You are here

The Duke's House Requires improvement

Reports


Inspection carried out on 22 April 2021

During an inspection looking at part of the service

The Duke's House is a residential care home providing accommodation, support and personal care for people who have a learning disability or autistic people. At the time of our inspection seven people were living at the home; the home can accommodate up to eight people. The home is in a residential area of New Brighton, across two three story Victorian properties which have been joined. Each person has a private en-suite room. There are communal lounges, a dining area, an accessible kitchen and office space on the ground floor.

At our previous inspection three people were living at The Duke’s House whilst building work was taking place. Following the renovations, five people moved into the home from the providers other homes as part of a remodelling of their services.

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

The service design and environment did not meet all people’s needs as outlined in their support plans. Some people’s known actions were those that caused upset and were likely to get a negative response from other people in the home. Our observations and feedback from health and social care professionals, people’s family members and staff; confirmed that the combination of these risks and the atmosphere they created was having a negative impact on people’s wellbeing.

There were enough staff to meet people’s needs. However, staff members told us that at times there was not always enough staff available to support people; and this has had a negative impact on people being able to do things they wish to do.

People’s family members, staff and outside health and social care professionals told us that there had been a very high turnover of staff and the staff team had remained unstable since our last inspection. One health and social care professional told us, “Staff turnover is massive.” Making effective improvements based upon learning from incidents and feedback from people; had been hindered by a high turnover of senior staff, high turnover of support staff and a lack of stability within the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not meet all people’s needs or maximise positive outcomes for them. The model of accommodation did not promote people living an ordinary lifestyle.

Right care:

• Staff were caring and kind towards people. However, people’s care was not always provided in a person-centred way, based on what was important to them. People's family members told us the provider had not worked in partnership with them in a meaningful way.

Right culture:

• There had been an extended period of change within staff teams and change of leaders within the service. Staff members described fractured teams. Health and social care professionals and people’s relatives criticised the provider’s communication and partnership working. Some people’s relatives told us they thought the provider needed to rebuild relationships and trust with them.

There was a system in place for recording and reviewing any safeguarding concerns. Referrals had been made to the local authorities safeguarding team. People and their family members told us they felt safe with staff members, who treated people well.

Managers and staff had responded appropriately to the COVID-19 pandemic. People supported each had a COVID-19 risk assessment and management plan in place.

There was a new home manager in place who was making an application to be registe

Inspection carried out on 24 September 2020

During an inspection looking at part of the service

About the service

The Duke’s House is a residential care home providing accommodation, support and personal care for people who have a learning disability, autism or a mental health support need. At the time of our inspection three people were living at the home; the service can support up to eight people. The home is across two three storey Victorian properties which have been joined together, in a residential area of New Brighton. Each person has an en-suite room; there were communal areas, and on the top floor office space and a room for staff to sleep in.

At our previous inspection The Duke's House shared the same staff team, management team, outdoor space, office and many other systems with the providers location The Duke's House 3 which was next door.

At the time of this inspection the provider was in the process of making changes that they had assessed would align the service with the values of Registering the Right Support. The provider was in the process of closing The Duke’s House 3 and remodelling The Duke’s House. Works planned included the redesigning and remodelling of outdoor space and changing some aspects of the outward presentation of the home. The provider told us that these changes will result in The Duke’s House fitting in with properties within the local community.

There were some indicators that the three people living at The Duke’s House had benefited from living with fewer people. Some progress had been made in aligning people’s support with the principles of Registering the Right Support. However, we are aware that most of the changes planned had not yet happened. Many of the changes to the interior of the building had not yet taken place and a further five people were due to move into the home. This will make the home larger than typical domestic style living arrangements, with eight people living in the home supported by a larger staff team. This is the third inspection when the home has not been full; it is not known if the redesign of the accommodation will mitigate any impact on people’s choice, control and independence.

The provider had completed an internal audit of the service against the principles of Registering the Right Support. We recommended that the provider continue to assess themselves against these principles which include the values of choice, control and independence when providing care and accommodation for people.

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

Leadership of the service remained inconsistent and the systems for checking on the quality and safety of the service had not always been effective. The manager in place during our last inspection had left; and the service had been led by interim managers since then. An existing manager who is registered with the CQC from one of the providers other services had recently been appointed as manager of The Duke’s House.

We have made a recommendation about the health and safety systems at the home.

We have also made a recommendation about the management of some medicines.

