Archived: Derwent House

Derwent House is a residential care home providing personal care for people who have a learning disability.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people but only 12 people were being supported at the time of our inspection. This is larger than current best practice guidance detailed in Registering the Right Support. The provider had started to work towards meeting best practice guidance and staff were encouraging people to be more independent and more involved in the service.

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

The provider’s legal entity was registered with us as a partnership and remained inappropriate at this inspection due to concerns that had been raised about the partnership. Action still needed to be followed to ensure the new company registration continued. The oversight of the service needed improving to ensure areas of concern and areas to improve were identified and acted upon.

Staff required further training to ensure their knowledge was fully effective at ensuring people received the best support possible. People were not always supported to have maximum choice and control of their lives and although staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support ensuring decisions made were in people’s best interest.

Medicines management required improving to ensure people had access to effective medicines and staff had sufficient guidance to know when to administer medicines. Staff understood their safeguarding responsibilities. People had risks to their health and well-being assessed and planned for. People were protected from the risk of cross infection and improvements were still being made. People were supported by enough safely recruited staff.

No one was receiving end of life care, we made a recommendation about ensuring people’s end of life preferences were planned for. No complaints had been received but the registered manager was aware of their responsibilities. We made a recommendation to ensure the complaints procedure on display was correct. People were supported in line with their communication needs. People had care plans in place which explored their preferences about how they liked to be supported. Activities were available for people to partake in.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service had started to reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities for them to gain new skills and become more independent.

People were involved in meal planning and could access food and drinks of their choice when they wanted them. People were supported to access other health professionals and were encouraged to remain healthy and had their needs assessed.

People were treated with kindness and respect by a caring staff team. People had their independence promoted and were encouraged to partake in decisions about their care.

People and staff felt positively about the registered manager and felt supported in their role.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 July 2019) and there were multiple breaches of regulation; and was rated inadequate in well-led. At this inspection the service had made some improvements and there was one remaining breach of regulation. The service remains rated requires improvement.

This service has been in Special Measures since 06 November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was planned to follow up on the concerns at the last inspection in line with our ‘special measures’ procedures. We needed to check that people were supported safely and whether the provider was meeting the Regulations.

We found improvements had been made. However, there were still improvements needed to ensure people received good support in relation to all key questions. We rated the key questions of safe, effective and well led as requires improvement. The overall rating is requires improvement.

Enforcement

We have identified a breach in relation to ensuring directors are fit and proper persons at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Derwent House is a residential care home registered to provide accommodation and personal care for up to 14 people with a learning disability. The service is provided in a converted house, which is next door to another of the provider's services. The accommodation comprises 13 bedrooms, with one shared bedroom, shared toilet and bathroom facilities, communal lounge, dining room and kitchen, with access to a garden. At the time of our inspection, thirteen people were being supported at the service.

We inspected this service within the principles of Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. We found that people using the service did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

People had been placed at risk of continuing harm because staff had not recognised and reported potential safeguarding concerns. The provider had not ensured lessons had been learned since the last inspection and further improvements were needed to ensure staff received training and support to provide care in line with the values of Registering the Right Support. There was a lack of structure within the management and the provider did not have effective systems in place to consistently assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.

People were not always supported to have maximum choice and control of their lives. The registered manager lacked knowledge to ensure people were supported to consent to their care and support in line with legislation.

There were enough, suitably recruited staff available to meet people’s needs and support them with activities. However, improvements were needed to ensure people were consistently supported to take part in activities that met their individual needs and promoted their wellbeing.

People were happy living at the service and were involved in day to day decisions about their care. However, improvements were needed to ensure staff practices consistently promoted a caring and respectful environment.

Risks to people’s health and wellbeing were assessed and staff understood the actions they should take to keep people safe. People were supported to take their medicines as prescribed.

People were involved in the planning and preparation of their meals. When people had specific dietary needs, staff followed professional advice to ensure these were met. People were supported to be involved in managing their own health needs and accessed other health professionals when needed.

People, relatives and staff were able to approach the registered manager if they had concerns and the registered manager worked with other agencies to ensure people’s changing needs were met.

Rating at last inspection: Inadequate (published December 2018)

Why we inspected:

At our last inspection in November 2018, we found continued and new breaches of the regulations and rated the service as Inadequate. People were not always protected from the risk of harm, there were insufficient staff and improvements were needed to ensure the provider followed safe recruitment procedures and had effective systems to continually assess, monitor and improve the service to ensure legal requirements were met. We placed the service in ‘special measures’ and placed conditions on the provider’s registration which required them to report to us on the action they were taking to meet the regulations.

This inspection was planned to follow up on the concerns at the last inspection in line with our ‘special measures’ procedures. We needed to check that people were supported safely and whether the provider was meeting the Regulations.

We found continued concerns during the inspection and there were breaches in regulations. We rated the key question of well led as Inadequate. The key questions Safe, Effective, Caring and Responsive were rated Requires Improvement. The overall rating is Requires Improvement.

Enforcement:

At this inspection, we have identified breaches in relation to safeguarding people from suspected abuse, leadership and governance of the service and ensuring people’s consent to care and treatment was sought in line with legal requirements.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this service is ‘Requires improvement’. However, the rating for well led continues to be ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

At our previous inspection in March 2018 we found that the provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had served two warning notices and asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found that the quality and safety of the service had deteriorated and there were serious areas of concerns and ongoing breaches of regulations. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Derwent House is a residential care home registered to provide accommodation and personal care for up to 14 people with a learning disability. The house is next door to another of the provider's services and has one shared bedroom and shared toilet and bathroom facilities. At the time of the inspection 13 people were living there. We inspected this service within the principles of Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion and promote people with learning disabilities and autism using the service living as ordinary a life as any citizen. We found that the model of care at Derwent House was not supportive of these principles and that people did not have choice and control over their day to day lives.

