choice and control of their lives. Mental capacity assessments and best interest decisions showed a lack of knowledge and understanding of the principles of the MCA. For example, some people’s MCA’s contained conflicting information relating to multiple decisions within one assessment process, which was not decision specific; did not contain the views of the people consulted regarding the decision and lacked detail with regards to the decision to be taken. People were not supported to make decisions about their care and staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA) including Deprivation of Liberty Safeguards. This meant people who lacked capacity or who had fluctuating capacity, did not always have decisions made in line with current legislation. Where the service had submitted DoLS applications to the local authority for consideration. People's capacity to consent had not been assessed prior to these applications being made and the service was unable to provide evidence that they had followed a best interests process. The failure to properly assess and record people's capacity and best interest decisions risked compromising people's rights. This was a continued breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.