Archived: Durlston House and Durlston Lodge

Updated 21 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 and 22 September  2015 and was unannounced.

The inspection was completed by two inspectors. Before the inspection, we reviewed other information we hold about the service, including previous inspection reports and notifications sent to us by the provider. Notifications are information about specific important events the service is legally required to send to us.

During the visit we spoke with two people who used the service, two relatives, the manager for Durlston Lodge, the registered manager for Durlston House, the area manager, five members of staff. Three staff were recently recruited to the home and a Communication Specialist from Head Office. A healthcare professional conducting a review of needs gave their feedback on their experience of the home.

We spent time observing the way staff interacted with people who use the service and looked at the records relating to support and decision making for three people. We also looked at records about the management of the service.

Updated 21 December 2015

Durlston House and Durlston Lodge provide accommodation and personal care for up to 14 people with autism. The accommodation is arranged into two separate houses with their own manager and staff team. At the time of this inspection four people were living in Durlston House and five people were living at Durlston Lodge. The home was last inspected in May 2013 and was found to be meeting all of the standards assessed.

A registered manager was in post. The provider (Homes Caring For Autism Limited) for Durlston House and Durston Lodge made the decision to have registered managers in both houses although both houses come under one Care Quality Commission registration. There is a registered manager at Durlston House and the manager for Durlston Lodge will be submitting an application to register as manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’

People were not always protected from inappropriate care and treatment as records were not always accurate or up to date. Report of incidents and accidents were developed following an event but they were not always analysed to assess that the most appropriate action was taken. Care plans and risk assessments were not updated following reviews.

Medicine management systems did not provide staff with clear direction on when and how to administer some prescribed medicines. Protocols for when required medicines such as anti-inflammatory medicines were not in place. Where creams such as local anaesthetics were prescribed the directions were “as directed.”

People’s mental capacity was not accurately assessed. The staff showed a good understanding of the principles of the Mental Capacity Act 2005 (MCA). However, MCA assessments for some people did not reach a conclusion on their capacity to make specific decisions. Best interest processes were not followed for people assessed as lacking capacity to make specific decisions. For example, care and treatment. The area manager told us MCA training was to be attended by all staff.

People were not able to discuss safety with us but two people told us they liked the home and their keyworker. A relative said their family member was safe living at the home. Staff knew the signs of abuse and the actions they needed to take for suspected abuse.

People’s care and treatment was delivered by sufficient staff. People had one to one support during the day and some people had two to one support for community activities. Staff said the staffing levels were good. A relative told us recruitment and retention had been a problem at the home. The registered manager for Durlston House said new staff was recruited to vacant posts.

The staff promoted positive relationships with people. Staff were helping people to develop their independent living skills and to improve their privacy. Staff were supporting some people at Durlston House to lock their bedroom and to use assistive technology to gain entry to their locked bedrooms. One relative said staff needed to help people use communication systems which support the person to “articulate their wishes”.

People's preferences, likes and routines were documented in their care plans. Care plans were developed on how staff were to support people to meet their needs. Relatives told us they were invited to reviews. They said at the review meeting they discussed their family member’s care and were able to make suggestions on the delivery of care.

Where risks to people’s health and wellbeing was identified risk assessments listed the actions needed from the staff to reduce the level of risk.

People, at times, used aggression and violence to express their emotions and as a means of communication. Behaviour management plans were devised on triggers and detailed how staff were to response to the behaviours exhibited. Staff used strategies and techniques to divert and diffuse aggressive and violent behaviours. We saw staff use the techniques to help people calm themselves. For example, giving people time and space to calm down.

Staff received appropriate training and support to meet people's needs. New staff received a comprehensive induction which prepared them for the role they were employed for. Staff skills were developed to ensure they were able to meet people’s complex needs. For example, they attended autism awareness and positive behaviour management training. Staff had regular one to one meetings with their line manager where they discussed performance, concerns and training needs.

People were supported to raise concerns and complaints which the staff took seriously and the registered manager investigated. Relatives said they knew the procedure for making complaints. They said their complaints were taken seriously.

People were supported by staff that worked well together, knew the vision and values of the organisation and helped build a culture of choice and person centred care. Quality assurance arrangements were in place to monitor the standards of care. Action plans were developed where standards were not being fully met. People’s views were sought through surveys and during care plan review.

We made recommendations for the service to seek advice and guidance from a reputable source, about the management of medicines and about the principles of Mental Capacity Act 2005

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