Archived: Dorset Learning Disability Service - 56 Maiden Castle Road

Dorset Learning Disability Service - 56 Maiden Castle Road is a residential care home providing personal care to four people at the time of the inspection. The service can support up to four people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of the safe, responsive and well led key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

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

Right Support

Some people were not always safe from harm from the people they lived with. There were restrictions in place and some punitive practices had developed. The service did not always support people to have the maximum possible choice, independence or have control over their own lives.

Staff did not consistently follow people’s risk management plans and this placed some people at risk of harm.

Staff were committed to supporting people to live full lives. However, this was difficult to achieve because the high use of agency staff impacted on people ability to do the things they enjoyed both in and out of the house.

The registered manager had not reviewed incidents when people had harmed each other. There was also no opportunity for staff to learn from these situations and improve practice.

Right Care

Staff did not always support people in respectful ways. This was because they asked them not to do things without explanations, or reasoning, or in line with their support plans. Improvements were needed to make sure people were supported by staff in a personalised way.

We observed caring interactions between some staff and people. Some staff were observed to encourage people to be as independent as possible. Staff told us they were very fond of and cared about the people at the home. Some people sought out staff’s company and laughed and smiled with them.

Right culture

People’s care and support was not always person centred and there was a culture of doing things a certain way because that was what had always been done. We were not assured people's support plans were being followed.

Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs and preferences.

The registered manager resigned with immediate effect during the inspection. The provider was responsive to initial feedback and ensured that an acting manager who knew people well was covering the home.

Both the acting manager and provider’s representative addressed the shortfalls and concerns we identified during the inspection. We have not yet been able to check the impact of these changes in practice on people’s experiences.

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 27 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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 Good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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

Follow up

We will request an action plan from 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.

Dorset Learning Disability Service – 56 Maiden Castle Road (Known as Maiden Castle Road) is a residential care home registered to provide personal care to up to 4 people. There were 4 people with learning disabilities living there, when we visited. The home is in a residential area of Dorchester.

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

People were supported by staff who cared about them and knew them well. There had been a time in April 2020 when staffing levels were not sufficient to keep people safe. This had been addressed and we were assured it could not be repeated.

People’s risk assessments and care plans provided information for staff about how to safely care for each person. Staff were confident in their understanding of how to mitigate the risks people faced.

Staff had a good understanding of indicators of abuse and felt confident any safeguarding concerns reported were listened and responded to.

Quality monitoring systems were being embedded to ensure that people’s care plans and risk assessments would reflect any changes to their needs. We were assured by the registered manager that they were focussed on ensuring these systems were effective.

People’s views were considered, and staff were confident in advocating on their behalf. Relatives and people’s legal representatives were consulted about care.

The provider was working to improve communication with statutory agencies and other interested parties. This included relatives who did not always feel informed about strategic and personnel changes.

The service was clean and free from odours. Staff were wearing face masks and following Covid 19 government guidance to minimise risks to people.

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. (report published April 2018).

Why we inspected

This targeted inspection was prompted to review areas of concern that had been identified during discussions with the management of the service during the period of coronavirus lockdown. These issues had been monitored and communication with the provider indicated that they were being addressed. The inspection was timed to ensure the impact of the newly appointed mentors supporting staff in the service could be reviewed.

As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. This targeted inspection also looked at the infection control and prevention measures the provider has in place.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this full report.

Follow up: We will return to visit as per our re-inspection programme. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dorset Learning Disability Service - 56 Maiden Castle Road on our website at www.cqc.org.uk

Dorset Learning Disability Service - 56 Maiden Castle Road provides care and accommodation for up to four people with learning disabilities. On the days of our inspection there were three people living at the care home.

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. At the last inspection on the 1 June 2016, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

We met and spoke to all three people during our visit and observed the interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example sign language or visual choices.

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there were sufficient numbers of staff to meet people’s needs and support them with activities and trips out. Staff said people were safe because; “There are always two staff on shift and a third when we have one to one planned trips.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to help ensure people could retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training and the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity and the Human Right needs of people.

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. People’s end of life wishes were not currently documented, however staff confirmed they were currently discussing this subject due to one person’s deteriorating health. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with the people they cared for. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager said any complaints received would be fully investigated and responded to in line with the company’s policy. Staff knew people well and used this to gauge how people were feeling. The policy was not provided in an accessible format for people as people currently living in the service would not understand the procedure. However, the registered manager and staff demonstrated they would always act on changes in people’s presentation.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager was approachable and made themselves available. The registered manager had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety of the care people were receiving. The provider’s governance framework, helped monitor the management and leadership of the service.

56 Maiden Castle Road provides care and accommodation for up to four people. On the day of the inspection four people were living in the home. The service provides care for people with a learning disability and associated conditions such as Autism.

The service had 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 was a positive culture within the service. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the homes philosophy and staff demonstrated they understood and practiced this when talking to us about how they met people’s care and support needs. They spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection processes in place and carried out checks when they employed staff to help ensure they were safe. Staff undertook appropriate and regular training and had opportunities to discuss and reflect on practice.

The atmosphere in the home was warm and welcoming. We saw people laughing and smiling and the interactions suggested people had formed positive and trusting relationships with the staff supporting them. Professionals we spoke with said they always experienced a feeling of ‘homeliness’ when they visited.

People’s support plans included clear and detailed information about people’s specific needs and preferences. Staff were familiar with this information and could tell us in detail about people’s daily routines and how they liked to be supported. People had their health and dietary needs met. Staff monitored people’s health and well-being and supported people to access health services when required. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported where possible to make everyday choices such as what they wanted to wear, eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

People were supported to lead a full and active lifestyle. Activities and people’s daily routines were personalised and dependent on people’s particular choices and interests. Staff recognised the importance of family and friends and supported people to maintain these relationships.

A system was in place to regularly review the quality of the service. This included a range of regular audits of people’s medicines, personal finances and the environment. Learning from incidents, feedback, concerns and complaints were used to aid learning and help drive continuous improvement across the service.

We observed residents moving freely around the home and interacting with the staff in a relaxed way.

People's relatives told us that the people who lived in the home were asked for their consent when making choices and decisions about their daily lives; and that people's choices and decisions were respected by the staff. A person's relative told us, "She can communicate her consent. She can let them know. We are all working together. I am included in decisions."

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way. A person's relative told us, 'There haven't been any errors with her medication.'

We found that there were sufficient numbers of staff, with the right competencies. A support worker told us, "Leonard Cheshire are very good at promoting staff getting qualifications. That was one of the reasons I came here.'

The home was taking account of people's comments or complaints. People's relatives, told us that they could be sure that their comments were listened to, and responded to appropriately.

We saw examples of how people were encouraged to be involved in events and activities inside and outside the home. One member of staff told us 'we try to help people do things for themselves'. Staff demonstrated skill and sensitivity about how change was handled, for example, helping the residents start to adjust to a new person due to move in.

We found that individual risk assessments took account of people's capacity and ensured safety. Staff coordinated care with relatives and other professionals for the benefit of people.

Staff were trained in safeguarding and demonstrated that knowledge and skills in this area.

Staff told us they felt supported and we saw that they received training, and supervision . There were systems and procedures for identifying and managing risk and we found examples of learning from incidents.