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The Dukes House 3 Inadequate


Inspection carried out on 11 December 2019

During a routine inspection

About the service

The Duke’s House 3 is a residential care home providing accommodation, support and personal care to three people who have a learning disability, autism or a mental health support need. The service can support up to six people. The home is a three storey Victorian building, in a residential area of New Brighton. Each person has an en-suite room; and there were communal areas.

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

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.

Staff had not always been effective in listening to a person’s communication and actions. 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.

The service didn’t always apply 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, c

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 Dukes House 3 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 Dukes House 3 is registered to provide accommodation for up to six 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 four people living at the service, two of whom occupied bedrooms within the main body of the house and two people, occupied their own flats which have been added to the building. The accommodation was provided over three floors. Access to the upper floors was by way of stairs. There was a secure communal garden to the rear of the property and secure entry system to the front of the property.

The Dukes House 3 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 19 and 25 November 2015 the service was rated Good. At this inspection we found the service remained Good.

Why the 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 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 chose how to spend their day and encouraged to be independent in all aspects of their lives and take responsibility for 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. A health care professional told us that the lives of people had improved since moving into the service.

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 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 19 and 23 November 2015

During a routine inspection

This unannounced and comprehensive inspection, took place on 19 and 23 November 2015. The service was newly registered, but we had been alerted to some concerns about staffing issues, by an anonymous caller and a whistle-blower, which were not substantiated during the inspection.

This service was additional to the providers other service at the adjacent premises and although registered as a separate service, was at times, supported by staff from the adjacent home. People from both services often intermingled.

The Dukes House 3 is an older property which had been extended to provide two flats, in addition to four bedrooms in the main part of the house. The flats were directed at more independent living.

The home was registered to provide a service for six people. The home specialised in providing accommodation and personal care to people with learning disabilities. At the time of our inspection, there were four people resident in the home; one person was living in one of the flats and three others were living in the main building. There was also a large communal lounge, a dining room and a large kitchen.

The service required that a registered manager be employed. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’

The home had a registered manager in post, who was an experienced manager and who also managed the adjacent home, also owned by the provider.

We saw that staff had been recruited appropriately and numbers of staff in the home were suitable to people's needs, throughout each day and night. There were appropriate employment policies in place such as grievance and disciplinary procedures and a whistleblowing policy.

Staff were able to demonstrate to us that they knew about safeguarding and who to report concerns to and most had received training in medication administration. However we found that some of the records relating to medication did not tally with the amount of medication in store.

We have made a recommendation about the management of medicines.

Staff had been trained appropriately and there was an induction period for new staff which included basic training and knowledge. They demonstrated their skill and knowledge when we observed the interaction with the people they were supporting.

Staff demonstrated that they knew about mental capacity and deprivation of liberty and used this knowledge with empathy and professionalism.

All the staff showed a caring approach and they involved and included people in everyday decisions.

The support for each person was person centred and tailored to their needs. We saw that relationships were good between the staff and the management and that people looked as if they were happy with their support. Other professionals who supported people and the relative we spoke with told us that they felt that the service was good, caring and well-led.