Dove House

About the service

The home is a two storey building, with a single storey extension and a patio and garden. People have their own bedrooms, some of which have an ensuite and people share the communal areas of the home, including an art room and a multi-sensory room. The home has recently been extensively refurbished. The service is registered to support nine people with a learning disability or autistic people.

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

Right Support: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff safeguarded people from the risk of abuse. They also identified, assessed and managed potential risks. There were sufficient staff deployed and staff were recruited safely. Medicines were managed safely at the home. Processes were in place to protect people from the risk of acquiring an infection. Processes were in place to ensure any incidents were reviewed and any learning from incidents was applied.

Right Care: People's relatives told us the care provided was person-centred and staff knew people well. A person told us, “Yes its good here,” and a relative said staff were ”very caring.“ We observed staff treated people with kindness and compassion, however our judgement on this aspect of the 'Right support, right care, right culture' guidance is limited as this was a focused inspection that considered the areas of safe and well-led only.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Relatives feedback included, “Since [name of registered manager] took over it has been really good, “ and, “They do a fantastic job.” The registered manager promoted a positive culture. People were supported to be involved in decisions and their relatives were consulted. Processes were in place to monitor the quality of the service and to identify areas for improvement. Staff worked with other agencies and professionals to support people’s care.

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 29 January 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

At the last inspection we found the provider was in breach of regulation. This inspection was completed to review actions the provider told us they would take to comply with the regulation. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dove House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dove House is a residential care home that provides care and accommodation to adults with additional needs including learning disabilities and/or autism. The home can accommodate up to nine people, at the time of the inspection eight people were living at the home.

The service was designed and registered before the principles and values that underpin Registering the Right Support and other current best practice guidance were established. This guidance ensures that people who use services can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, people’s accommodation was spread between two areas of the adapted building with a connecting internal door. The home was situated in a semi-rural area of Rake; however, people could use the home’s vehicle to access the local and wider community with staff support. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Systems to monitor the quality of the service and ensure all records were comprehensive, complete and accurate were not always effective. Audits did not identify the issues highlighted in this inspection report. There was a clear management structure in place and staff told us they felt supported.

Risk assessments and guidance for staff follow to support people’s epilepsy management were not robust. People had appropriate support to manage their medication, however, staff did not consistently record open dates on people’s prescribed topical creams or medicines. Not all staff had received an annual review of their mediation competencies in-line with best practice guidance. There were clear systems in place to ensure people were protected from the risk of harm or abuse.

We have recommended the provider reviews best practice guidance to support proactive end of life care planning. People’s communication needs were fully considered, staff used a range of communication approaches and tools to promote meaningful engagement. People had opportunities to engage in activities inside and outside of the home. Relatives told us they knew how to raise concerns and felt comfortable sharing their views with the home.

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 06 March 2019).

Why we inspected

The inspection was prompted due to concerns shared by the local authority about an investigation being completed by the provider following issues raised about a person’s care and treatment, and management of their healthcare needs. The provider had failed to notify us about these safeguarding concerns. We also received concerns about the quality of people’s care records, moving and handling practises, people’s engagement in activities and the culture of the service. As a result, we undertook a responsive focused inspection to review the Key Questions of Safe, Responsive and Well-led only. 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.

You can see what action we have asked the provider to take at the end of this full report.

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

Dove House provides accommodation and care for up to nine people with a learning disability. The home is located in a semi-rural area in Rake, Hampshire. At the time of the inspection nine people were living at the home. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

Good (published 24 September 2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People told us they were happy, felt safe and that staff had a good understanding of their needs and preferences. Staff listened to what people wanted and acted quickly to support them to achieve their goals and aspirations. Staff were innovative and looked to offer people solutions to aid their independence and develop their skills.

People had good community networks which were personal to them. This included, day services and supporting people to access the local amenities and maintaining regular contact with family and friends. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards enabling people to learn essential life skills. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People 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.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The service met the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support'. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A full description of our findings can be found in the sections below.

Follow up:

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

Dove House provides accommodation and personal care for up to nine people who have learning disabilities. The home specialises in providing support and care to people who sometimes demonstrate behaviour which may challenge others. Although under one registration, the home is separated into two separate areas of accommodation; Dove House which provides support for up to five younger people and Dove Lodge which provides support for up to four older people. At the time of our inspection nine people were using the service.

Dove House has 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.

Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. Staff were aware of how to protect people from abuse. Relatives told us their family member felt safe.

Risk assessments were in place for each person on an individual basis. People using the service were living with a learning disability and had complex needs. Risks had been identified in relation to people’s conditions and behaviours, such as epilepsy and self-injurious behaviour. Staff were aware of the risks and knew how to mitigate them.

Incidents and accidents were recorded appropriately and investigated where necessary. Any learning or changes to support plans or support guidelines were discussed at staff meetings.

There were enough staff on duty to meet people’s needs. The registered manager explained how staffing was allocated based on the assessed needs of people using the service. Emergencies such as sickness were covered by staff picking up extra shifts and sometimes agency staff. The registered manager told us the home was currently recruiting for extra care workers. Recruitment was carried out safely to ensure that potential members of staff were suitable to work in the home.

Medicines were administered safely by staff who had been trained to do so. Competencies in relation to the administration of medicines by staff were checked by the registered manager annually. Medicines Administration Records (MAR) were kept for each person and were checked weekly. Medicine stock levels were monitored. The supplying pharmacy carried out an annual audit of medicines in the home.

People were asked for their consent before care or support was provided and where people did not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005. This meant that people’s mental capacity was assessed and decisions were made in their best interest involving relevant people. The registered manager was aware of her responsibilities under the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications for people using the service.

Relatives told us they were very happy with the care provided by the service. Staff understood people’s preferences and knew how to interact and communicate with them. People behaved in a way which showed they felt supported and happy. People were supported to choose their meals. Snacks and drinks were available in between meals. Staff were kind and caring and respected people’s dignity.

Support plans were detailed and included a range of documents covering every aspect of a person’s care and support. The support plans were used to ensure that people received care and support in line with their needs and wishes. We saw this reflected in the support observed during the visit.

There was evidence in support plans that the home had responded to people's health needs and this had led to positive outcomes for people.

There was an open and transparent culture within the home. Staff were able to raise any issues or concerns with the registered manager who listened and responded. The home had a pleasant atmosphere, where staff worked well together and supported the registered manager in her role.

The service maintained a detailed system of quality control in order to ensure the quality of service was maintained and improved. This included daily checks weekly checks and monthly provider audits. Actions were identified as a result and completed by the registered manager.

Staff and people had been involved in the development of the home. Most recently the home had hosted an event. The organisation of the event included staff and people ensuring everyone had input into decisions about the home.

Arrangements were in place to ensure people received care according to their needs. Risks assessments were completed and person centred care plans developed. These informed staff's practices, supported people's independence and protected their rights.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. A robust recruitment process was in place and records showed this was followed and all necessary checks were completed.