Daneswood Care Home

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service design and model did not fully meet the principles of Right support, right care, right culture. This is because the service is larger than what is usually considered practicable to provide person-centred care and support. The service was registered with us prior to the Right support, right care, right culture guidance being implemented. The service was able to demonstrate they met these principles; the home had been split into 3 areas and people’s compatibility had been considered regarding who they lived with. People received person centred care and support.

People were supported by staff to pursue their interests. People had plans in place to guide staff on how to support them if they became anxious or upset. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. 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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People’s medicines were managed safely.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

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

Rating at last inspection

The last rating for this service was requires improvement (Published 29 November 2019).

At our last inspection we recommended that the provider considered current guidance on medicine management in care homes and took action to update their practice accordingly. At this inspection we found the provider had acted upon the recommendation and made the improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

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

Daneswood Care Home is a residential care home providing personal and nursing care for up to 17 people with learning disabilities and/or autism. At the time of inspection there were 17 people living at the home. One of these people was on a short stay placement. People living at the home had complex needs so had limited or no verbal communication. Each person had their own bedroom, and everyone had access to a range of communal spaces including a dining room, conservatory and lounge area.

The service was registered and designed prior to the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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 using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 17 people. Seventeen people were using the service. This is larger than current best practice guidance. However. the management were working on trying to reduce the service having a negative impact on people by reviewing the building design. Staff did not wear anything that suggested they were care staff when coming and going with people. Although, there were still some identifying signs and industrial bins outside to indicate it was a care home.

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

People appeared happy and comfortable around staff and their relatives told us they were happy and safe. However, improvements were required with areas of medicine management and we made a recommendation to the provider about them. The management was responsive to some concerns found during the inspection. Most risks had been identified with ways to mitigate them.

Systems were in place to monitor the quality and safety of care people received. The management strove to be open and constantly develop and improve the support people received. When systems had identified issues, actions were being taken to rectify them. However, some concerns identified on the inspection had not been recognised by the management.

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not always have choice in the food they ate or at what times meals were served. The location of the home meant some limitations on accessing the community.

People and staff felt there were enough staff. During the inspection people were able to participate in a range of activities due to positive staffing levels. Staff had received a range of training. Specialist training was sourced if a member of staff had a specific role or people had specific needs.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals which was important due to the complex needs of people living at the home.

Staff were kind and caring and knew the people living at the home well. Staff respected privacy and dignity throughout the inspection.

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.

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

Rating at last inspection

The last rating for this service was good (published 3 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

Daneswood Care Home provides care and accommodation for up to twenty people with complex needs who have a range of learning disabilities and include autism. At the time of the inspection 15 people were living at the service.

There was a registered manager in post. 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 consistently told us that they thought the service provided an excellent standard of care and support to their relative living at Daneswood care home. They told us, “Very caring. Couldn’t ask for more. It gives us peace of mind,” “A gem of a service. Staff are so supportive,” “Excellent. The communication is very good” and “If there are any changes at all they (manager) lets us know."

The service had received numerous compliments and positive comments. These included, “Extremely competent,” “They are very good at listening and acting on advice,” “Daneswood had a gentle, caring and encouraging ethos in which people flourish” and “With great confidence we can say that placing (person’s name) at Daneswood was the best decision we ever made.”

Family members told us they believed their; relatives had a lot of opportunities to lead a good quality of life within the boundaries caused by their disability. They told us they felt their relative was supported safely and with respect. Comments included, “It’s been a great move for (person’s name). They are so happy at Daneswood it’s an excellent place for people to live if they need the level of support (person’s name) needs” and “The staff are wonderful. It’s really important (person’s name) had the same staff team and on the whole this happens. It gives us total peace of mind.”

People living at Daneswood Care Home were supported to lead fulfilled lives which reflected their individual preferences and interests. Each person was supported by a member of staff called a key worker. A keyworker in the care sector is a member of staff assigned to support a specific person. In some instances people were supported by two keyworkers. There were enough staff available to make sure everyone was supported according to their own needs. Staff told us they loved their jobs and felt they had all the support they needed to carry out their role. They told us, “Could not imagine working anywhere else” and “I wish I had come into this work a long time ago. It’s the most satisfying job I’ve ever had.”

Staff were observed to be very attentive and available to people. They did not restrain people or prevent them from going where they wished. We observed staff encouraged people to engage in meaningful activities and spoke with them in a friendly and respectful manner. Where a person was upset the staff member was able to engage with them and focus on another activity, which calmed the person quickly. It demonstrated staff knew the person well and how to manage an event in a calm and controlled way.

