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Dixon House Requires improvement

Reports


Inspection carried out on 11 February 2020

During a routine inspection

About the service

Dixon House is a residential care home providing personal care and support for up to 11 people with a learning disability. This is larger than current best practice guidance. However, the potential negative impact of the home being bigger than most domestic properties was eased by the building design fitting into the residential area. At the time of the inspection eight people were using the service.

The service in the main, reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities for them to gain new skills and become more independent. Some progress was needed with goal planning and this was ongoing.

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

People and their relatives were happy with management of the service. However, the provider had not given proper attention to overseeing the service and checking people were receiving safe and effective care. There had been changes in management and leadership which had an influenced on the day to day running of the service. Staff did not have access to policies and procedures to guide their conduct and there were no development plans for the service.

People said they felt safe at the service, but we found the provider had not ensured people were provide with a safe environment. Some risks had not been properly assessed and managed. We found some shortfalls with the support people received with medicines. We have therefore made a recommendation about the management of medicines. Staff were aware of safeguarding and protection matters. Staff recruitment checks had not always been fully completed, the registered manager took action to introduce better systems.

Although people were happy with the support they received, there were some shortfalls with ensuring staff had enough skills and knowledge. We made a recommendation about staff training and development. Some progress was needed to ensure people’s assessed needs could be appropriately met at the service and in providing a homelier environment. 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. People were satisfied with the variety and quality of the meals. People were supported with their healthcare needs.

People made positive comments about the caring and friendly attitude of staff and said their privacy and dignity was respected. Staff were respectful of people's choices and opinions and had an awareness of their individual needs. Staff had enough time to support people and listen to them.

People had a support plan to respond to their needs and choices. People were supported with their chosen activities, relationships and community involvement. Activities and goal planning were not properly included in people’s support plans, but the registered manager agreed to make improvements. People did not have any complaints about the service they received. They had access to a complaint's procedure and were confident they could raise any complaints and concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we have identified breaches in relation to risks to people’s health, safety and wellbeing and monitoring and oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to ensure improvements are made. We will monitor the progress of improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection

Inspection carried out on 8 August 2017

During a routine inspection

Dixon House is registered to provide nursing or personal care for up to 11 people who have a learning disability. On the day of our inspection there were nine people living in the service.

At the last inspection this service was rated overall Good. This was an unannounced inspection which took place on the 8 and 9 August 2017. At this inspection we found the service remained Good.

People who used the service told us they felt safe when being supported by staff members at Dixon House. Staff had been trained in safeguarding adults and knew their responsibilities to report any concerns. There was also a whistle-blowing policy in place to protect staff who reported poor practice.

Risk assessments such as, epilepsy, bathing, diet and nutrition, bedrooms and manual handling were in place to keep people safe whilst staff members were providing support. These were reviewed on a regular basis to ensure they remained relevant and up to date.

Records showed that robust recruitment processes were followed by the service when employing new members of staff. We saw references and identity checks were carried out as well as Disclosure and Barring Service checks.

Medicines were managed safely in the service. Only those people trained to do so were permitted to administer medicines. One person was assessed as being able to self-administer and the relevant risk assessments were in place in relation to this.

Staff received an induction and were supported when they commenced employment to become competent to work with vulnerable people. Staff were well trained and regularly supervised to feel confident within their roles.

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 who used the service had been given a copy of the complaints policy and staff knew how to respond to any complaints they may receive. Records we looked at showed there had not been any concerns or complaints raised since our last inspection.

We observed a good rapport between people who used the service and staff. We saw that staff appeared to know people well and understand their needs. People who used the service appeared relaxed.

Care plans we looked at were person centred and contained detailed information that was easy for staff to follow to ensure people’s support needs were met. We saw these were reviewed on a regular basis with the person and their relatives (if they wished). All care records were in an easy read format to assist people to be more involved in the planning of their care and support.

Policies and procedures were in place to guide staff in their roles. These were accessible to all staff and we saw they had been reviewed on an annual basis to ensure they remained relevant and appropriate.

Regular meetings were held with people who used the service, their relatives and staff members to ensure the service received feedback and improve the service. Surveys were also sent out as another means of gaining feedback on the service.

All the people we spoke with who used the service, relatives and staff members told us they felt the management team were approachable and supportive.

Further information is in the detailed findings below.

Inspection carried out on 09 December 2014

During a routine inspection

We carried out this inspection on 09 December 2014 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service is registered to provide nursing or personal care for 11 people who have a learning disability. On the day of the inspection 08 people resided at the home.

We last inspected this service in January 2014 when the service met all the standards we inspected.

This inspection took place on 09 December 2014 and was unannounced. During the inspection we spoke with six people who used the service, two care staff and the registered manager.

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.

