The Dairy House

The people we met had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements.

The care service worked in line with the values that underpin the Registering the Right Support 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.

People’s experience of using this service:

During the inspection we found people were given choices and their independence and participation within the local community was encouraged.

Although we found the care people received did not continue to meet our outstanding characteristics, people still received good care and support.

Staff knew how to recognise and report abuse and were confident any concerns raised would be responded to by their managers. Risk assessments were in place to ensure people’s safety. Medicines were managed and administered safely. ‘As required’ medicines had protocols in place but some required more detail to instruct staff on when and how to administer them safely. Where medicines errors had occurred, learning had been shared and implemented.

There were a range of checks in place to ensure the safety of the home. Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team. There were systems in place to manage infection control.

There were sufficient staff available to support people in their home and in the community. Relatives commented about the amount of staff changes there had been. The provider had recognised this and put plans in place to enable staff consistency. Staff said they felt well supported by the registered manager and the providers senior managers.

Staff received the right training and support to enable them to effectively support people. People’s complex needs were well planned for. Staff supported people to have good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs.

People were supported to, communicate, make choices and maintain their independence through a range of assistive technology. Staff knew people well and were able to interpret non verbal communication.

Where people lacked the capacity to make decisions for themselves, their capacity to make these decisions had been considered. However, the assessments were not always decision specific in line with the Mental Capacity Act 2005.

People were involved in choosing what they wanted to eat and were supported to have a healthy and nutritious diet. There was some disparity over the texture of one persons meal. We discussed this with the registered manager who told us they would amend this and ensure all staff were aware.

Staff were aware of people's routines and preferences, and they used this information to develop positive relationships and deliver person centred care. Relatives told us core staff knew their family member well.

Staff described how they supported people by treating them with respect and dignity. Staff recognised when people were not happy and responded appropriately to support them. We observed occasions when staff did not seek consent before supporting them, we discussed this with the registered manager who told us they would raise awareness with the staff regarding this.

Relatives told us staff were kind and caring. Staff were caring and understanding towards people and people were comfortable in the presence of staff.

People participated in chosen activities and accessed the local community, staff encouraged people to participate in things of interest to the them.

Care plans were detailed and relatives told us they felt involved in their family member’s care.

Relatives said they were regularly invited to person centred planning meetings and reviews. Relatives felt able to raise concerns with the staff or the registered manager directly.

The service had good links with the local community and key organisations, reflecting the needs and preferences of people in its care. Statutory notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

The aims of the service were embedded within the staff team who were passionate about providing person centred support for all the people living at the service. There were systems in place to monitor and improve the quality of care and support provided.

We have made a recommendation for the provider to revisit the Mental Capacity Act 2005 in relation to people making decisions.

Rating at last inspection: Outstanding (report published September 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the quality of service good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The Dairy House can accommodate up to 15 people. The home specialises in providing care and support to adults who have a learning disability, autism and/or a physical disability. All bedrooms are for single occupancy and have en-suite facilities. The home is staffed 24 hours a day.

At the time of our inspection there were 15 people living at the home, this included one person who was in hospital. The people who lived at The Dairy House were unable or found it difficult to tell us about their experiences of life at the home so we used our observations of care and our discussions with staff to help form our judgements.

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.

Without exception people’s representatives and health and social care professionals could not praise The Dairy House enough. Comments from people’s representatives included “We are always impressed by the care and consideration given to [Person’s name] by staff, they keep us in touch and there is always a welcome.” And “Just excellent in every respect.” Comments from health and social care professionals included “I have always found the staff genuine, caring, well trained, respectful, thoughtful and encouraging and always having the individuals comfort, health and happiness as a priority. The consistently high standards are far above anything I have witnessed elsewhere.”

The atmosphere in the home was very warm and welcoming. There was lots of laughter and friendly banter between staff and the people who lived at the home.

