CQC report explained · a residential care home
What the CQC found at The Dene Lodge - Minehead
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2022
The Dene Lodge - Minehead was rated Requires Improvement; inspectors found kind staff and safe infection control, but serious gaps in consent, care records and management.
This was an unannounced focused inspection on 6 July 2022. One inspector spoke with people, a visitor and staff, observed care, and checked care plans, medicines records, staff files and safety records.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also rated Requires Improvement. Inspectors found people generally felt safe and received kind help with personal tasks, but care was often focused on completing tasks rather than supporting choice, independence and social activity.
There were important gaps in records and decision-making. Care plans and risk assessments were not always up to date. Two people received medicines hidden in food or drink without the required evidence of capacity assessments, consultation or best-interest decisions.
The home had improved its infection prevention and control and was no longer in breach of Regulation 12. However, the inspection found new breaches of Regulations 9, 11 and 17. A new manager had been appointed and was due to start the week after the inspection.
Kind physical care
Staff were observed helping people in a kind and gentle way. People who could express their views said they felt safe.
“People looked comfortable with the staff who supported them. When staff supported people with a task, we observed they were kind and gentle.” from the report
Improved infection control
The provider had addressed the previous infection control breach. Inspectors were assured about visitors, admissions, protective equipment, testing and outbreak management.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12.” from the report
Access to healthcare
Staff worked with doctors, nurses and other professionals to monitor people's health and manage long-term conditions.
“People lived in a home where staff had good relationships with local professionals. This helped to ensure people had access to healthcare support when they needed it.” from the report
Safe environment
The building was maintained and equipment was checked. People could use attractive gardens and suitable equipment.
“People lived in a home which was well maintained and had been adapted to meet people's physical needs.” from the report
Covert medicines
seriousTwo people were given medicines without their knowledge. The records did not show capacity assessments, consultation with representatives or best-interest decisions, and did not confirm whether crushed medicines were suitable.
“There was no assessment of the person's capacity to give or withhold consent in the person's care plan.” from the report
Out-of-date risk records
seriousRisk assessments were not always reviewed after people's circumstances changed. One person's assessment still recorded low falls risk after five falls.
“Since that time the person had fallen five times, but the assessment had not been updated and therefore no control measures had been recorded to reduce further risks.” from the report
Limited activities and choice
needs fixingCare was often task-focused. People had little social interaction when the activity worker was absent, and inspectors saw choices about routines, television and activities being missed.
“On the day of the inspection there was no activity worker. We saw that people spent time sat in the lounge and there was very limited social interaction.” from the report
Incomplete care plans
needs fixingSome care plans did not give enough detail about personal care, preferences or responses to anxiety. This could lead to inconsistent or unsuitable support.
“Some care plans contained minimal information to enable staff to meet their needs in a planned way.” from the report
Weak oversight
seriousThere was no registered manager and no effective audit system to check care quality or drive improvement. Records and risk assessments were therefore not reliably kept up to date.
“There was a lack of effective systems to assess, monitor and improve the quality of care people received.” from the report
Poor presentation of specialist meals
minorPureed meals were provided, but the presentation made it hard for people to identify the food and choose which parts to eat.
“Meat and vegetables had been pureed together to create an unattractive brown mush.” from the report
- 01How will you make sure capacity assessments and best-interest decisions are completed before any medicines are given covertly?
- 02How will you keep care plans and risk assessments updated after falls or other changes in need?
- 03What dementia care training and guidance have new staff received since this inspection?
- 04How will you provide regular activities and social contact when the activity worker is not present?
- 05What audits does the new manager now use to check care quality and drive improvement?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and the overall rating used the previous inspection ratings for those areas. This explanation was written from the published report of 3 August 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, August 2021
Rated Requires Improvement; inspectors found kind care and adequate staffing, but infection control, risk records and oversight needed improvement.
This was an unannounced focused inspection on 7 July 2021. Inspectors looked only at Safe and Well-led, after concerns about infection control, staffing and how the home was managed. They spoke with people, a relative and staff, observed care, and checked care plans, medicines, recruitment, training and safety records.
The home was not always following COVID-19 guidance. Some staff did not wear masks correctly or always use disposable aprons, and testing arrangements were not robust. Risk assessments and care plans were not always kept up to date, including after a fall and for people with diabetes.
Inspectors found people appeared comfortable with kind staff. Staffing was adequate during the visit, medicines records were generally complete, and the building and equipment were well maintained. However, quality checks did not always identify problems or prevent repeated falls. The overall rating fell from Good at the previous inspection to Requires Improvement.
Kind and familiar staff
People appeared comfortable and relaxed. Staff knew people well and understood their preferred routines.
“People looked comfortable and relaxed with staff. Staff were seen to be kind and caring towards people.” from the report
Adequate staffing
Inspectors found enough staff during the visit to keep people safe and respond to their needs. People said they did not wait long for help with call bells.
“At the time of the inspection people were being supported by adequate numbers of staff to keep them safe.” from the report
Safe environment
The building was well maintained, and equipment and safety systems were regularly checked.
“People lived in a building which was well maintained and safe. There were regular health and safety checks carried out in house and by outside contractors.” from the report
Good medicines records
Medicines administration records had no gaps in the sample checked. Records included information such as allergies and people's preferred way of taking medicines.
“There were no gaps in these records, including those concerning topical applications.” from the report
Support for family contact
Staff helped people keep in touch with relatives during the pandemic through video calls, phone calls, photos and visits.
“The staff had helped people to keep in touch with family and loved ones during the pandemic.” from the report
Infection control
seriousThe home was not always following government guidance on testing and protective equipment. Inspectors found that some staff wore masks incorrectly and did not always wear disposable aprons for personal care.
“A number of staff were not wearing facemasks correctly. Staff said they were not always wearing disposable aprons when supporting people with personal care.” from the report
Out-of-date risk plans
seriousSome care plans did not contain current guidance for staff. One falls assessment had not been reviewed after the person fell and needed hospital treatment, and diabetes plans were missing.
“One person had a falls risk assessment which was completed in January 2021. The person had a fall in June 2021, resulting in hospital treatment, but the risk assessment had not been reviewed or updated.” from the report
Weak quality checks
needs fixingAccident and incident audits counted events but did not look properly at causes or patterns. Inspectors found no evidence of preventative action when some people had repeated falls.
“There was no recorded evidence of an attempt to establish trends or cause in these figures.” from the report
Medicines decisions
needs fixingOne person received medicines hidden in yoghurt, but the report found no mental capacity assessment or best interests meeting for this decision. CQC recommended further work on the Mental Capacity Act.
“However, no mental capacity assessment had been undertaken, to ensure the person was not capable of giving or withholding consent, and no best interests meeting had been held.” from the report
- 01What changes have you made to COVID-19 testing and the correct use of masks and disposable aprons?
- 02How do you make sure falls risk assessments are reviewed promptly after a fall or hospital treatment?
- 03What current care guidance is now in place for people with diabetes?
- 04How do your accident and incident audits identify repeated falls and lead to preventative action?
- 05What process do you now use for mental capacity and best interests decisions about medicines given covertly?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other key questions were not inspected and previous ratings were used. This explanation was written from the published report of 3 August 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 The Dene Lodge - Minehead
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- August 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2017Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2010
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 9 December 2010.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
76 live-in carers within about two hours of Somerset
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 £1,370 a week. 62 can care for a couple. 12 years' experience on average.
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
“She was not phased by anything, she was adaptable, kind & gave us complete confidence to go away & not worry about a thing!”
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.