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Inspection carried out on 5 December 2019

During a routine inspection

About the service

Dales House is a small residential care home in the city of Hull. It is situated in a residential area which is close to local shops and amenities. The service is registered to provide accommodation and personal care to seven adults who have primary needs associated with a learning disability. The service was supporting seven people at the time of our inspection.

The service demonstrated 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

People were provided with exceptional care that was personalised to their preferences and routines, which enabled them to live their lives in the way they wanted. People achieved their goals and positive outcomes through accessing a wide variety of opportunities and activities with the support of dedicated staff.

People’s independence was promoted as staff encouraged choice, control and inclusion in the local community in line with the principles and values of Registering the Right Support and other best practice guidance. This enabled people who use the service to achieve the best possible outcomes and live as full a life as possible.

People were happy with the care provided as staff were kind, caring, attentive and respectful. Staff had developed positive relationships with people and their families which were built on trust, honesty and respect.

People were protected from avoidable harm and abuse by trained, knowledgeable staff. Recruitment, induction and ongoing processes helped ensure only suitable staff were employed and that they had the required skills and knowledge. Staff were supported by the management team through supervision, team meetings and annual appraisals.

Staff supported people to access appropriate healthcare services, followed professional advice and provided consistent care. People were encouraged to eat a healthy diet and any concerns were raised with the relevant healthcare professionals. People received their medicines as prescribed.

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 management team promoted a positive and supportive culture, which supported people to achieve good outcomes. Quality assurance systems had maintained the quality and safety of the service. Learning from and working with other organisations helped ensure people got the support they needed.

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

Rating at last inspection

The last rating for this service was good (published 06 June 2017).

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.

Inspection carried out on 5 May 2017

During a routine inspection

Dales House is situated in a residential area in Hull and can provide accommodation and personal care for up to seven people who have primary needs associated with learning disability. The service has seven single bedrooms, two sitting rooms and a dining room. There are sufficient bathrooms and shower rooms to meet people’s needs and all areas of the service are accessible to people with mobility difficulties. One of the seven bedrooms is available to accommodate people who require respite care.

At the last inspection on 22 and 23 April 2015, the service was rated Good. At this inspection, we found the service remained Good although, due to the strong person-centred culture apparent within the service, we judged the fundamental standards had been exceeded when we asked the question, “Is the service Responsive" and the overall rating for the responsive domain is outstanding.

Personalised care plans and flexible staffing enabled people to develop and lead very fulfilling lives. The staff team had an excellent understanding of people's complex needs. The way staff responded to people's needs, and approached them with care and compassion, had led to them having an outstanding quality of life, being able to participate in meaningful activities and being part of the ‘family’ at Dales House. The staff team were responsive to people's individual needs and had been flexible in organising a wide range of community-based activities to enable people to feel part of the wider community. All staff described working together as a team. They were dedicated to providing exceptional person-centred care and helping people to achieve their potential; in discussions, staff knew people’s needs really well. The environment was very tailored to people’s individual needs; there was colourful signage throughout the service, a homely atmosphere and a wide range of equipment to ensure people’s safety, accessibility and wellbeing.

The service was a safe place for people to live. Recruitment procedures were thorough and there were sufficient staff, used in a flexible way to support people’s needs. Staff knew how to safeguard people from the risk of abuse and harm, had received training and also had procedures to guide them. There were procedures in place to manage risk which helped to ensure people were safe whilst not being too restrictive.

People’s health and nutritional needs were met. People were supported to attend appointments and access community health care professionals for advice and treatment when required. Medicines were managed effectively and staff ensured people had their medicines as prescribed. The menus provided people with nutritious meals and alternatives were available. Staff told us the menus could change dependent of people’s choices each day.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff approach was observed as kind, caring and compassionate. They treated people with dignity and respect whilst still maintaining a friendly and professional manner. There were very positive comments from people who used the service, relatives and visiting health and social care professionals about the registered manager and staff team.

We saw from records that staff had received training appropriate for their development, supervision and appraisal. Staff told us the registered manager led by example and were supportive of them. They felt listened to, able to make suggestions and were confident in supporting people who used the service.

There was a quality monitoring system in place which consisted of audits and checks and obtaining people’s views about the service. Surveys were carried out and results of quality monitoring were displayed in an easy to read format so people could see what action had been taken to address their suggestions and comments.

Further information is in the deta

Inspection carried out on 22 and 23 April 2015

During a routine inspection

We undertook this unannounced inspection on the 22 and 23 April 2015. This was the first inspection since the service was registered with the Care Quality Commission on 10 October 2014.

Dales House is situated in a residential area in Hull and can provide accommodation and personal care for up to seven people who have primary needs associated with learning disability. The service has seven single bedrooms, two sitting rooms and a dining room. There are sufficient bathrooms and shower rooms to meet people’s needs and all areas of the service are accessible to people with mobility difficulties. One of the seven bedrooms is available to accommodate people who require respite care. The service is new, within its first six months of registration, and at the time of the inspection there was one person who lived at the service. Another person was in the process of moving to alternative accommodation as the service was unable to meet their needs. Some people used the respite service at intervals and one person received a day care service.

The service has 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.

Staff were generally recruited in a safe way but there had been one occasion when full checks had not been received prior to the start of employment. We found there was sufficient staff employed to support the people who used the service and they received induction, training, supervision and support.

People received their medicines as prescribed but we found improvements were needed in some aspects of recording of medicines. We saw one person had not required any medicine to calm their anxiety, which had been an improvement for them.

The heating and hot water system in place helped to minimise the risk of Legionnaires disease but there was no routine to flush through unused hot water outlets and shower heads. This was needed in the bedrooms and any other areas currently unused to help prevent the spread of legionella infection. We found all areas of the service were clean and tidy.

We found people lived in an environment that was safe. There were policies and procedures to guide staff in how to keep people safe and risk assessments were completed. These included guidance for staff in how to minimise risk whilst still ensuring the people could make decisions. Staff knew what to do to keep people safe from the risk of harm and abuse.

We found people’s health and nutritional needs were met. They had access to a range of health professionals for treatment, advice and support. The food prepared looked well-presented and people were provided with choices and alternatives.

We found staff followed the principles of the Mental Capacity Act 2005 and when people were assessed as not having capacity, meetings were held to discuss options for their care in their best interest. We also found the registered manager had made appropriate applications to the local authority when they felt people had been deprived of their liberty.

The building had been adapted to meet people’s needs and there was equipment to help them access all areas.

We observed staff interacted positively with people they supported. They spoke with people in a kind and caring way and respected their privacy and dignity. Health and social care professionals described staff as professional and skilled.

People’s needs were assessed and care plans were person-centred. Staff confirmed they had time to read care plans and it was clear via discussions with them that they knew people’s needs well.

We found information was provided to people in a format that met their needs. The surveys which formed part of the quality monitoring system need to be further developed to make them more accessible to people who used the service.

There was a quality monitoring system but this was still in the early stages due to the new status of the service. Although auditing documentation was available this had yet to be used to test out specific areas of the service.

The registered provider had developed an open and inclusive culture where staff and people who used the service felt able to raise concerns and make suggestions.