Dolphin Court

We found the following examples of good practice.

¿ Visiting to the home is arranged through an appointment system.

¿ Temperature checks are carried out on all people visiting the home.

¿ All visitors to the home are required to wash their hands and wear masks on arrival.

¿ All visitors are requested to sign in the visitors log book.

¿ Risk assessments were sent out to families who were updated weekly.

¿ Virtual visits were arranged for families who are not able to visit their relative in the home. These took place over the internet and using the telephone,

¿ A detailed contingency plan was available for staff to follow, which provided them with up to date guidance on Covid 19.

¿ People admitted to the service would be required to be tested for Covid 19 and isolate for 14 days in their own room on admission. The last admission was approximately three years ago.

¿ Personal protective equipment (PPE) was available to staff who were using the appropriate PPE throughout our inspection.

¿ Staff had received training in infection prevention and control as well as the donning and doffing of PPE.

¿ The home had enough supplies of PPE and arrangements were in place to monitor stock and re order supplies as required.

¿ Staff had worked with people to ensure they understood why staff were using masks. Masks were given to the people living at the home so they could explore and become familiar with them. Some people chose to wear the masks.

¿ Systems were in place to test the staff weekly for Covid 19. When people were being considered for testing the registered manager told us they would have to have capacity and best interest decisions in place. Appropriate plans were in place to ensure the correct action was taken if anyone tested positive.

¿ One flat was vacant and was kept available to be used if needed to isolate people.

¿ The environment was clean, and arrangements were in place for regular cleaning with special attention being paid to touch points. The correct receptacles were available for the removal, following use, of PPE which was kept for 72 hours prior to being disposed of into the main waste bins.

¿ Comprehensive communication arrangements were in place to ensure people, staff and their relatives were kept up to date about Covid 19 prevention measures and the safety arrangements within the home.

¿ Contingency plans were in place for winter and the possibility of a second wave of Covid 19 should the home become affected.

¿ Vulnerable staff were risk assessed and supported to manage any health conditions or to shield if required.

Further information is in the detailed findings below.

Dolphin Court is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dolphin Court accommodates 15 people with a learning disability and / or physical disability in three adapted buildings and three flats. The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were safeguarded from avoidable harm. Staff adhered to safeguarding adults procedures and reported any concerns to their manager and the local authority.

Staff assessed, managed and reduced risks to people’s safety at the service and in the community. There were sufficient staff on duty to meet people’s needs.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff completed regular refresher training to ensure their knowledge and skills stayed in line with good practice guidance. Staff shared knowledge with their colleagues to ensure any learning was shared throughout the team.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regards to any health needs.

Staff applied the principles of the Mental Capacity Act 2005. 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. An appropriate, well maintained environment was provided that met people’s needs.

Staff treated people with kindness, respect and compassion. They were aware of people’s communication methods and how they expressed themselves. Staff empowered people to make choices about their care. Staff respected people’s individual differences and supported them with any religious or cultural needs. Staff supported people to maintain relationships with families. People’s privacy and dignity was respected and promoted.

People received personalised care that meet their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People participated in a range of activities.

A complaints process ensured any concerns raised were listened to and investigated.

The registered manager adhered to the requirements of their Care Quality Commission registration, including submitting notifications about key events that occurred. An inclusive and open culture had been established and the provider welcomed feedback from staff, relatives and health and social care professionals in order to improve service delivery. A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

Further information is in the detailed findings below.

Dolphin Court is registered to offer support and accommodation for up to 15 people with learning disabilities. On the days of our visit there were 14 people living at the home. Care was provided in three adjoining houses and three separate flats above the houses. The flats are for single occupancy and had their own entrances. Three flats were occupied and 11 people lived in three houses.

There was a registered manager in place. 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. There was a registered manager with overall responsibility for Dolphin Court, and an assistant manager for each of the three houses and flats and they are line managed by the registered manager.

We carried out a comprehensive inspection of this service in December 2014 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who use the service. Staff were not consistently aware of safeguarding procedures, and not all incidents had been reported appropriately. There were not always enough staff to ensure the needs of people could be met at all times. Risk assessments did not always identify the risk and the support that people required and some care plans had not been updated to reflect changes in people’s needs. The service was not always well led; staff did not always know who was in charge. We asked the service to submit an action plan telling us when they would be compliant and this was received.

