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Inspection carried out on 31 July 2017

During a routine inspection

Care service description

Felbrigg House is a privately owned service providing care and support for up to 11 people with different learning disabilities. People may also have behaviours that challenge and communication needs. The service is a detached property close to the centre of Dover. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to access facilities in the local area and to access a variety of activities.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service Good.

Why the service is rated Good.

The registered manager had good oversight of everything that happened at the service. They promoted the ethos of the service which was to give personalised care and support to people. To support them to achieve their full potential and be as independent as possible.

People indicated that they were happy and felt safe. They were settled, contented and relaxed in the company of staff. People were safeguarded from abuse and protected from the risk of harm. Staff had been trained in safeguarding adults and knew what action to take in the event of any suspicion of abuse.

Risks to people’s safety were assessed and managed appropriately. Assessments showed how risks could be minimised. People were supported to take risks and not be restricted by them. The staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review any accidents and incidents and make any relevant improvements as a result. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Before people decided to move into the service their support needs would be assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People received care that was personal to them. People, and those close to them, were involved in planning and reviewing their care and support. Care plans contained a lot of duplicated information and where cumbersome. Information was difficult to locate. The registered manager was addressing this. This is an area for improvement.

People received their medicines safely and when they needed them. They were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

People were encouraged to access the kitchen whenever they wanted and were able to prepare their own drinks whenever they wished. They were supported to shop for and prepare meals of their choosing. People were encouraged to eat a healthy and nutritious diet.

People’s privacy was respected. They 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.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs. People were given support in the way they preferred. People had many opportunities to go out and about. People were encouraged to try new experiences and develop new interests to enrich their life and increase their confidence and self-esteem. People’s confidence had developed to enable them to make more choices and decisions themselves and become more independent. People led active lives and they showed us pictures of the things they

Inspection carried out on 20 December 2016

During an inspection to make sure that the improvements required had been made

Felbrigg house is a detached house close to Dover town centre. The service is registered to provide accommodation and personal care for up to 11 people who have a learning disability. There were 11 people living at the service when we visited.

The accommodation is set over two floors with bedrooms on both floors. There are good sized communal areas. The home was clean, tidy and well decorated.

Rating at last inspection

At the last inspection, the service was rated Good overall and Requires Improvement in the ‘responsive’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 24 August 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Person Centred Care. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Felbrigg House on our website at www.cqc.org.uk

At this inspection we found the service remained Good overall and is now rated Good in the ‘responsive’ domain.

Why the service is rated Good

The service had improved since the last inspection. People’s care plans had more detail in them and guidance was in place for staff to support people with their health conditions. People had plans to move towards their goals and there were records of what they had achieved. People had access to a variety of activities. The breach of Regulation 9 found at the last inspection had been met.

People knew how to complain and any complaints received were responded to appropriately.

Inspection carried out on 15 & 17 July 2015

During a routine inspection

This inspection took place on 15 and 17 July 2015, was unannounced and was carried out by two inspectors.

Felbrigg House is a privately owned service providing care and support for up to 11 people with different learning disabilities. People may also have behaviours that challenge and communication needs.

The service is a detached property close to the centre of Dover. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to access facilities in the local area and to access a variety of activities.

There was a registered manager working at the service. 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. The registered manager supported us throughout the inspection.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLs authorisations for people who were at risk of having their liberty restricted. They were waiting the outcome from the local authorities who paid for the people’s care and support. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People were satisfied with the care and support they received. The care and support needs of each person were different and each person’s care plan was personal to them. People or their relative /representative had been involved in writing their care plans. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. The care plan folders contained a large amount of information and staff did not use them to refer to when supporting people with their day to day needs, partly because it would take their attention away from the person for too long. Staff knew people well but some of the care, for example developing independence skills, was unspecific and therefore it was difficult to measure if people were achieving and developing.

Potential risks to people were identified. There was guidance in place for staff on how to care for people effectively and safely and keep risks to a minimum without restricting their activities or their lifestyles. People received the interventions and support they needed to keep them as safe as possible.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People knew who their key worker was and had a choice about the key workers who worked with them. People had key workers that they got on well with. Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. When people could not communicate verbally, staff anticipated or interpreted what they wanted and responded quickly.

People were involved in activities which they enjoyed and told us about what they did. Planned activities took place regularly. People had choices about how they wanted to live their lives. Staff respected decisions that people made when they didn’t want to do something and supported them to do the things they wanted to.

People said and indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted and were involved in buying food and preparing their meals. If people were not eating enough they were seen by dieticians or their doctor.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

Staff had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with a senior member of staff. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other basic training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy, autism and diabetes. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There were enough staff to take people out to do the things they wanted to so that people were involved in activities which they enjoyed.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed. The provider responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire or a gas leak the staff knew what to do.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support, and to be part of the continuous improvement of the service.

The registered manager had sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that the service was well led and that the management team were supportive.

The registered manager notified the Care Quality Commission of any significant events that affected people or the service. Comprehensive quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements

The complaints procedure was on display in a format that was assessable to people. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 8 October 2013

During a routine inspection

People who used the service said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. One person told us about the support they received to do the activities they enjoyed.

People told us that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed. People said that they were happy with the care they received and got on well with the small team of staff.

All of the people spoken with expressed a great deal of satisfaction from living at the service and did not have any concerns about their quality of care. People told us that they felt safe and that if they were not happy or concerned about anything they would speak to the manager.

People were happy with the arrangements for receiving their medication and were involved with this process at a level that suited them.

There were effective processes to assess and monitor the quality of service that people received and to identify, assess and manage risks to the health, safety and welfare of the people using the service.

Inspection carried out on 2 December 2012

During a routine inspection

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed.

People told us they received care from a small team of staff and were happy with the care received and had no concerns relating to the home.

All spoken with expressed a great deal of satisfaction from living within the service and did not raise any concerns about the quality of care. All said if they were not happy they would speak to staff or the manager.

A relative spoken with was very complimentary of the quality of care provided. She commented that “I can’t fault them at all, staff are very good”. She also said “They are always taking people out” and I am kept fully informed”.

Inspection carried out on 19 January 2012

During a routine inspection

People expressed that they were happy at Felbrigg House. They told us they liked the staff and took part in lots of activities that they enjoyed.

People told us that they were involved in making choices about their care and were encouraged to be as independent as possible.

People’s relatives told us that they thought the service was “Excellent”. They said that they had seen improvements in their relatives since they had been at the service.

Reports under our old system of regulation (including those from before CQC was created)