Archived: Dorset Learning Disability Service - 97 Monmouth Road

97 Monmouth Road provides care and accommodation for up to three people. On the day of the inspection three people were living at 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.

The atmosphere in the home was warm and welcoming. We saw people laughing and smiling and the interactions showed people had formed positive and trusting relationships with the staff supporting them. Professionals from the Learning Disability service were very positive about the care provided by staff. They said they felt the registered manager had worked hard to recruit a good, caring staff team.

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 by 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 meeting people’s 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. Staff said they were well supported and had opportunities to discuss and reflect on practice. People received care and support from staff who knew them well and who had the skills and training to meet their needs. There was a strong emphasis on training and continuing professional development throughout the staff team.

Staff were supported to understand and manage people’s behaviours in an appropriate and lawful way. Training was provided and guidelines were in place to help staff identify possible triggers as well as what action to take if difficult or challenging behaviour occurred. We saw staff managed behaviours in a calm manner, providing reassurance and distraction to prevent situations from escalating.

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 spoke with one relative of a person who lives in the home. They told us that they felt positive about the quality of care their family member received and with their relationships with the staff.

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

A relative told us that their family member was asked for their consent when making choices and decisions about their daily lives; and that their choices and decisions were respected by the staff. The relative told us, "She can communicate general decisions. If there is anything that needs to be discussed, they do run things past us.'

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's been no errors with her medication.'

We found that there were sufficient numbers of staff, with the right competencies. A support worker told us, "I have NVQ 2 -- I've been here for 16 years; but I've worked for Leonard Cheshire for 26 years."

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

We used a number of different methods to help us understand the experiences of people using the service because the people using the service had limited speech and difficulties with communication related to their disability. We observed people in their day to day environment. We gathered evidence from the care records and talking to staff.

We observed staff demonstrating skills in communicating with people with a respectful and warm approach. We found a positive atmosphere where people were respected. We found evidence that relatives and friends involvement was actively encouraged.

Each person had a care plan that was highly personalised and guided staff in the delivery of preferred care and support. Individualised risk assessments allowed people to participate in everyday life inside and outside home. Our evidence showed plans were regularly updated. Staff worked closely with other professionals to ensure the safety and welfare of people who used the service.

Staff had an understanding of safeguarding and demonstrated by example that they had knowledge and skills in this area.

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