People were fully supported to follow their interests and take part in social activities. The home had a wide range of meaningful activities suited to people’s individual needs and which brought positive outcomes and enhanced their quality of life. Staff members were available to support peoples’ needs and engage in a range of activities. For example people were engaged in crafts and artwork. Others chose to walk around areas of the service freely and as they chose with the support of the staff. There was community involvement. For example, the service had built community links with a local community hall, where people had attended a play’s dress rehearsal, had sing along and enjoyed parties. People also visited the local pub for meals. The service had spent time supporting the pub staff to understand certain behaviours and work with the service’ staff to ensure people were in as safe and enjoyable environment as possible.

People told us they thought Daneswood Care Home was extremely well led. Families and staff told us they were kept informed about any changes in the service. For example a monthly newsletter was made available to people. The service had an open and positive culture with a clear focus on enabling and supporting people to maximise their quality of life. The service had an exceptional range of quality assurance systems to continually reflect on its practices and make positive changes to enhance the experience of all stakeholders. Families and professionals consistently gave us positive feedback about how the service was personalised to meet people's individual needs. Staff knew each person as an individual, their preferences and interests.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge to carry out their role. Systems were in place to support staff in their role through supervision and appraisals. The staff team were well supported by the registered manager through daily communication. Staff told us, “I had a really good induction which gave me the confidence to do the job” and “It was only the support I got at the beginning that made me realise that this was the job for me. I think we get really good support but saying that, we need it because it can be stressful at times.”

The service provided a wide range of training subjects which were relevant to the needs of the people they supported. A training matrix identified what each staff member had undertaken and identified when a refresher course was due.

There was an open and supportive culture at Daneswood. Staff and relatives said the registered manager and other senior staff were approachable and available if they needed to discuss any concerns. Relatives knew how to raise concerns and complaints. They told us concerns raised had been dealt with promptly and satisfactorily.

People using the service did not have the capacity to make informed decisions about how their care and support was delivered. We identified that the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff had a good understanding of the principles of the legislation and training was updated regularly. A staff member told us, “It’s important that we (staff) understand the importance of making sure people have the authorisations in place for their own protection, but is always monitored and reviewed.”

Care records had recently been reviewed and reorganised due to the level of information included. This had helped staff report information in a more concise way. Records were detailed and contained specific information to guide staff who were supporting people. There was information in easy read formats which helped people receive information so that they could have more informed choices. Risk assessments were in place for each person, which identified individual risks For example, using a vehicle and irregular activities. Where activities took place regularly, risk assessments were included in people’s care documentation.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. The provider responded appropriately to an allegation of abuse.

When people were at risk, staff followed effective risk management policies and procedures to protect them.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when a DoLS application should be made, and in how to submit one. This meant that people were protected from discrimination and their human rights were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Care plans reflected people's current individual needs, choices and preferences. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's health was regularly monitored to identify any changes that may require additional support or intervention.

Staff supported people to take informed risks with minimal necessary restrictions.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

Parents and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.

Is the service responsive?

Where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation.

Is the service well-led?

There was a registered manager in post and all other conditions of registration were met.

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement.

We saw that staff communicated well with people and encouraged them to be independent and make choices about their every day life.

People's needs were assessed and where needs were identified care plans were developed to ensure these identified needs were met.

People were supported to access GP's, dentist, optician's and other health professionals when appropriate. We saw that care plans were in place for specific health conditions such as epilepsy which were reviewed regularly by the staff with input from health professionals.

The home provides people with a balanced diet of organic, locally produced, home cooked food. We observed that people were supported to eat and drink by staff as described in their care plans.

We found the home had effective procedures in place to manage medication safely.

We examined the home's recruitment procedures and found that these were robust and ensured that suitable qualified and experienced staff were recruited to work at the home.

Appropriate arrangements were in place in relation to the recording of medicine.

The provider sent us a copy of their action plan in November 2012, and kept us informed of their ongoing progress in respect of meeting the action plan. This included sending us supporting documents to demonstrate compliance. The purpose of this inspection was to review the warning notice, to check that the necessary improvements had been made.

Since our last visit a new permanent manager had been appointed and was in the process of receiving a handover from the interim manager. Staff we spoke with were very complimentary about the new manager and said that they were very approachable.

During our visit we found that systems had been put in place to ensure that the service provided, was regularly assessed and monitored in relation to the quality of service that people received. The provider was now meeting this essential standard.

We spoke with two relatives who were both happy with the service their relative received.

We were told by staff how people made choices, how they communicated that they were in pain and whether they were happy or sad. Staff had received training in the Mental Capacity Act 2005. People who did not have capacity to make decisions had decisions made for them in their best interest.

We saw that people who used the service were protected against the risk of unlawful or excessive control or restraint. This was because the provider had made suitable arrangements to ensure that it was only used safely and when necessary for the safety of the individual or others.

Appropriate arrangements were not in place in relation to the recording of medicine. At the time of the visit staff did not have access to a clear up to date medicine policy describing how they were expected to handle medicines.

Although the home had a quality monitoring system in place, this was not working effectively to identify and minimise risks and improve the quality of the service. There was no overall analysis of incidents that took place which looked at frequency, trends and potential learning.