Doughty's

At our last inspection in May 2016 we rated the service good. At this inspection, on the 22 November 2018, we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service continues to meet all relevant fundamental standards. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

We received a high level of praise for the service. People using the service were very positive and complimentary about the service and told us they would recommend the service to family and friends whole-heartedly. Staff said they were proud of the service they provided and enjoyed working here, one commenting that their relative had lived in Doughty’s very happily for 20 years. An external professional also provided very positive feedback advising us that they use Doughty’s as an example of good practice.

The service had continued to build on its established good service, working both internally and in partnership with numerous outside agencies to provide the most appropriate and up-to-date methods of care and support. The service continued to seek improvements whenever possible. Improvements made since the last inspection included establishing electronic databases, establishing a separate training budget, developing a trainee carer pilot scheme with the local job centre, introducing external HR support and introducing a sophisticated electronic medicines administration system.

People who used the service all reported they felt safe and that staff were always available when they needed them. Staff all received training in adult safeguarding and knew how to recognise and act to help protect people against the risk of harm. Risk assessments were in place and staff were knowledgeable about the management of risks to people. A new electronic medicines administering system had been introduced which was effective and minimised the risk of errors. All the people we spoke to felt the care provided was effective in meeting their preferred outcomes and that staff were suitably skilled and very well trained. Several noted that they have had new carers come in but that the trainees are taught how to do things well and that the staff can always look at peoples’ care plans which detail what is required clearly. The service continued to show a strong commitment to staff development, both in terms of a comprehensive induction and an ongoing training programme; with the competency of staff checked regularly by management. The service worked closely in partnership with other professionals and voluntary agencies to improve the quality of life and encourage healthier, active lives for the people using the service. 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.

All the people we spoke to were complimentary about the staff attitudes and their approach to care-giving. We observed staff being respectful of people’s privacy and attentive to their wishes. Staff reported that they were actively encouraged by management to spend time talking to people, to enable them to know and respect people as individuals and support their preferences. People using this service told us staff responded quickly to their call bells and that care provision was timely and effective. People had their daily care plan checked and revised monthly by their keyworker alongside a weekly visit from one of the managers to check all is well. Doughty’s has maintained its accreditation for providing end of life care and endeavours to support a person’s preferred wish, if it is to remain at Doughty’s.

People using the service reported that management ran a ‘tight ship’. All the people we spoke to reported they had a good relationship with management and their opinion of the service was sought both informally and via annual surveys. Records showed the support plans were reviewed in detail by management twice yearly. Staff meetings were held regularly and staff reported feeling valued and well supported. Doughty’s have participated in various schemes to bring in additional expertise such as occupational therapy student placements and a cognitive stimulation therapy initiative which added value to people’s lives alongside upskilling staff. The service operates a development plan which shows they continue to seek ways to innovate and improve.

Further information is in the detailed findings below.

Doughty's is a historic charitable service which offers the registered activity Personal Care. The charity is based on a complex of Alms Houses and care is only available to people living on the site and as such is more comparable to a supported living scheme than a main stream domiciliary care agency.

The service 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.

We received a high level of praise for the service. People and their relatives were positive and complimentary about the service provided.

People who used the service felt safe. Staff received training in adult safeguarding. They knew how to recognise and take action to protect people against the risk of harm. The service took action to manage risks to peoples’ safety at individual and service level. Risk assessments were in place and staff were knowledgeable about the management of risks to people.

The service followed safe recruitment practices and there were sufficient numbers of staff with the knowledge and skills to meet people’s needs. Staff had access to good training and development opportunities. The service was active in encouraging staff to develop their skills and knowledge in order to deliver high quality care for people.

People received appropriate support with their medicines. Staff received regular training and assessments of their competency in the administration of medicines. Where the service was responsible for the ordering, receiving, and storing of people’s medicines this was done safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. The service was working within the principles of the MCA. Staff demonstrated knowledge in this area and the service had clear procedures and guidelines to ensure they were meeting the requirements of this legislation.

People were supported to maintain their health, this included supporting people who were at nutritional risk. The service supported people to access health care professionals and took actions to follow their advice and recommendations.

People and relatives were complimentary about the kind and caring nature of the staff. Staff showed they knew people and their needs well. Staff demonstrated a commitment to promoting people’s independence and people told us they felt their independence, privacy, and dignity were respected. The service recognised that people could become socially isolated and the negative impact this could have. They took steps to address this and promoted social opportunities for people.

The service took action to ensure people felt involved and listened to regarding their care needs. Opportunities for people to raise and discuss their concerns and experiences were provided. The service planned and reviewed peoples’ care with them. People told us they received care how and when they wanted it.

The registered manager and provider made efforts to ensure they were involved in the service and able to identity issues that might affect the quality of the service provided. Quality assurance measures were in place, however they had not identified that not all records relating to the service provided were robust or accurate.

There was an open and transparent culture within the service that fostered reflective learning. The service demonstrated a commitment to sharing good practice and the provision of high quality care through its participation in a number of initiatives.

Appropriate arrangements were in place in relation to obtaining people's medication. Medicines were prescribed and given to people appropriately.

Appropriate checks were undertaken before staff began work to ensure that only suitably vetted people were employed to work with vulnerable adults.

People who used the service were asked for their views about the care and support provided and they were acted on. We saw that annual surveys were undertaken with actions for improvements identified.

People were given support by the provider to make a comment or complaint. We reviewed the complaints procedure in place at Doughty's and found that this contained relevant information about the complaints process.

People we spoke with told us they had been involved in the planning of the care and support they needed The staff explained that they always ensure 'person-centred' care and aimed to promote people's independence at all times. Care and support plans were detailed and up to date.

We spoke with people using the service about the different activities they could join in with if they chose to do so. They all stated that there were regular things to do such as trips out in the mini-bus as well as activities on site such as music sessions and craft work.

People living at Doughty's told us that they felt safe and had no concerns. We noted that the premises and environment promoted people's safety and security. The grounds and gardens were exceptionally well maintained and people told us how much pleasure they got from these.

We saw that there were enough suitably trained and experienced staff to meet the needs of people using the service.

The home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and management audits were in place and records were available.