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.

The provider had not taken action to ensure that people were safeguarded from abuse. They had failed to respond and learn lessons from an incident that had resulted in psychological abuse of some people who used the service. There were still insufficient safely recruited staff to meet people's assessed needs. The provider could not be sure that staff were trained and safe to fulfil their roles.

The service did not always provide care that promoted people's independence as much as they were able. A lack of staff and resources meant that systems and routines had been put in place which prevented people from living as ordinary life as possible. People were not always treated with dignity and their right to privacy was not always considered and respected. People's protected characteristics had not been identified or considered as part of their care planning. People did not always receive care that met their individual assessed needs.

People were able to take assessed risks when accessing the community independently and risks associated with health care conditions were minimised through risk assessment and equipment. People's medicines were stored and managed safely. Staff followed safe infection control procedures when supporting people to prevent the spread of infection.

The principles of the Mental Capacity Act 2005 (MCA) were being followed to ensure that people who lacked the mental capacity to agree to their care at the service were supported to do so.

People had enough food and drink of their liking to maintain a healthy diet. People had access to a range of health care professionals if they became unwell or their needs changed.

There was a complaints procedure. People we spoke with felt able to speak up about any concerns they had. Some people had plans put in place as to how they wished to be cared for at the end of their life.

Staff told us they felt supported and that the management was approachable.

Derwent House is a 'care home' registered to care for up to 14 people. At the time of the inspection 13 people were using the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed 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.' Registering the Right Support CQC policy'.

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.

The provider had failed to improve and meet the regulations following our previous inspection and the new registered manager was not supported by the provider to understand their responsibilities in relation to their registration with us.

There were insufficient quality assurance systems in place for the provider to monitor and improve the quality of service for people.

There were insufficient numbers of staff to meet the assessed needs of people. People were not always safeguarded from abuse as safeguarding procedures were not always followed.

The principles of the MCA were not always followed to ensure people were not being unlawfully restricted.

Risks of harm to people were assessed and minimised through the effective use of risk assessments. People's medicines were stored and administered safely. Safe recruitment procedures were followed when recruiting new staff. Control measures were in place to reduce the risk of infection.

People's needs were assessed and staff knew people's individual needs and plans of care. Staff worked with other agencies to ensure people received holistic care and when people were unwell or their needs changed health care support was gained.

People were supported to maintain a healthy nutritional diet of their choice. Staff received support, supervision and training to be able to fulfil their roles effectively. The environment was designed and adapted to meet the needs of people who used the service.

People who used the service were treated with dignity and respect and they were involved in the planning of their care and the running of their home. People's right to privacy was upheld and they received care that was personalised and met their individual needs and reflected their preferences.

People were supported to engage in hobbies and activities of their choice and people and their relatives were able to raise concerns and they were acted upon. People would be supported at the end of their life according to their wishes.

People and the staff liked and respected the registered manager.

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Derwent House is a care home for people with learning disabilities or autism spectrum disorder. A maximum of 14 people can use the service. At the time of our visit, 13 people lived in the home.

The home had 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.

Staff understood the importance of gaining people's consent and knew the principles of the Mental Capacity Act. However, one person who lived at the home did not have capacity to make decisions and was having their liberty restricted without a Deprivation of Liberty Safeguard (DoLS) in place. This was rectified after the inspection.

The registered manager had not sent two statutory notifications to the CQC to inform us of an incident and a death at the home. Statutory notifications are sent to the CQC to help us monitor the care people receive and to ensure they are safe.

The providers and the registered manager were well respected and provided good care to people who lived in the home. However there were no formal systems in place to check that delegated responsibilities were carried out, and to ensure the home and other homes in the provider group would continue to meet the regulations.

The deputy manager gave staff good day-to-day support and was well liked by people who lived at the home. People and staff felt management were approachable and supportive.

Staff understood the risks related to people's physical health and well-being, and followed people’s individual risk assessments to ensure they minimised any identified risks. Staff understood the local authority's safeguarding policies and procedures and knew when to report concerns about abuse.

There were enough suitably trained staff to support people's needs. Staff recruitment procedures reduced the risk of the provider employing unsuitable staff.

Staff were kind and supportive of people's needs. People enjoyed living at Derwent House and led lives which reflected their interests and preferences.

People received healthcare when needed, and their medicines as prescribed.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

People told us they could make choices about their care and that the choices they made were respected by the staff.

We saw that staff interacted positively with the people who used the service, and people received support from staff in a caring manner.

We saw that people were not protected from the risks associated with medicines, because appropriate systems were not in place to ensure that medicines were stored and administered as prescribed.

We found that the provider did not have effective systems in place to consistently assess and monitor the quality of the service provided. People were at risk of receiving inappropriate care because of this.

We spoke with four people using this service, one relative and three members of staff. People using the service told us that they liked living in the home. One person said, 'I have been here a long time and I like it'. Relatives that we spoke with told us that they were happy with the care provided. One relative said, 'The home is excellent, very welcoming and the staff are approachable. They always make themselves available if I need to talk to them and I have every confidence that people get a good quality life'.

During our inspection we saw that people were supported to make decisions and were involved in the planning of their care. We saw that people were treated with care and respect.

We saw that people were supported to access the community and that appropriate risk management plans were in place to promote independence.

We saw that staff had the required knowledge and skills to provide the level of care that people required. We also saw that people using the service were protected from harm, abuse and neglect. Arrangements for the management of people's finances had been improved.

During our inspection we identified that adequate systems were not in place to assess and monitor the quality of the service.