Archived: The Dell

The Dell is a service for up to 48 people who have a learning disability and/or Autism. Accommodation is provided across eight bungalows on one site. At the time of this inspection 24 people were living at the service. There is also a central office block used for catering and some day service activities.

The service was a large with a number of bungalows set back from the nearby residential area. The service is bigger and was larger than current best practice guidance. The size and layout of the site did not fit into the local community and there were identifying signs that this was a care home such as industrial bins. The grounds were not well maintained, there was broken fences, overgrown gardens and a lack of maintenance and care across the site.

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

The service didn’t always consistently 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.

We visited all of the occupied bungalows and found a number of environmental concerns, some of which had been identified on a previous inspection and had still not been addressed due to a failure by the provider to take appropriate action.

Risks in relation to fire safety had still not been adequately managed.

Staffing levels were being maintained, primarily through the high use of agency staff. Staff were not always well deployed in order to meet people’s individual needs.

The management of risk and medicines continued to be ineffective and placed people at risk of harm.

The service was not always well led and there was a lack of quality assurance processes in place to identify the issues found during the inspection.

Rating at last inspection: The last rating for this service was requires improvement (published 4 April 2019), and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections, however at this inspection we have rated the key question of Well Led Inadequate.

Why we inspected: We received concerns in relation to the management of medicines, staffing levels and the managerial oversight of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement: We have identified breaches of the regulations in relation to safe care and the governance and management of the service. Please see the action we have told the provider to take at the end of this report.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

People’s experience of using this service:

People did not always receive a service that provided them with safe, effective and high-quality care.

The environment was not always well maintained and repairs were not actioned in a timely manner.

The management of risk and medicines was ineffective and placed people at risk of harm.

The service was not always well led. There was a lack of effective quality assurance processes in place

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

People received support from staff who were kind and treated them with respect.

People were supported to maintain a healthy and balanced diet.

People had support plans however these were often out of date and did not reflect the care and support they needed.

The Dell has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. The Dell was designed, built and registered many years before this guidance was published. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because the model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs.

Rating at last inspection: The rating at the last inspection was ‘Good’. The last report for The Dell was published on 13 April 2017.

Why we inspected: This inspection was brought forward as we had received some concerns about environmental standards at The Dell.

Follow up: We will continue to monitor the service through the information we receive.

The service had a registered manager in post. 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 and associate Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge. There were appropriate arrangements in place for medicines to be stored and administered safely.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.