CQC report explained · a residential care home
What the CQC found at Dauntsey House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2022
Requires Improvement; inspectors found risks in medicines, incident management and oversight, although people described kind care and enough staff.
This was an unannounced focused inspection on 22 October 2022. Inspectors looked at whether the home was safe and well-led. They reviewed care records, medicines records, incidents, safeguarding records, recruitment files and quality checks. They also spoke with people, relatives, staff and a visiting healthcare professional.
Inspectors found medicines were not always managed safely. Risk plans were not strong enough, some incidents had not been reported properly, and records did not show what had been done to prevent problems happening again. Some staff had started work before all required recruitment checks were completed.
A new registered manager had identified some problems and started making changes. However, the home's systems had not found or dealt with the shortfalls. People and relatives said they were happy with the care, the home was clean, and there appeared to be enough staff. The overall rating changed from Good at the last inspection in 2018 to Requires Improvement.
People felt happy with their care
People and relatives said they were happy with the care and felt able to raise concerns.
“People and relatives all told us they were happy living at the service.” from the report
Enough staff seen
People and relatives said staffing was sufficient, and inspectors observed staff meeting people's needs in a timely way.
“During our inspection we observed enough staff were available to meet people's needs in a timely way.” from the report
Clean home and infection controls
The home was clean, staff used protective equipment, and infection prevention guidance was available. Two areas needed repair.
“The home was clean, and people told us they were happy with the cleanliness of their rooms.” from the report
Approachable new manager
Staff and relatives said the new registered manager was visible, accessible and approachable. The manager had begun working on problems identified at the home.
“The new manager is accessible and approachable.” from the report
Medicines were not always safe
seriousSome medicines records lacked important information. Guidance was missing for some as-required medicines, covert medicines had not been checked as safe to give in food or drink, and cream applications were not clearly recorded.
“Medicines were not always managed safely. People prescribed 'as required' medicines did not have protocols in place to give staff guidance on administering this type of medicine.” from the report
Risks and incidents were not managed well
seriousRisk plans did not always give staff enough guidance. Some incidents between people had not been referred to the local safeguarding team, and records did not show what had been done to reduce the chance of recurrence.
“Failing to assess and mitigate risks to people's safety placed people at risk of harm.” from the report
Weak quality checks
seriousThe provider's audits and monitoring had not identified important problems in medicines, incidents, care plans and recruitment records. This meant the provider did not have a reliable overview of safety and quality.
“Failing to have systems in place to assess, monitor and improve the quality and safety of the service placed people at risk of harm.” from the report
Recruitment checks were incomplete
needs fixingSome required pre-employment checks had not been completed before staff started work. The registered manager took action during the inspection.
“Staff had not always been recruited safely. Some pre-employment checks had not been completed prior to staff starting work.” from the report
- 01What changes have been made to medicines records, as-required medicines, covert medicines and topical creams?
- 02How do you now record and review incidents, including referrals to the local safeguarding team?
- 03How are risks for people who may become distressed or involved in altercations assessed and managed?
- 04What checks are completed before new staff start work, and how are recruitment records audited?
- 05What progress has been made on the action plan requested by CQC, and how is the provider checking that improvements last?
This was a focused inspection of Safe and Well-led only; ratings for the other key questions were carried forward from the last inspection. This explanation was written from the published report of 1 December 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2021
Dauntsey House was inspected but not rated; inspectors found strong infection control during a COVID-19 outbreak.
This was a targeted, announced inspection on 22 December 2020. It looked at infection prevention and control because the home had a coronavirus outbreak.
Inspectors found good practice. PPE supplies exceeded government guidance, staff used PPE correctly, and infection control training was up to date. Testing was in place for staff and residents.
People who tested positive were isolated in their rooms. Visitors were not admitted at the time, apart from end-of-life visits. The home had changed its layout, used risk assessments and added staff to help reduce mixing.
The home was inspected but not rated. This visit does not give an overall quality rating or ratings for the other areas of care.
PPE supplies
The home had more PPE than current government guidance required and placed PPE stations around the building.
“Stocks of PPE exceeded current government guidance levels. PPE stations had been established throughout the service to help ensure staff had access to it when required.” from the report
Infection control planning
The home had clear procedures and risk assessments for residents, staff and visitors.
“Clear procedures and risk assessments for people, staff and visitors had been developed to maintain good practice in relation to infection control and to provide safe care.” from the report
Testing and staff practice
Staff were tested weekly and residents monthly. Inspectors saw staff wearing PPE correctly, and training was up to date.
“Staff training in infection control and personal protective equipment (PPE) was up-to-date. Staff were observed wearing PPE correctly.” from the report
Managing the outbreak
Residents who tested positive were isolated, visitors were restricted apart from end-of-life visits, and an extra staff member helped reduce mixing.
“Due to an outbreak, people tested covid-19 positive were isolated in their rooms.” from the report
Inspectors raised no specific concerns in this report.
- 01What infection control measures are now in place, and how do they differ from those used during the December 2020 outbreak?
- 02How often are staff and residents tested now?
- 03How are visitors, including end-of-life visitors, managed if there is an infection outbreak?
- 04How will the home support a resident who walks around while reducing the risk of mixing with other residents?
- 05Can we see the latest full inspection report and ratings for areas that this targeted inspection did not cover?
This was an announced targeted inspection of infection prevention and control during a coronavirus outbreak; it did not assess the other four areas of care or give an overall rating. This explanation was written from the published report of 21 January 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Dauntsey House
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- December 2022Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2021Inspected but not ratedSafe: Inspected but not rated
- August 2018Goodstayed GoodSafe: GoodWell-led: Good
- March 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- June 2011
Registered with the Care Quality Commission on 16 June 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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