Saint John of God Hospitaller Services - 1-2 Dalby View

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection.

• The environment was clean. Additional cleaning was taking place, including of frequently touched surfaces.

• Staff wore appropriate PPE and there were sufficient supplies. The registered manager and the acting deputy carried out weekly checks to ensure the service always had enough PPE for staff to access.

• Staff had undertaken training in putting on and taking off PPE and other COVID-19 related training such as hand washing.

• People and their relatives were supported to keep in contact using a range of technology as well as visits to the home, in line with government guidance.

• People and staff participated in a regular testing programme.

• Appropriate vaccination status checks were in place.

1-2 Dalby View is a care home providing personal care and support to eight younger adults, some of who may be living with learning disabilities and autism. There were eight people using the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Improvements had been made since the last inspection and these included improvements to the environment, record keeping and governance.

The service was registered to support eight people. Care and support was provided from two adjoining bungalows each one accommodated four people. It therefore conformed with current best practice guidance.

The atmosphere was bright and welcoming and the buildings were better-maintained with a good standard of hygiene. There was a stronger, more effective governance system in place. Processes were in place to manage and respond to complaints and concerns.

There were enough staff available to provide individual care and support to each person. Staff upheld people's human rights and treated everyone with respect and dignity. Communication was effective and staff and people were listened to. Staff said they felt well-supported and were aware of their rights and their responsibility to share any concerns about the care provided.

Information was accessible to involve people in decision making about their lives. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People were extremely well-cared for, relaxed and comfortable. Staff knew the people they were supporting very well and care was provided with patience and kindness. Staff ensured people's privacy and dignity were always respected.

The service was flexible and responsive to people's needs and was able to accommodate changes to them. Records were personalised, up-to-date and accurately reflected people's care and support needs. Care was centred and tailored to each individual. Risk assessments identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

People, relatives and staff were confident about approaching the management team if they needed to. They were complimentary about the team and the workforce. There was evidence of collaborative working and good communication with other professionals to help meet people's needs.

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 19 January 2019) and there were two breaches 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 regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Saint John of God Hospitaller Services - 1-2 Dalby View is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate a maximum number of eight people with a learning disability. There are two bungalows (four people in each) situated on the same site. At the time of the inspection there were eight people who used the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was on leave at the time of our inspection. However, the deputy operations manager was present and supported us with this inspection.

At our last inspection in December 2016 we rated the service as good. At this inspection we found deterioration and rated the service as requires improvement. This is the first time the service has been rated Requires Improvement.

At our last inspection of the service in December 2016 we found those people lacking capacity did not have decision specific mental capacity assessments or best interest decisions formally recorded. At this inspection we found no improvement had been made. It was our judgement, through speaking with staff, that decisions such as accessing health professionals and taking medicines had been made in people’s best interest, but there was no formal recording of this.

The home environment needed refurbishment and some furniture such as wardrobes and drawers needed replacement. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

We found some care plans were confusing or contained insufficient information to ensure people’s care needs were met. Care records contained numerous generic risk assessments which were not needed and made care records difficult to navigate. Care records provided information to staff on support people needed when getting up on a morning and when they were retiring to bed. However, there was limited information about how people liked to spend their day and the support they required from staff to do this.

Quality monitoring was undertaken, however, we found some of this to be ineffective as this did not identify the areas of concern that we found at this inspection.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Medicines were managed safely with an effective system in place. Staff competencies around administering medicines were regularly checked.

There were enough staff on duty to meet people’s needs. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The home was clean and tidy. Appropriate personal protective equipment and hand washing facilities were available. Staff had completed infection control training.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place.

People told us they enjoyed the food provided. Staff supported people to maintain their health and attend routine health care appointments.

People who used the service told us that staff were kind and caring. People had access to a range of activities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager and provided.

The home 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.

Dalby View is registered to provide care and support to people in two separate bungalows. The service provides care, support and accommodation to eight adults who have learning disabilities and / or physical disabilities. The service is close to all local amenities. At the time of the inspection there were eight people using the service.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We did note there wasn’t a cyclical routine for the testing of fire call points which meant some call points had not been tested as much as others. The registered manager contacted us after the inspection to confirm they had taken action to address this.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, falls, burns and scalds. This enabled staff to have the guidance they needed to help people to remain safe

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people who used the service.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had received induction training and shadowed other more experienced staff when they were first recruited. The majority of staff had completed training in food hygiene, fire awareness, emergency first aid, moving and handling, safe handling of medicines and safeguarding. There were some gaps in training for behaviour that challenges, Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. We were informed that this training would take place early in the New Year.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported, however at the time of the inspection, processes had not been followed to formally record this. Information was supplied to us after the inspection to confirm that staff at the service had commenced this process.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were kind, caring, respectful, and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

People’s independence was encouraged. Activities, outings and social occasions were organised for people who used the service, however these had been limited in the last few months as some staff had left the service leaving a limited amount of staff available who were able to drive. We were told by the service improvement manager that new staff would be recruited in the very near future and there was a criteria that they must be staff who are able to drive.

People’s needs were assessed and their care needs planned in a person centred way. We saw that risks identified with care and support had been identified and included within the care and support plans.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

One person told us, 'The staff are very, very good. If you ask for anything to be done for you, then they do it.'. People also said, 'It is wonderful here' and 'Staff really care about us.'

We found that people's care was planned and delivered in line with their needs. The staff were very knowledgeable about people's care needs and how to meet them. We noted that the staff team had been very stable and all of the staff had been in post for a number of years. We found that the manager made sure the home provided effective care and encouraged staff development.

The home was well-maintained and the provider had an on-going programme of redecoration which ensured it was kept to a high standard,

We found that effective procedures were in place should people wish to complain.