The registered manager spoke with great passion and pride when they told us about the quality of care people received and of the staff team. They described the provider as being “full of kindness.” They told us “We have a fantastic staff team who are all committed to making people’s lives happy and rewarding.”

The registered manager and staff team had formed excellent relationships with people. It was evident they were totally committed to providing high quality care. Staff were highly motivated and inspired to offer care which was kind and compassionate. One member of staff told us “I love my job. Our residents get the most amazing care. I feel proud to be part of such a great team.”

People were treated with the greatest of respect and a great deal of thought and effort had gone in to making people’s bedrooms special for them. For example, decorating walls with murals which reflected people’s hobbies and interests. Where people had been unable to communicate their preferences and choices, staff had used objects of reference and had liaised with people’s families to ensure people’s personal space reflected their preferences and that they were happy and comfortable.

The service was using and exploring innovative ways to help them communicate with people and to ensure people lived a full and happy life. The provider had an assistive technology manager who showed us recently developed technology in the sensory room. We observed a person interact with the ‘magic carpet.’ This is an innovative interactive floor projection system that enables people to engage with games, music and images simply by moving on or over the projected surface.

Staff supported people to develop and maintain independent living skills. There was an emphasis on enabling people to maintain a level of independence regardless of their disability. When we arrived at the home staff supported one person to show us around and this had made a great deal to them.

Routines in the home were flexible and were based around the needs and preferences of the people who lived there. People were able to plan their day with staff and they were supported to access social and leisure activities in the home and local community. The arrangements for social activities focused on meeting people’s individual needs. One person’s goal was to go to university. Staff supported them to attend a local college where they were working towards a qualification.

Staffing levels were good and people received good support from health and social care professionals. A speech and language therapist was employed. They provided staff training and sessions to people who lived at the home on how to help people experience positive interactions. We were able to see the very positive outcome this had for one person who lived at the home.

People were unable to look after their own medicines. Staff made sure medicines were stored securely and there were sufficient supplies of medicines. People received their medicines when they needed them.

People were supported to eat well in accordance with their preferences and needs. Each person had a nutritional assessment which detailed their needs, abilities, risks and preferences and we saw people were supported by staff in accordance with their plan of care.

The service helped people to maintain contact with the important people in their lives. Visitors were welcomed and people were supported to telephone, email and face to face internet their loved ones.

There were systems in place to monitor health and safety and the quality of the service provided to people and to continuously drive improvements.

The home had a warm, friendly and homely atmosphere. Relatives were very positive and passionate about the home. Comments included "it knocks spots off others", "best home ever" and "so glad to have managed to get X here".

Staff were trained and skilled in recognising and responding to people's individual needs. People responded positively to staff interactions and appeared very comfortable and at ease with them.

Staff were recruited appropriately, very enthusiastic about their work and felt well supported. Relatives were very complimentary of the staff employed, felt welcome at the home and included in people's care. They told us "they always keep me informed - I get updates all the time", "staff are so understanding" and "they (the staff) go the extra mile".

Each person had a plan of care which was personalised, regularly reviewed and contained all the information necessary.

The home was decorated, furnished and maintained to a very high standard.

Meals were prepared and served which were varied and nutritious.

A complaints policy/procedure was in place.

Staff interacted with people in a kind and respectful manner. People were offered choices about how and where they spent their day. A visitor told us that the staff were 'always' kind and respectful. They said 'the staff and owner go over and above to make sure people have everything they want.'

The care plans we looked at promoted a very person centred approach to care. We found that people's heath needs had been appropriately monitored and that people had access to a range of health care professionals.

People who lived at the home were supported to take part in a wide range of activities and social events and the home enabled people to maintain contact with their families and friends.

The home followed appropriate procedures for the management and administration of medication. This meant that people received their prescribed medicines when they needed them.

Staff received the training and support they needed to meet the needs of the people they supported. Staff morale was noted to be very high.

The home had a complaints procedure which provided people who used the service and their representatives with clear information about how to raise any concerns and of how their concerns would be managed.