At times there remained some disconnect between the described ethos of the service, care planning and how staff supported people on a day to day basis. Staff gave us mixed feedback regarding the atmosphere and culture within the home. Some staff still described aspects of the culture as negative.

Communication and partnership working had improved in some areas. However, family members of the three people living at The Duke’s House told us that although they think that the changes at home sound “great”; the communication with the provider during these changes had been poor. The provider still did not have a coherent vision that was agreed and understood across all health and social care professionals, family members, managers and support staff.

People told us that they felt safe living at The Duke’s House and staff were kind towards them and treated them well. They told us that they felt comfortable speaking with staff members and wo

Inspection carried out on 11 December 2019

During a routine inspection

About the service

The Duke’s House is a residential care home providing accommodation, support and personal care to six people who have a learning disability, autism or a mental health support need. The service can support up to eight people. The home is across two three storey Victorian properties which have been joined together, in a residential area of New Brighton. Each person has an en-suite room; also, there were communal areas, and on the top floor office space and a room for staff to sleep in.

The Duke’s House shares the same staff team, management team, outdoor space, office and many other systems with the providers location The Duke’s House 3 which is next door. We inspected both services at the same time; specific information regarding The Duke’s House 3 is reported in a separate report.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. Registering the Right Support, 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.

The service was next door to another location provided by Lifeways Inclusive Lifestyles. To the public they look like and in many aspects operate as one care home; between them can accommodate up to 14 people. This is larger than current best practice guidance. In some ways this was mitigated, for example; there were no identifying signs to indicate it was a care home and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people. However, in other ways the care home was in contrast to the surrounding homes. For example, the three front gardens had been converted into one large car park, there were large gates across all entrances and there were no bay window coverings and when the lights were on the public could see into people’s communal areas from the street.

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

Staff were caring in their interactions with people and it was evident that staff endeavoured to have positive relationships with people. Whilst staff as individuals had a caring approach towards people; the provider had not developed, promoted or ensured that there was a caring culture at the home that respected and enabled people.

The home had a very restrictive environment. The provider had taken depriving people of their liberties for granted and had not ensured that people’s fundamental rights were acknowledged and protected.

The systems in place for assessing, monitoring and managing risks when supporting people were inadequate. They had not always ensured that the use of restraint had been safe and effective. This meant that important information regarding people’s safety was not always available for staff.

People’s risk assessments had not always been reviewed following a significant incident. The safe and effective use of restraint had not always been reviewed after significant physical interventions. There was inadequate debriefing and learning from incidents; even when staff members told us that they had raised safety concerns about the management of incidents.

The PBS principle of listening to a person by their communication and their actions had not been consistently applied. The culture at the home had not promoted staff being curious and exploring with them, what views or decisions they were communicating.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Inspection carried out on 13 June 2018

During a routine inspection

The inspection took place on 13 and 14 June 2018 and was announced.

The Duke's House 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 Duke's House is registered to provide accommodation for up to eight people. The service specialises in providing support to people with a learning disability and or autism who need support with their personal care. On the day of our inspection there were six people living at the service.

The Duke's House 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'.

At the last inspection on 2 August 2016 the service was rated Good. At this inspection we found the service remained Good.

Why this service is Good.

The service had a relaxed feel and people could move freely around the service as they chose. People were supported to have maximum choice and control over their lives and participate in activities they enjoyed.

People’s individual needs had been assessed and the information used to develop support plans. These provided staff with guidance about the care and support people needed and how they wanted this to be provided. People were consulted about their care to ensure wishes and preferences were met.

People told us they chose how to spend their day and were encouraged to be independent in all aspects of their lives such as taking responsibility for undertaking their own cleaning, laundry and personal shopping.

People received a varied and nutritional diet that met their preferences and dietary needs.

People were supported by a consistent staff team who knew them well. Staff had been recruited safely and had the skills and experience to meet people’s needs and provide effective care.

People received their medicine safely and were supported to access the support of health care professionals when needed. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. The registered provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

The management and the staff team worked in collaboration with external agencies to provide good outcomes for people. Staff felt any concerns would be taken seriously and acted on. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.

Inspection carried out on 2 August 2016

During a routine inspection

This comprehensive inspection was unannounced and took place on the afternoon of 02 August 2016.

The Duke’s House is in a large, Victorian building and is a home providing accommodation and support for up to eight people. At the time of our inspection, there were five people living in the home. These people lived with a range of learning disabilities , mental or physical health conditions. Each person had their own room and shared the communal living areas and garden area. The home is situated near shops and public transport.

