Dalvington/The Oaks

Dalvington/ The Oaks is a care home that provides accommodation with support for up to 15 people with a learning disability or autistic spectrum disorder. At the time of inspection there were 14 people using the service.

The home had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks were assessed and kept up to date to ensure people could be supported safely and participate in activities that they enjoyed.

People and their relatives told us people were supported safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were able to receive visitors without restrictions in line with best practice guidance.

Right Care

People were protected and safeguarded from abuse and avoidable harm by staff that understood their responsibilities to keep people safe. There were sufficient numbers of staff to meet people’s needs.

Right Culture

The culture in the service was open and positive, with systems in place to promote and provide person centred care. People and their relatives together with staff were involved in the running of the service and the provider worked in partnership with others to achieve good outcomes for people. The quality of care was monitored and lessons were learned when things had gone wrong.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (27 October 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about restrictive practices. A decision was made for us to inspect and examine those risks. we found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this report.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People's experience of using this service and what we found

There were not always enough staff to ensure people's safety at all times.

The service was not always well led. Ineffective quality monitoring systems meant there was no oversight of the risks associated with people's health safety and welfare. The provider’s quality checks had not identified the improvements required to make sure the Mental Capacity Act had consistently been followed. Opportunities to learn lessons and drive improvements when concerns were raised had been missed

Risks associated with people's care and support arising from needs were not managed safely.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 06 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made however the provider was still in a continued breach of regulation 17 Good Governance.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We had also received concerns from a whistle-blower and a health and social care professional.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dalvington/The Oaks on our website at www.cqc.org.uk.

Follow up

We have arranged to meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dalvington/The Oaks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Dalvington/The Oaks accommodates 13 people in two adapted buildings and is designed to meet the needs of people with a learning disability. On the days of our inspection 13 people were living at the home.

The provider had adopted some of the principles and values that have been developed and designed to underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The aim is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post who was present during our inspection. 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 of the service on 30 January 2017 the service was rated as 'Good' overall. On this inspection we found the provider had not maintained their rating of 'Good' overall and we have changed the rating to 'Requires Improvement' overall.

Staff and the management team knew how to report allegations of abuse. However, we identified three potential safeguarding incidents which had not been reported to the local authority or the Care Quality Commission.

The provider’s and registered manager’s quality checking arrangements were not consistently robust and effective in ensuring there was an effective oversight of the home. The issues and risks to people’s safety and welfare we identified during our inspection had not always been effectively reduced by the management teams own checking procedures.

There were risks to unauthorised people having access to people’s personal information because this had not been stored securely. Some environmental risks required a more robust oversight to ensure people were not at risk from infections spreading and or of avoidable harm due to radiator tops being loose.

Staff had been provided the training relevant to the need of people they provided care to. The registered manager had a training planner and this showed staff training was being refreshed when required in line with the provider’s expectations.

Staff were knowledgeable about the support and equipment people required to reduce risks to their individual safety and welfare. Where people required wheelchairs or shoes adapted to meet their needs these were in place through consultation with healthcare professionals as required.

The registered manager kept staffing numbers under review and had increased these to meet people's needs. We have made a recommendation about staff deployment to ensure this is kept under review too so risks to people’s safety were reduced further.

People's individual needs and requirements were assessed prior to them moving into the home. People had support to eat and drink safely and comfortably, and contact had been made with various healthcare professionals where required to obtain advice about meeting people's nutritional needs. Staff supported people to maintain their health alongside relative's involvement.

People were supported to have maximum choice and control of their lives and staff always support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff obtained people’s consent by using their preferred communication methods whilst supporting people’s care.

Staff supported people with kindness. People had support to express their views and opinions, and care was provided with dignity and in private. Relatives were welcomed into the home and were involved in their family members care and support.

People's needs were written into support plans as guidance for staff to follow. The management team were reviewing care documentation to ensure staff had all the information they required to provide responsive care. People were supported to do leisure activities for fun and interest which also met their emotional, social and psychological needs. There was a sensory room for people to use as they chose for their relaxation and enjoyment and space for people to eat, be alone and share with their visitors.

People who lived at the home, their relatives and staff felt able to approach the management team at any time. The registered manager was responsive and showed accountability to wanting to make the required improvements to remedy the shortfalls we had identified during our inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

Dalvington/The Oaks provides accommodation and personal care for a maximum of 15 people who have a learning disability, some of whom also have physical disabilities. The home consists of two separate bungalows, one called Dalvington with accommodation for seven people, and one called The Oaks with accommodation for six people. There were 13 people who lived at the home when we visited.

At the last inspection on 16 and 17 December 2014 the service was rated as good. Since the last inspection a new registered manager had been appointed. 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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People were supported by staff to have their medicines when they needed them and staff recorded when they had received them. Staff had received medication training and there were arrangements in place for managing people’s medication safely.

Staff were available to meet people’s needs promptly and they demonstrated good knowledge about people living at the home. Staff we spoke with felt they had the right skills to support people living at the home and attended regular training to ensure they kept their knowledge updated.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff sought the consent of people before providing care and people could choose the support they received.

People were involved in choosing their meals and staff were seen to assist people to eat and drink where needed. People were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP. Where appointments were needed at hospital these were supported by staff and any changes to care needs recorded and implemented.

