Archived: Queen Elizabeth's Foundation Dorincourt

accommodation and personal care for up to 43 people living with physical support and health needs, some of whom also have a learning disability. There were 37 people living at the service at the time of the inspection.

We found the following examples of good practice.

• Current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

• Staff had received regular training about infection prevention and control including specific training about personal protective equipment (PPE) and how to use it correctly. The frequency of infection prevention and control training had increased in response to the COVID-19 pandemic.

• People who had to isolate in their rooms received frequent support from staff to engage with activities of their choice and equipment had been purchased to help with this.

• Rotas and the deployment of staff had been adapted to ensure that wherever possible staff did not work across different units within the service to reduce the risk of infection being spread.

Queen Elizabeth Foundation Dorincourt is a residential care home without nursing providing accommodation and personal care for up to 45 individuals living with complex physical support and health needs, some of whom also live with a learning disability. There are 14 self-contained flats, and two group homes for five and six people and a larger home for 20 people. At the time of the inspection 35 people lived in the service across the different households.

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

The management team carried out a range of quality and safety audits, but actions were not always addressed in a coordinated way or shared with staff. There was a lack of organised approach to continuous improvement of quality and safety and inconsistent management oversight of the overall service priority actions, although we saw some of the identified actions had already been completed. The provider had already started addressing the governance improvement needs.

We identified some concerns around infection prevention and control (IPC) practice in the service. This included staff changing the personal protective equipment (PPE) between tasks and PPE storage. The registered manager addressed those actions immediately after the inspection.

People were protected from the risk of abuse, neglect and avoidable harm. Staff were aware of how to recognise and report safeguarding concerns. Staff knew how to support people safely and individual risks to people were assessed and addressed. People received safe support with their medicines.

There were enough staff deployed to support people. The provider adhered to safe recruitment practices. Staff felt supported in their day to day work throughout the COVID-19 pandemic. People and their relatives were kept up to date with COVD-19 related changes to the service and told us the service had a person-centred and transparent culture. The management team maintained good working relationships with other healthcare professionals and community-based organisations.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

As this was a focused inspection, we did not look at all aspects of Right Support, Right Care, Right Culture. However, we would expect the service to be able to demonstrate how they were meeting the underpinning principles of the guidance. The service was able to show the model of care and setting maximises people's choice, control and independence, the care is person-centred and promotes people's dignity, privacy and human rights and the ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 14 January 2017).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of risks to people receiving care and support and service governance and quality monitoring. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with governance and quality monitoring in the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make some improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for

Queen Elizabeth's Foundation Dorincourt on our website at www.cqc.org.uk.

Follow up

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

Some people had significant communication needs and used body language, gestures or sounds to communicate. Some people could use a few key words to communicate their needs, whilst others were able to talk or use technology to communicate.

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.

There were sufficient staff to keep people safe. There were recruitment practises in place to ensure that staff were safe to work with vulnerable people. People were involved in the recruitment and selection of the new manager.

People were protected from avoidable harm and people told us that they felt safe. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. However where some people had an as required medicine, there were no guidelines in place to tell staff when and how people should have them. We have made a recommendation.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as personal care, use of equipment, health, and the environment and they were updated frequently. The registered manager ensured that actions had been taken after incidents and accidents occurred.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken, however they lacked details. We have made a recommendation. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place to meet people’s needs.

Although some improvement could be made in staffs knowledge on autism and the Mental Capacity Act. People were involved in delivering safe guarding training. There was an induction programme in place which included staff undertaking the Care Certificate. Staff received regular supervision.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning peoples care. People’s choices and views were respected by staff. Staff and the registered manager knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. People’s care needs were reviewed on a regular basis. Peoples care plans were detailed and promoted people's independence but they were not always accessible for people.

There were activities in place which people enjoyed. However, people told us that they wanted more opportunity for activities in the community. People were supported to develop independent living skills.

The home listened to people, staffs and relative’s views. There was a complaints procedure in place. Complains had been responded to in line with the organisations policy.

The management promoted an open and person centred culture. Staff told us they felt supported by the manager. People, staff and relatives told us they felt that the management was approachable and responsive.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. Staff were motivated and aware of their responsibilities. The manager understood the requirements of CQC and sent in appropriate notifications.

During our inspection we spoke with six people who used the service, six members of staff and the manager. The specialist advisor also spoke with another three members of staff and the manager.

People who used the service told us that they had care plans and they had signed them. People were complimentary about the staff and care they received. One person told us, 'Staff always come quickly when I use my call bell.' We saw that people were involved and consulted about their care and treatment.

People told us they liked the food provided by the service. They told us that they had a choice of food and they could always ask for a different meal if they did not like the food on offer.

People told us they enjoyed living at the service and were being provided with support and opportunities to promote their health and well-being.

People told us that there was always a member of staff available when they needed them. One person told us, 'I have one to one support in the afternoon with a member of staff and this has never been missed.' They told us they had regular meetings with the manager and the chef and they were able to talk to the manager at any time.

We saw that people and their relatives were involved in how the service was run. For example, the service regularly sought feedback from who used the service and their relatives through regular meetings and surveys.

All the people we spoke with told us that there were lots of activities and outings on offer at the centre. We observed a wide range of these activities during our inspection. For example, arts and crafts, sports activities and life coaching. One person told us that they had the opportunity to have one to one time with a life coach so that they could talk about their aims and achievements.

We spoke to staff about their knowledge of safeguarding. All staff were able to tell us that they were aware of their role and responsibilities in relation to safeguarding and knew what to do when reporting incidents.

All the staff members we spoke with told us that they felt supported. However, they all said that there were concerns about staffing levels. This was confirmed by the manager and by people using the service.