Delrose

Delrose is a residential care home providing accommodation and personal care to up to 9 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 9 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence, and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people, and providers must have regard to it.

At the time of the inspection, the provider was working to improve the quality of service people received. Visiting professionals from the local authority and local NHS services (ICB) had identified widespread examples of poor and unsafe care. The provider had agreed standards had slipped at Delrose and was cooperating fully with the ICB’s large scale safeguarding enquiry. The provider was working to a thorough, credible improvement plan at the time of inspection.

Right Support

The service did not always support people to have as much choice, control and independence as they could. The service did not always plan care so people’s freedoms were restricted only if there was no alternative. The service did not always support people in a safe, clean, and well-maintained environment. The provider had measures in place to improve people’s support.

Right Care

People did not always receive kind and compassionate care. Staff did not always protect and respect people's privacy and dignity. Staff did not always respond to people’s individual needs. The service did not always have enough suitably skilled staff to meet people's needs and keep them safe. The provider had measures in place to improve people’s care.

Right Culture

Staff were not always responsive in supporting people's needs. Staff did not take all necessary steps to ensure risks of a closed culture were minimised so people received support based on transparency, respect, and inclusivity. The provider had measures in place to improve the culture at Delrose. This included introducing new staff and management who were experienced but did not know the people living at Delrose as well as staff who had worked there for some time.

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

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 9 December 2022).

Why we inspected

The inspection was prompted in part due to concerns received about a decline in service quality at Delrose. We decided to inspect and examine those risks and measures in place to reduce them.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next assess the service quality.

Delrose is a residential care home providing accommodation and personal care to up to 9 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 9 people using the service.

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

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 expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The service supported people to have as much choice, control and independence as they could. The service planned for when people experienced periods of distress so their freedoms were restricted only if there was no alternative. The service supported people in a safe, clean, and well-maintained environment.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. The service had enough suitably skilled staff to meet people’s needs and keep them safe.

Right Culture:

Staff knew and understood people, and were responsive, supporting people’s needs. Staff turnover was low, which supported people to receive consistent care. Staff ensured risks of a closed culture were minimised so people received support based on transparency, respect, and inclusivity.

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 10 February 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

We received concerns in relation to how the service supported people safely. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating of good.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Delrose is a residential care home providing accommodation and personal care for younger adults with a learning disability and younger autistic adults. At the time of the inspection there were six people living at Delrose, some with complex needs. The service can support up to nine people.

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

The provider had made improvements in areas we found needed improvement at the last inspection. The provider had consolidated improvements in the area of infection prevention and control. The service had maintained standards in other areas such as the management of medicines and protecting people from abuse. We were assured that the provider used personal protective equipment (PPE) in line with government recommendations during the COVID-19 pandemic, and we were assured by the provider’s practice in other areas of infection prevention and control we looked at.

Staff told us they had seen improvements in how the service was managed. There was an improved focus on following up actions. A system of audits, checks and processes was in place to embed improvements already made and drive further improvements.

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 and update

The last rating for this service was requires improvement (published 15 August 2019). We found breaches of two regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 June 2019. We found two breaches of legal requirements. The provider completed an action plan after that inspection to show what they would do and by when to improve in the areas of good governance and safe care and treatment.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led, which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Delrose 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.

Delrose is a residential care home providing accommodation and personal care to younger adults with a learning disability or autism. At the time of the inspection there were five people living at Delrose, some with complex needs. The service can support up to nine people.

Within limitations caused by the internal layout of the building, the service has been developed and designed in line with 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 was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties but consistent with other properties in the same road. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, or cameras outside, but industrial bins and formal car parking indicated it was not a domestic home. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

The provider had made improvements since our last inspection towards making sure people’s service met the minimum standards required. People received a service which met minimum standards in effective, caring, and responsive. However, there were still areas for improvement in safe and well led.

The provider’s management and quality assurance systems did not proactively identify concerns and put measures in place to improve the service people received. Management did not always follow up promptly when external circumstances affected people’s care and support. For 10 months before our inspection there had been no registered manager in post.

There had been recent actions to improve how the service protected people from the risk of the spread of infection. However, some of these were yet to complete and others were not sustained and fully embedded in the service. There were sufficient numbers of suitable staff to support people safely.

People’s care and support was based on thorough, detailed and person-centred assessments and care plans. The provider had made improvements to how staff performance was based on training, supervision and appraisal. People had support to maintain a healthy diet and access to other healthcare services.

There were positive, caring relationships between staff and people they supported. The service promoted and respected people’s dignity, privacy and independence.

People had care and support which met their needs and respected their choices and preferences. The provider complied with the legal standard for supporting people with communication needs arising for a disability or sensory impairment. People had access to a range of appropriate activities which sustained their wellbeing.

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 service did not 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, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. However, people’s support was not always focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 9 January 2019) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, but the provider was still in breach of two regulations. Delrose has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation in relation to the effectiveness of the provider’s management and quality assurance systems, and to the protection of people against risks associated with the control and spread of infection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will take appropriate action in line with our protocol for services which are repeatedly rated requires improvement. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Delrose is a care home that provided personal care to five people with a learning disability or autism at the time of this inspection.

People’s experience of using this service:

Since our last inspection the registered manager and other managers had left the service. The provider had made arrangements to cover their absence. However, they had not made all the improvements identified at our last inspection. There had been no registered manager in post since August 2018.