People were comfortable around staff providing care and relatives told us people had developed good relationships with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

Relatives said communication was good and staff and the registered manager were available to them. They said staff listened to them and they felt confident they could raise any issues should the need arise.

People, relatives and staff were all complimentary about the service provided. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The management team ensured regular checks were completed to monitor the quality of the care that people received and action had been taken where areas were identified for improvement.

As part of this inspection we spoke with a relative and a visitor, the registered manager and four carers. We also reviewed records relating to the management of the home which included four care plans, four daily care records, and three food record charts. We looked at the results of the latest satisfaction survey, health and safety and personal finance audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Although there had been staffing vacancies in the past, new staff had been recruited and were in post or due to commence working within the month. Carers told us that they had sometimes been short of enough staff who knew people and a person had completed a survey and said, 'any problems arise when staff who do not know the person are not available.' This showed us that there had been problems in the past but that the service had taken steps to address them. Daily staff numbers had varied according to the activities and needs of people using the service.

We saw that a comprehensive risk assessment had taken place before people had gone to live at the home. These were not all updated annually although they were audited by carers every three months. No action plan was in place if changes were needed. A person who had a percutaneous epigastric tube (PEG) did not have a care plan for the care and use of it. All of the people using the service had communication difficulties and all the care plans that we saw reflected this. However, we spoke with a carer in one house who told us that they had not read any care plans for people living there because they usually worked in the other house. They did not know the specific care or communication needs of the people living in the house.

A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

One relative that we spoke with by telephone told us that they visited at different times and were unannounced. They said the person using the service, 'Is always smiling and is always clean and tidily dressed.' They thought that the carers were generally very good. Another frequent visitor said that the person using the service 'loves it here' and 'always looks well looked after.'

Most of the comments made in the annual satisfaction survey were positive. One person described the service as, 'the perfect home for (the person).' Another said, 'I can tell by regular visits that (the person using the service) is happy there and is well cared for.'

People were offered a variety of food, including fruit and vegetables. People who needed help to eat were assisted at mealtimes. We saw that food charts were kept for people who had assessed nutritional needs.

All staff had received the appropriate training to meet people's needs, which included training about safeguarding people and healthy eating.

Is the service caring?

The service was caring. A relative that we spoke with told us, 'I think staff are caring.' They said that carers always made them feel welcome to the house" and that it felt like a family home. A visitor said, 'They are very caring, I can see that.' A person who completed the survey said, 'Most of the staff are wonderful and caring.'

All but one of the carers that we spoke with knew people's needs and we observed them interact with different people in ways that they could understand. A carer talked with us about a person. They told us what the person liked to do and what could make them anxious or upset in a way which showed us that they cared about them. They said, 'my job is to help give people the best life I can.' Also, 'I like seeing them smile.'

Is the service responsive?

People's preferences, interests and aspirations had been recorded. All but one of the carers that we spoke with could tell us what these were for different people. We saw that a person wanted to go on holiday and this was being planned for. People took part in a wide range of activities that they enjoyed. A relative told us a person, 'does lots of things (they) didn't do at home. (They) would be bored at home now.'

We saw that when relatives could not visit people, the service arranged for carers to take people to their homes to visit. A person told us that they had made suggestions to improve the outdoor spaces so that more people could enjoy them. They said that plans had been made in response. We did not see evidence that there service had responded to the latest survey where only four people believed that there were agreed outcomes for the people using the service. Nine people had completed the survey. We did not see that any attempt had been made to engage people using the service in a survey, in a format they could understand.

Is the service well led?

The service had a recently registered manager. Not all of the carers that we spoke with knew that they were the permanent manager. There were also two deputy managers. Carers said that the managers were supportive and approachable and that they had regular supervision meetings. Appraisals had not all taken place in 2013 but were on course to be completed in 2014. The provider sent an annual satisfaction survey to monitor what relatives thought about the quality of the service, although we did not see an action plan based on the results, to make improvements. Two people who completed the survey said that the service was improving. This all showed us that the service was making improvements to the way it was led.

We looked at care records for three people and other supporting documents for the service. Consent had been obtained from people before care and treatment had been provided. Alternative arrangements had been made to support people who were unable to consent to their treatment or support. Staff told us they: 'Always ask people if it's ok or if they are happy with me giving care before I give it'.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs. People told us they were: 'Happy with the staff' who worked at the home.

We saw that staff were kind and caring in their approach to people who lived in the home. Recruitment procedures were in place to make sure that suitable staff were provided to care for people.

At our last inspection in October 2012 we had concerns about sufficient numbers of staff available to support people with their planned activities. We found improvements had been made. We found that any comments and complaints people made were responded to appropriately.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used SOFI to observe how people were feeling and their engagement with staff. We found that overall people had positive experiences. People who used the service appeared calm and relaxed in the environment and responded positively to interactions with support workers.

The individual needs of people were assessed and supporting plans had been developed which were reviewed regularly. But we found that there were not always sufficient numbers of suitably skilled staff available to ensure people could pursue interests outside of the service.

There were appropriate arrangements for management and administration of people's medication and people who visited the home told us that that they had no worries about the care of people who used the service. They said that they felt they were kept safe from the risk of harm.

We saw that there were arrangements for monitoring the quality of the service and people told us that they felt comfortable raising issues of concern with management if necessary.