The service required 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. There was a registered manager in post who had been there for several years.

We saw and were told by relatives, that the registered manager was open and transparent and that they were very approachable. Relatives felt the management of the home was good. The registered manager was also supported by two deputy manager posts, although one of these had recently been vacated due to internal promotion.

We looked at records relating to the safety of the premises and equipment, which were correctly recorded. We toured the home and observed that staff and people interacted in a friendly and positive way with people.

There was insufficient soap in some bathrooms and several toilets were dirty or stained.

The remainder of the home was clean and in good order apart from recent damage done by one person, which was in the process of being repaired.

We looked at the recruitment files for staff. We saw that safe recruitment practice occurred with the recently recruited staff.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the files looked at and there was updated information that reflected the changes of people’s health.

We viewed rotas for the staff. The staffing levels were sufficient in all areas of the home at all times to support people and meet their needs and the relatives we spoke with considered there were adequate staff on duty.

Records we viewed showed that the required safety checks for gas, electric and fire safety were carried out.

Inspection carried out on 11, 12 September 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our visit there were five people living in The Duke�s House. We talked with two people who used the service and with three members of staff as well as the deputy manager for the home and the area manager for the provider. We looked at various paper records including three care plans and eight staff files.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available or on call in case of emergencies. Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked. Staff were trained in safeguarding principles and procedures.The home had a safeguarding policy which was regularly monitored. Medication storage and administration was done in accordance with guidelines. Appropriate risk assessments had been carried out and action plans put into place for safe practice. A person living in the home told us, "I feel safe".

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place for this.

Is the service effective?

People appeared happy. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people.

People and their families had been involved in the creation of their care plans where possible and continued to be involved throughout their stay in the home. We noted that peoples preferences about, for example, activities, room layouts or clothing choices, were respected by the staff. The people who used the service people were supported, where necessary, to make these choices and decisions.

Is the service responsive?

People's needs had been assessed before they moved into the home and frequently reassessed whilst they lived there. They had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and relatives had been asked for their feedback on the service.

The home completed various other audits throughout the year, which contributed to an annual audit. An action plan had been produced to address any areas of concern raised through all of the audit and feedback processes.

The provider had a number of premises and homes and for all, used the same IT package for much of its record keeping and policies. The manager was able to demonstrate effective knowledge of this and show us that she had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications.

Inspection carried out on 13 June 2013

During a routine inspection

People who lived at the home did not always have the mental capacity to make certain decisions. We found evidence that �best interests� meetings were held for any major decision affecting any individual regarding their welfare. We found staff understood the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the issues of consent.

Relatives spoken with were happy with the care provided. One relative said: �I couldn�t be happier with the quality of care� and another said "The staff are brilliant." We found care plans contained specific guidance for staff on how to look after people. In particular there was clear guidance for staff regarding the use of de-escalation techniques needed for individuals who could present with distress reactions.

We observed that the home was generally clean throughout. However the manager was not aware of the appropriate guidance for the prevention of infection control but the provider employed a health and safety officer to monitor infection control.

We found there was a robust recruitment process in place to ensure only suitably skilled people were employed to look after people at the home.

We found there was a complaints system available for people who lived at the home for them to express any concerns.

Inspection carried out on 27 November 2012

During a routine inspection

During our inspection we spoke to people who lived at the home and their relatives. We invited them to share with us their views and experience of the care they received.

One person who lived at the home said �Staff treat me nice, they help me with shopping.�

A relative told us �The home has done really well with our family member, she is happy there. I am involved in the planning of her care, there is a meeting which we all attend to discuss her care.�

We looked at four care files, these were well organised and had a person centred approach. The service helped the people who lived at the home to maintain contact with the families; they sent regular cards and letters to advise family members of the activities they had done that month and how well they had maintained their bedroom.

We made general observations within the home of the wellbeing of people and observed staff had a positive rapport with the people who lived at the home.

Inspection carried out on 2 September 2011

During a routine inspection

One person told us that they had just been out for a bike ride and he like to do this everyday, and he was very fit we saw that staff rotas accommodated this.

One person told us that they had been out for breakfast that morning and later in the day we were told that someone had been out for lunch.

Some people living in the home often have difficulty with verbal communication, during our visit we saw that the people living there appeared settled and content.

One person told us that they liked living in the home.

Reports under our old system of regulation (including those from before CQC was created)