The provider had made improvements to people’s individual risk assessments and had improved the process for keeping people safe from unwanted intruders in the home. However, there was still a risk that people might receive unsafe or inappropriate care and support because the provider’s processes to learn from accidents and incidents were not followed. Processes were in place to protect people from risks associated with medicines, the spread of infection, and risks arising from insufficient numbers of suitable staff.

The provider had made improvements to how they supported staff to deliver effective care and support in line with people’s needs, and staff felt supported. However, records in place did not show that all staff had received all the training they needed, particularly around managing people’s behaviours. There had been no formal process of supervision and appraisal, although the interim manager had taken steps to restart this.

The atmosphere in the home had improved, and staff were more motivated and empowered. There were systems in place to monitor and assess the quality of service, but these had not been effective in delivering all the improvements needed to comply with regulations in a timely fashion. The provider had not met all their regulatory requirements.

People were well treated and supported. Staff helped them to be as involved as possible in decisions about their care. Staff treated people with respect.

People received care and support which met their individual needs and reflected their preferences. The provider took complaints and concerns seriously as opportunities for improvement.

People’s assessments and care plans were detailed and individual to the person. People’s care and support included effective plans to support them to have a healthy diet, and to access other healthcare services. Where people lacked capacity to make decisions the provider acted in line with legal requirements to support people to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible, and the policies and systems in the service supported this practice.

Rating at last inspection:

At our last inspection (report published 29 June 2018) we rated the service requires improvement. This is the second consecutive rating of requires improvement.

Why we inspected:

We carried out an announced comprehensive inspection of this service on 12 and 16 April 2018. We found breaches of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the “all reports” link for Delrose on our website at www.cqc.org.uk.

The comprehensive inspection in April 2018 identified concerns in all five key areas. We therefore covered all five key areas in this inspection.

Enforcement:

We found three continuing breaches and one new breach of regulations. You can see the action the provider needs to take at the end of our full report.

Follow up:

Until the provider can show they are compliant with the fundamental standards in the regulations, we will continue to monitor the provider’s progress in line with our procedures for services that are repeatedly rated requires improvement. These procedures will include proportionate enforcement action, requesting an agreed improvement plan with timescales, and meeting with the provider to monitor progress.

At our last inspection in April 2017 we rated Delrose as good. However we had received information of concern which prompted us to return ahead of the next scheduled inspection. This was a comprehensive inspection which looked at all areas of the service. We identified breaches of four regulations and found areas for improvement in all key areas. You can see what action we have told the provider to take at the end of the full version of this report.

Delrose provides residential care and support to a maximum of nine people who may be living with a learning disability, autism, or have mental health needs. The service occupies a large converted residential home near to local shops and other services.

Delrose 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.

Since the provider registered to carry on a regulated activity at Delrose, we have published guidance called “Registering the Right Support” for services for people with a learning disability or autism. The values which underpin “Registering the Right Support” include choice, promotion of independence and inclusion. People with a learning disability or autism using the service can live as ordinary a life as any citizen.

Although Delrose is close to local community facilities, its location on a busy main road introduced risks to the safety of people with very complex needs, which the provider found difficult to manage in a way that allowed people to access the community as freely as any citizen. There were people living at Delrose whose family did not live nearby which meant the service was not meeting an entirely local need for this type of service, and the provider had experienced recent difficulties in recruiting suitable staff from the local community.

There was a registered manager in post who was also the provider’s area manager. A registered manager is a person who has registered with us 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 provider’s system of risk identification and risk assessment was not always interlocked with the support planning process which meant people were not fully protected against risks to their safety and welfare. The provider had not made sure people were supported by staff with sufficient knowledge and experience to support them safely. The provider’s process to review and learn from accidents and incidents was not always followed.

The provider had not managed the induction of new staff effectively which meant people were supported by staff whose competence to support them had not been signed off. Staff were not supported to deliver high standards of care and support because the provider did not make sure there were timely supervisions in line with the provider’s own policy.

People did not always receive care and support that met their needs and reflected their preferences. The provider’s governance processes were not operated effectively to identify where the service failed to meet the fundamental standards that people should be able to expect.

The provider had processes in place to manage and administer people’s medicines safely. The home was well maintained and kept clean. There were arrangements to protect people from the risk of the spread of infection.

Staff supported people to eat and drink enough and advised them on keeping to a healthy diet while respecting their right to make choices about their diet. Staff were mindful of the need to seek people’s consent to care and support. Where people lacked capacity to make decisions about their care and support the provider complied with legal requirements to assess their capacity and make decisions in their best interests.

More experienced staff had established caring relationships with people using the service, but less experienced staff lacked confidence to do so. People’s dignity was not always promoted and respected in the language used to record their support.

The provider engaged with people and their families. Informal and formal complaints were followed up. Although the provider’s governance system had not prevented a decline in standards, there was a comprehensive improvement plan in progress to restore them.

The home 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Relevant recruitment checks were conducted before staff started working at Delrose to make sure they were of good character and had the necessary skills. However, for some staff unexplained gaps in employment history had not been challenged by the provider.

People and their families told us they felt safe and secure when receiving care. Risk assessments were in place which minimised risks to people living at the home and fire safety checks were carried out.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Staff were trained and assessed as competent to support people with medicines. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

People received varied meals, including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans were regularly reviewed to ensure people received personalised care. A complaints procedure was in place.

Staff felt supported by the manager and staff meetings took place.