Duxbury House Residential Care Home

Duxbury House is a care home providing personal care to six people at the time of the inspection. The service can support up to six adults living with a learning disability and mental health conditions. Duxbury House is situated in a residential area of Blackpool close to the promenade. A lounge, dining room and paved external areas are available for people to choose where to relax.

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

Staff demonstrated a good awareness about safeguarding people from harm or abuse. The registered manager completed risk assessments to guide staff to support each person safely. People stated they felt safer with staff administering their medicines and confirmed they received them on time. The home was clean throughout and there were good stocks of PPE for staff use during the current pandemic. Staff went about their duties calmly and patiently, spending time sitting down talking with people.

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. We found elements of care plans included recorded actions to assist people that were strict in nature, which could infer restrictive practice.

We have made a recommendation about support planning.

The registered manager and staff worked in a multi-disciplinary approach with local services to optimise continuity of care. Care records contained risk assessments to mitigate the risk of malnutrition. The registered manager provided a training programme to develop staff skills.

The registered manager and staff were respectful of people’s diverse cultures. Care and communication included detailed recording of people’s backgrounds and life stories to increase awareness of each person and their needs.

The registered manager engaged with people to understand their life histories and create personalised care plans. They and their staff provided regular and ad hoc activities to maximise people’s wellbeing and social skills. The provider had not received any formal complaints, but provided information to people about raising issues they may have.

People and staff talked about an open culture where they were encouraged to raise any concerns or suggestions about improving the service. The registered manager regularly completed audits to check everyone’s safety and welfare.

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 able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. Staff supported people to make their own decisions and lead discussions on what they wanted to do. Staff were consistently kind and respectful, ensuring each person maintained their independence and privacy. People confirmed they were happy and settled at Duxbury House.

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 good (published 07 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about food hygiene, choice and liberty, management of people’s finances and support for them to access medical treatment services. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Duxbury House on our website at www.cqc.org.uk.

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.

At the last inspection on 27 August 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

During this inspection, people we spoke with said they felt safe at the home. One person commented, “It’s a good place, I feel very safe here.” Care records we saw included risk assessments to guide staff to minimise potential risks to people who lived at Duxbury. Staff we talked with demonstrated a good understanding of safeguarding people from unsafe or poor care.

We found medicines were stored securely and administered with a safe approach. The provider undertook regular audits to assess the safety of medicines management. They ensured staff had relevant training to underpin their skills and understanding.

The provider had systems to ensure people were protected against the employment of unsuitable staff. People and staff we spoke with told us staffing levels were sufficient. A staff member stated, “There’s enough staff. I go out with people on a daily basis because there’s two staff to make this possible.” We saw staff training was reinforced by supervision for staff to review their development.

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.

Staff worked with individuals to meet their nutritional requirements with a healthy living approach. For example, guidance in care files included support about the risks of obesity as well as malnutrition. One person told us, “The meals are great. It’s all about healthy living.”

We observed staff engaged with people in a friendly, caring, patient and knowledgeable approach. People said staff were compassionate, supportive and kind. One person who lived at Duxbury told us, “Even my [relative] says it’s the best place I’ve been in. She goes home happy and relaxed.”

People we spoke with commented the registered manager and staff worked with them in developing their support plans. We saw records were detailed, personalised and contained information about each person’s backgrounds, life histories and preferences.

The registered manager regularly completed a range of audits to assess quality assurance and the safety and wellbeing of everyone at Duxbury. They held regular ‘resident’ meetings to give people the opportunity to raise any issues and involve them in the home’s development. Staff told us the provider had a hands on approach and worked with them as part of the team. One employee said, “We have regular team meetings and discuss any ideas to help our residents.”

Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Duxbury House.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe living there. Comments included, 'Since I have been here I have come on leaps and bounds. All the staff are very supportive'. Also, 'I go out nearly every day with my keyworker. I couldn't do without her'.

Systems were in place to make sure staff learn from events such as accidents and incidents, complaints, concerns and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve. The provider/manager told us they took all incidents seriously and gave examples of where they had used experiences of incidents to adapt change. For example, working with other professionals to enable a more appropriate placement for people whose needs had changed.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. All staff were enrolled to undertake the relevant training in mental capacity in the near future. This would enable them to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

People's mental health and care needs were assessed with them, and they were involved in developing their plans of care where possible. One person we spoke with told us, 'My keyworker always talks things through with me, so does the manager'.

Systems were in place to monitor peoples dietary needs. This had been identified in support plans so staff could deliver an effective nutritional plan to meet individual needs. Examples of this included two people who had reduced their weight based upon healthy eating and exercise plans. One person told us, 'I never thought I could manage to lose weight like this but it's been so easy with the help I have been given'.

People we spoke with told us the service was flexible to meet their individual needs. 'I like the fact I can do the things I want but with the support of the manager and staff. It's made my life easier'.

In order to deliver effective care the provider/manager and staff demonstrated an understanding of the needs of people living at the home. Staff we spoke with told us they worked well as a team to ensure peoples needs were being met. One said, 'It a small home and we all communicate well so information is being passed down all the time'.

Is the service caring?

People were seen to be supported by attentive and respectful staff. We saw that care workers showed patience and gave encouragement when supporting people. Most people who lived at Duxbury House were independent and were supported to go out with staff. Some of the comments from people we spoke with included, 'I don't know what I would do without F'., she is always on hand for me'. Also, 'Great bunch of staff, always around when you need them'.

We spent time speaking with people about the level of care they provided. Staff we spoke with told us it was a role they were proud to work in. 'I love working here, it's just a very caring environment and people are appreciative of the care they receive'. People were seen to be supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Personal profiles had been developed by staff. Staff we spoke with told us this had helped them to understand things that were important with individual residents. For instance once a month a member of staff accompanies a resident to a venue which enables them to take part in a personal interest of theirs.

Is the Service Responsive

People had access to a range of literature relating to the complaints procedure. People we spoke with said they knew how to make a complaint if they were not satisfied with something that affected them. One person told us, 'I always say if I am not happy with something. They always seem to listen to me and get it sorted out. Staff we spoke with told us a system was in place to investigate record and reach outcomes for any complaints they received. People could therefore be assured complaints would be investigated and action taken as necessary.

Is the service well led

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a range of quality audit systems in place. We saw they were complete and up to date. They covered the environment, health and safety as well as staff and resident meetings. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had an understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.