At this inspection, we found the provider had made improvements to how the service was run. The service had robust systems in place to maintain people’s safety at all times. For example risk assessments were carried out to identify and minimise both known and unknown risks to people.

Staff had comprehensive knowledge of their responsibilities in relation to safeguarding people from abuse. Staff were aware of the differing types of abuse and how these may present, who to inform of suspected abuse and how to maintain peoples confidentiality.

The service was aware of and met the legal obligations around the Mental capacity Act and deprivation of liberty safeguards.

Staff underwent a comprehensive induction period and ongoing training which enabled them to effectively support people in their care.

Staff were able to identify their own training needs and request additional training if needed.

Medicines were administered, recorded and stored in line with company policy and good practice. Staff were aware of the importance of medicines management and showed good knowledge of the medicines they administered and their purpose.

The service operated a person centred approach to the delivery of care which meant that care was tailored to the individual’s needs. People were encouraged to be involved in decisions about their care where appropriate.

Family members, healthcare professionals and advocates contributed to people’s care plans and risk assessments.

Staff treated people with dignity and respect at all times. Staff had significant knowledge of the people they supported and were observed encouraging people to express their needs in a positive and inclusive manner.

The service had a warm and welcoming atmosphere where people were encouraged to share their views and opinions. Throughout the inspection staff were observed interacting with people in a professional and warm manner.

The service had adequate numbers of staff at all time to ensure people’s needs were met.

People were supported to access external health care professionals to ensure their health and wellbeing was monitored and maintained.

The registered provider had supported the registered manager and their staff with additional resources to improve the management, staffing, care planning and quality assurance systems at the home. Relatives and staff felt positive in the recent changes in the service

At this inspection we found the registered provider and manager had met all of the requirements of the Regulations to meet the fundamental standards.

We visited Dolphin Court on three separate occasions as part of this inspection. During our inspection we spoke to six care staff, two 'house managers', the registered manager and two relatives. We also received comments by email from one relative and spoke to a representative from the local authority safeguarding team. We met most of the people living at Dolphin Court. The majority of the people who lived there had complex communication needs so we did not speak to them about their views. We spent time observing the care and support given to people during the day and in the evening.

We saw that most people looked happy and relaxed. We observed staff interacting with people in a friendly manner and treating them respectfully. People, who were able to, moved freely around their home and those that needed assistance were supported appropriately. On one occasion we saw a member of staff help someone off the floor in a way that was different from that which was described in their care plan. Another member of the care team immediately corrected them and later reported this to the registered manager.

The relatives we spoke to raised some concerns about communication and staffing levels, however they felt their relatives were safe and care was good.

One relative spoke highly of the staff. They said 'The TLC [tender loving care] at Dolphin is extraordinary', and 'The level of personal care is exceptional'. When we asked if they felt their relative was safe they said yes and added 'I would move heaven and earth for her not to be moved from there'. Another relative said staff were 'Generally good people' and some were 'Particularly good'. Another relative told us 'I think the staff do sterling work'.

There were processes in place to ensure that medicines were received, stored and administered safely. Only trained and competent staff attended to this.

We found that the systems for monitoring the quality of the service meant that shortfalls were highlighted and acted upon.

We found that people living at Dolphin Court were involved in the decision making about their lives and the service. Each person's way of communicating was unique, we found that staff knew people well and had clear and detailed care plans which enabled them to understand people's wishes and respect them. We also found that privacy and dignity were respected and independence encouraged.

We looked around all three houses and the office building and found that all areas were clean and hygienic. They were also accessible and suitable for the people living, working and visiting the home. For examples, there were ramps and wide doors for people who use wheelchairs.

We sampled the policies and procedures relating to the building and equipment. We found that the policies and procedures in place promoted the safety, independence and comfort of people living in the service.

As part of this inspection we spoke to three staff, two relatives, the manager of House 2 and the newly appointed Regional Operations Manager. We were also assisted by an administrator for the home.

We spent most of our time in House 2 where we met the people living there, chatted to them and observed their care and interactions with staff. People were not able to give us their views verbally, however we saw that they were able to express themselves to staff and interact positively with them .