Archived: Dorset Learning Disability Service - 20 Edward Road

Dorset Learning Disability Service – 20 Edward Road is a residential care home which is able to provide personal care and accommodation to up to three people. The home specialises in the care of people who have a learning disability. At the time of the inspection three people lived together in the home.

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

The home had been developed and designed in line with the principles and values that underpin Registering the Right Support. Work was underway to enhance the principles and values behind this and other best practice guidance. This meant that staff were working to ensure that people who use the service could live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Whilst this work was being undertaken by the provider organisation, people's care was not always delivered in line with the Mental Capacity Act and restrictive practices were not being monitored effectively. There was a breach of regulation.

People were supported by staff who cared about them and worked together to meet people’s individual needs. Staff felt well supported and happy in their roles. This helped to create a relaxed and happy atmosphere for people to live in.

People were supported by staff who knew them well and were able to communicate with them This enabled people to make choices about their day to day routines. Work to enhance communication skills and systems within the home was ongoing.

People were supported by adequate numbers of trained and experienced staff to keep them safe and meet their needs. The provider had a robust recruitment process which helped to minimise the risks of abuse to people. People were very comfortable and relaxed with the staff who supported them. The specialised training needs of the staff team were being addressed. We have made a recommendation about the monitoring of how this training is implemented and embedded.

People’s needs were assessed, recorded, reviewed and met. Each person had a support plan which gave staff guidance about how people preferred to be cared for. Staff knew people well and were able to provide personalised support to people.

The provider worked with other health and social care professionals to make sure people received the care and treatment they required. This included meeting changing health care needs.

People benefitted from a provider and management team who has systems in place to monitor quality and implement improvements to the service people received. Recording was not always adequate to ensure monitoring was effective. We received assurances from the registered manager and senior staff that this would be addressed.

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

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 January 2017). There were no breaches of regulations.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 systems in place to provide information about the service on offer and other contact details of other professionals needed improvement. The registered manager told us that if people wanted information this would be provided. However there was no system in place to provide information to people important to those living at the home in a way that did not involve staff being consulted. The registered manager acknowledged this and agreed to look at this issue with the provider.

There was a weakness in the responses made in relation to certain behaviours. Whilst we found that staff knew people’s needs and behaviours well they were not always recording their observations. This made it difficult for management and other health care professionals to usefully analyse incident reports and develop strategies to support this affected by the behaviours. The registered manager agreed that they needed to update the auditing of this issue.

There were plans in place to update the home and to clear the gardens of equipment that had become unused or in disrepair. The provider told us that throughout December 2016 works would start on addressing the maintenance in the home. They also shared with us a documented action plan that identified what works would be carried out and by when.

Staff understood the importance of people consenting to support and encouraged choice making where possible. They understood the importance of enabling people to make their own decisions wherever possible and seeking the involvement of appropriate people when making decisions to provide care in a person’s best interests.

People receiving support were safe and well cared for. They were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse.

Staff were consistent in their knowledge of the person’s needs and spoke with confidence about the care they provided to meet these needs. Care was delivered in a way that met the person’s needs and promoted their independence and dignity.

There were enough safely recruited staff to ensure the care could be provided. Staff told us told us they felt supported in their roles and had received training that provided them with the necessary knowledge and skills to do their job effectively.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood the need to share information about changes in people’s health.

Relatives spoken with were positive about the care their relation received and told us the staff tried to ensure people had positive experiences.

There were systems in place to monitor the quality of the service and people were encouraged to contribute to the management of the service.

We looked at two people's care plans, and saw that care plans included detailed information about their needs, identified risks and how they preferred to be supported. However not all risks had been assessed. We saw for one person with swallowing difficulties that advice had not been sought from a speech and language therapist to provide advice to manage this risk.

Medicines were prescribed and appropriate arrangements were in place in relation to the recording of medicines . All staff told us that all staff received training on the administration of medicines.

There were effective recruitment and selection processes in place. Staff told us that two references were obtained and checks were made whether they had any criminal convictions or cautions before they started work.

We spoke with three relatives who all told us that they had not had to make a complaint but were able to raise any concerns with the registered manager. One person told us, "Generally speaking I am asked at the review meeting if there are any issues or concerns to raise."

The home was adapted to meet the needs of the individuals who lived there including one person who used a wheelchair. The care plans had been developed in a person centred way and we found that service users were respected. The involvement of relatives was supported and encouraged. Relatives told us they were satisfied with the care overall however would like greater involvement and regular progress reports.

There were systems and procedures for identifying and managing risk however due to the absence of up to date risk assessments, an effective and safe service could not be assured for each individual.

Staff had been trained in safeguarding and demonstrated knowledge and skills in this area. We saw that safeguarding incidents were investigated as part of the provider policy.

Staff received training and development, supervision and annual appraisals. Staff told us that they felt supported.

There were established systems for managing health and safety, individual reviews and learning from incidents.