People who used the service told us they felt safe and felt able to voice any concerns to the manager, staff or their families.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We found action had been taken where necessary to ensure people’s capacity to make their own decisions had been assessed. Where any restrictions were in place we found these were legally authorised under the Mental Health Act 1983 or with people’s consent. One person had a best interest decision about not being able to go out unattended. We found this had been approached using the correct procedures and personnel. This person had an independent person acting to protect their rights and review the decision on a regular basis.

Staff were recruited using current guidelines to help minimise the risk of abuse to people who used the service.

People had signed their consent to agree to their care, treatment, the administration of medication if required and their agreement to be photographed.

People were encouraged to be independent. We saw that people were mostly self-caring and kept their rooms as they wished. They also cooked and shopped for themselves. Staff intervened only when they had to or at the request of people who used the service.

Activities, hobbies and interests were provided. This included two people who worked for part of the week. The activities were suitable for the age group and included going out to clubs, on holidays, ten pin bowling, to cinemas or shows and to music and dance sessions. There were also activities held indoors and on the day of the inspection several people were involved in making Christmas decorations or doing arts and crafts sessions. People told us they were happy with the activities they could join in. People who used the service also told us they could go out independently if they wished.

The environment was well maintained and people were able to help choose their décor or furnishings to make the environment more homely to them.

Staff told us they received a recognised induction, completed enough training to feel confident in their roles and were supervised. Staff felt supported at this care home.

People’s needs were regularly assessed and updated. Staff were updated at each shift at their handover sessions. Staff responsible for writing care plans did so regularly which were audited for accuracy by the registered manager.

The administration of medication was safe, staff competencies were checked and the system audited for any errors by the registered manager and the local pharmacy.

People who used the service, staff and other agencies were asked for their views about how the service was performing. We saw that the registered manager had taken action to provide a better service from the views such as attending new activities and changing the menus.

The registered manager audited systems at the home, including infection control and the environment. Gas and electrical equipment was maintained to help keep people safe.

Inspection carried out on 22 January 2014

During a routine inspection

During our visit we spoke with two people using the service and two staff. We spoke with other people when they returned from their morning activity.

People told us they were happy with the support they received. One person said, �It�s a nice place; I like it here�. We found people�s support plans contained some useful information about their preferred routines and likes and dislikes. This would help staff to support people in the way they needed and wanted.

All areas of the home were bright, safe and comfortable and there were systems in place to maintain standards of the environment. People had access to a range of appropriate equipment to safely meet their needs and to promote their independence and comfort. One person said, "I like my room it is lovely and quiet; I have all the things that I need".

Staff had undertaken training that gave them the skills and knowledge to meet people�s needs. One member of staff commented, �It�s a good place; I enjoy working here�. People made positive comments about the staff team. They said, �Staff are very nice� and �Staff are lovely�.

People were encouraged to express their views and opinions of the service through regular meetings, reviews and during day to day discussions with staff and management.

Inspection carried out on 26 April 2013

During an inspection to make sure that the improvements required had been made

People spoken with told us they were happy with their care and accommodation and said they were treated well by the staff at the home.

People told us they were happy with the current system used to administer their medication. During the inspection we observed a member of staff administering medication to people who used the service and saw that medicines were safely administered.

We found that work had been done to repair the lighting in an en suite shower room. And loose carpets on the staircase and landing had been fitted securely. People told us they felt the entrance lighting and fitted carpets helped them feel safer in their home.

We found there was an up to date homes maintenance log which identified how the premises would be maintained with timescales.

Inspection carried out on 5 February 2013

During a routine inspection

People spoken with told us they were happy with the support they received in the home. They said, �I�ve been here a long time. It�s my home� and �I like it here, it�s nice�.

We looked at the support plans of two people who used the service and saw there were procedures in place to ensure their consent was gained in relation to the care provided.

People spoken with told us they received appropriate support with their medication. We saw systems in place for the administration of medicines. We observed staff who did not follow the homes medicine administration procedure. We saw that not all medicines were stored according to the homes medicine policy. This meant that people might be at risk from the unsafe management of medicine.

People spoken with told us they were happy living at Dixon House. They said, �It�s nice here, I like my bedroom� and �I had a bedroom upstairs, but the one I�m in now is better�. We saw systems in place to record maintenance due in the home. However the provider had not ensured that all areas of the home were safe for people who used the service. This meant that people might be at risk from unsafe surroundings.

We saw evidence that support workers were appropriately qualified and provided with training relevant to their role. We observed staff using inappropriate moving and handling to a person who used the service. This meant that people might be at risk from unsafe care and support practices.

Inspection carried out on 20 March 2012

During a routine inspection

People were involved in planning their care and support and they were supported to make choices and decisions about matters which affected them.

People had no concerns about their care, treatment and support.

People were treated with dignity and their privacy was respected. They were encouraged to be as independent as possible.

They knew about their care plans which explained to support workers what they needed to do to support them and to help meet their needs.

People were being consulted about the service and were always asked what their needs were.

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