CQC report explained · a residential care home
What the CQC found at Duncan House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were considered safe, with suitable risk assessments, enough staff and thorough recruitment checks. Medicines were stored and administered safely, but some records and guidance were not clear or complete.
- Effective?
- Good
- Care plans reflected people's individual needs, choices and goals. Staff had relevant induction, training, supervision and support.
- Caring?
- Good
- Staff treated people with kindness, patience, dignity and respect. People were supported to make choices and maintain independence.
- Responsive?
- Good
- Care and activities were personalised to people's needs, interests, moods and communication styles. The home had an accessible complaints process and responded to complaints.
- Well-led?
- Requires improvement
- The management team was supportive and inclusive, but its quality checks did not always identify gaps in medicine records. The home also did not always notify the CQC about DoLS authorisations as required.
What inspectors found, March 2019
Duncan House was rated Good overall, but inspectors found weaknesses in medicines records and rated the home Requires Improvement for being well-led.
This was an unannounced, comprehensive inspection on 22 January 2019. One inspector reviewed records, spoke with people, staff and family members, and observed care. The inspection covered all five CQC questions.
Inspectors found that people were safe, supported by enough suitable staff and cared for by staff who knew them well. Care was kind, respectful and personalised. People were supported to make choices, stay independent, join activities and keep in contact with their families.
The main problems were in management checks and medicines records. Some medicine records had gaps or conflicting information, and guidance for some medicines to be given when needed was not always clear. The home also failed to notify the CQC about some Deprivation of Liberty Safeguards authorisations. The overall rating was Good, with Well-led rated Requires Improvement.
Person-centred care
Care plans were detailed and tailored to each person's preferences, interests, emotional needs and goals.
“People's care plans were exceptionally person centred and described people's personal likes and preferences, their social interests, as well as physical and emotional needs.” from the report
Kind and respectful staff
Inspectors saw positive relationships between staff and the people living in the home. People's privacy, dignity and choices were respected.
“Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.” from the report
Independence and activities
People were supported to make decisions, go out, take part in community activities and pursue their own interests.
“The variety of individual and personalised activities which took place demonstrated that staff had a positive impact on people's lives.” from the report
Safe staffing
There were enough staff to meet people's needs, and recruitment checks were thorough.
“People's needs were met by sufficient staff to keep people safe.” from the report
Incomplete medicines records
needs fixingSome medicine administration records had missing signatures or reasons for refusals. Other medicine information conflicted, and guidance for medicines given when needed was not always clear.
“People's medication records were not always accurate and had conflicting medicine information.” from the report
Quality checks missed problems
needs fixingThe home's audits did not identify gaps in medicine records. The manager had started a new audit process, but inspectors still rated Well-led Requires Improvement.
“However, we found these were not always effective. For example, in relation to audits of people's medicine administration records (MAR).” from the report
- 01How have you corrected the gaps and conflicting information in medicine records?
- 02What checks now make sure staff sign medicine records correctly and record any refusals?
- 03What written guidance is now in place for each person's medicines that are given when needed?
- 04How do you make sure the CQC is notified promptly about new DoLS authorisations?
- 05What evidence can you show that the new quality audit process is identifying and fixing problems?
This was an unannounced comprehensive inspection covering Safe, Effective, Caring, Responsive and Well-led, with ratings given for all five questions. This explanation was written from the published report of 6 March 2019 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 Duncan House
2 rated inspections over 3 years: the service has held its Good rating throughout.
- March 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 January 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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42 live-in carers within about an hour of West Berkshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 36 can care for a couple. 14 years' experience on average.
“Titus has compassion, patience, a great sense of humour and a very professional attitude.”
“Barbara treated my mother-in-law with enormous love and compassion and provided an environment where she could feel safe and seen”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.