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Inspection carried out on 10 October 2017

During a routine inspection

The Dexters is registered to provide care and support for up to 21 people with mental health needs and/or learning disabilities. The home is situated close to York city centre. The main property is made up of two adjoining terraced properties which have been combined together to make up one larger building. The accommodation is over three floors. There is also a separate annex building, with three bedsits, at the rear of the main property. At the time of our inspection 21 people were using the service.

At the last inspection in September 2015, the service was rated Good. At this inspection we found the service remained Good overall and was now rated Outstanding in the key question: Is the service responsive.

The home had two registered managers, who shared joint accountability for 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. One of the registered managers was the owner of the organisation, and the other registered manager had responsibility for the day to day management of the home and staff. Throughout this report, when using the term ‘registered manager’ we are referring to the registered manager who had responsibility for the day to day management of the home.

The support people received was extremely responsive to their individual needs. Staff were very knowledgeable about each person’s needs and preferences and highly detailed care plans were in place which enabled staff to provide personalised care. There was an extensive range of activities available to people, tailored around their individual skills, wishes and interests. Staff were especially skilled and creative in working in partnership with people to identify and organise their care and activities of interest to them. This had enhanced people’s well-being and quality of life.

People told us they felt safe and well cared for. Staff received safeguarding training and knew how to report any concerns. Risks to people were assessed and minimised, whilst promoting people’s independence and well-being.

Staff had been recruited safely and there were enough staff to assist people in a timely way. There were robust arrangements for supporting people with their medicines.

People were supported to have 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.

Staff received the training, support and supervision they needed to support people effectively.

People received appropriate support with their nutritional needs. People were supported to access a range of health services and we received very positive feedback from visiting healthcare professionals about the service.

People and relatives said staff were caring and we observed them to be kind, friendly and attentive. Staff treated people with dignity and respect and promoted their independence.

People and visiting healthcare professionals told us the home was well-managed. There was a robust quality assurance system in place which included the completion of daily checks and weekly audits in relation to the quality and safety of the service. People were asked for their views in individual review meetings and ‘tenant meetings’ and we found that these were acted on wherever possible. The management team promoted a very positive person-centred culture within the service.

Inspection carried out on 3 September 2015

During a routine inspection

The inspection took place on the 3 September 2015. It was unannounced. During our last inspection of the home in July 2013, the provider was compliant with all of the regulations.

The Dexters provides care and support for up to 20 people with mental health issues and/or learning disabilities. The home is situated close to York city centre. The home comprises of 2 houses next door to each other, one of which is used to support people who are moving towards more independent living. There were 19 people accommodated on the day of our visit.

The home has a registered manager. 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 told us they felt safe and staff received training in safeguarding vulnerable adults.

Risks were identified and recorded in people’s individual care plans and people were supported to take responsible risks.

There were sufficient numbers of staff on duty who went through a thorough recruitment regime before employment commenced. People spoke highly of the staff employed.

People received their medication safely. They were supported to manage their own medicines where possible.

Staff received appropriate induction, training and support to help them in their roles. We were told that staff were skilled in caring for people.

People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct authorisations had been applied for.

People received a varied choice of meals and were supported to make their own meals where possible. Access to other professionals was sought where needed.

People told us they could access a range of health care services although the provider may need to review their emergency procedures where a head injury may be suspected.

People were well cared for and happy living at The Dexters. People spoke highly of the care provided. People told us they were treated with dignity and respect by staff.

People had detailed care records in place to record how they should be cared for and the support they may require. These records were reviewed regularly.

The home had good management systems in place to support people. People’s views were sought and regular meetings were held to seek people’s views. However, quality monitoring systems could be further developed so that all aspects of service delivery could be monitored.

Inspection carried out on 1 July 2013

During a routine inspection

We spoke with most of the people who used the service. They said they were happy with the care and support provided. When we asked one person if they liked living at The Dexters Limited they said "Super home, couldn�t be better.� Another person said it was �Marvellous, just marvellous.�

We looked at the care records and saw that people had been supported to make decisions. We also saw that issues around capacity and deprivation of liberty had been considered.

We saw that there were opportunities for people using the service to make choices and have a say in how their treatment or care was delivered. One person said �I meet with (my key worker) every month and they ask me what I would like to do.� We found that care and treatment was personalised and equality and diversity taken into account. There was evidence that people took part in a range of activities in the community.

People said they thought The Dexters Limited was a safe place to live. One person said �I�ve been here over 12 years, it�s a good home.� Throughout our inspection we observed positive interactions between the people who used the service and the staff that supported them. One person who used the service said "It�s a super home, staff couldn�t be better.�

The quality of the services was regularly assessed and monitored to ensure that it was safe and was meeting people's needs.

Inspection carried out on 4 February 2013

During an inspection looking at part of the service

During our last inspection on 10 December 2012 we identified some concerns relating to medication. We asked the provider to address the issues raised. This was a follow up visit to check whether the provider had taken appropriate action to address the issues that we had previously found.

We spoke with three people about the medication systems that were in place at the home. All three people told us they had no concerns. One person said �Staff help me with my medicines. I get them when I need them. Everything is alright.� We spoke with two staff who confirmed with us that the medication systems in place were now robust. We looked at the issues relating to the medication systems that had been previously found. We saw that these issues had now been addressed. Medication systems were in place to protect people�s health and wellbeing.

Inspection carried out on 10 December 2012

During a routine inspection

We saw evidence on care records viewed that people were consulted on matters relating to their care and welfare and that consent was obtained. Examples of this included 'consent for treatment' and 'patient agreement to investigation or treatment' forms on care records. We also saw that if a person refused treatment that their decision was respected.

We saw that health care professionals were contacted as people's needs changed. The Deprivation of Liberty Safeguards were only used when it was considered to be in the person's best interest. We saw evidence of this on the records viewed. We saw that the home had acted and was continuing to act in accordance with the legal requirements and acting on advice from other professionals. This helped to ensure that decisions were made in the person's best interests.

There were issues relating to medication. We have asked the provider to address these.

There were effective recruitment and selection processes in place. This meant that the provider was assured that staff were suitable to work in the care industry.

One member of staff told us "People living here have a very good, open relationship with staff and would raise any concerns however small with their key worker or other staff". We also saw that people were asked if they had any concerns at their monthly care review and that these were acted upon.

Inspection carried out on 21 December 2011

During a routine inspection

The people who used the service told us that they had agreed to the care and support they were receiving. One person said �I have signed to say I agree with the care and support I get�. Another person said �The manager asks for my views. The staff listen to me�.

People we spoke with said that the staff looked after them well. We observed that people were receiving the help they needed. We saw people being supported to make decisions about how they wanted to spend their time and live their lives. One person said �The staff always help me�. Another person said �Living here is good�.

We asked some people �If you were not happy with how the staff looked after you or if you had a complaint would they tell someone?� The people we spoke with said �Yes�. They said that they had no issues or complaints. One person said �I like living at the home�.

The people who used the service told us that staff were there to help them. One person said �The staff are good�. Another person said �The staff do their very best for us, they take care of me�.

People told us that they spoke to the manager everyday and that she asked them if everything was alright for them. They confirmed they were looked after and they felt the home was a good place to live. One person said �I appreciate living here. I am listened to�. Another person said �The quality of the service is very good, nothing is too much trouble. We all live as a family�.

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