23 April 2015
During a routine inspection
Dulwich Manor is owned by Livlife (UK) Limited. The service is situated in Derby, and provides care and support for up to 9 people over the age of 18 years with either a learning disability or a mental health need. At the time of this inspection there were seven people accommodated.
This inspection took place on 22 and 23 April 2015. The first day was unannounced.
At our last inspection in June 2014 the service was not meeting the regulations we inspected with regard to the care and welfare of people, ensuring staff had the necessary training to provide relevant care and having systems to ensure the quality of services provided to people. We followed up these issues and found improvements had been made, though further improvements were needed to ensure people were supplied with a service that meets fundamental standards.
A registered manager was in place. 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 and associated Regulations about how the service is run.
Since our previous inspection in June 2014, we had received information from the local authority stating that the service had made improvements to the premises, staff training and quality assurance, but more progress was needed.
People and their relatives said they felt safe in the service.
Testing of fire systems was in place though structural fire requirements had not been fully installed.
The service was not completely following the guidance in people’s risk assessments and people were at risk of unsafe care.
Staff had received training on how to protect people who used the service from abuse or harm. They demonstrated they were aware of their role and responsibilities in keeping people as safe as possible.
The Commission had not been informed of a situation of potential abuse to people which meant that monitoring action to prevent these situations and keep people safe could not be considered.
Staffing levels needed to be reviewed to ensure people's needs were always met.
We found people received their prescribed medication in a safe way by staff trained in medication administration.
Detailed risk assessments had not always been undertaken to inform staff of how to manage and minimise risks to people's health from happening.
The provider supported staff by an induction and some ongoing support, training and development. However, effective training had not been provided to all staff, though we saw evidence this had been planned for the near future.
The Mental Capacity Act (MCA) 2005 is legislation that protects people who may lack capacity to consent to their care and treatment. We found examples where the manager was following this legislation, which informed us that people’s capacity to consent to specific decisions had been assessed appropriately.
People who used the service had their dietary and nutritional needs assessed and planned for, though treatment prescribed from a GP and medical specialist had not been fully included in a person's care plan to ensure effective care was provided. People received a choice of what to eat and drink and staff supported them to maintain their health and they liked the food provided.
People who used the service and relatives told us they found staff to be caring, compassionate and respectful. Our observations found staff to be kind and attentive to people’s individual needs.
Proper referrals have been made to medical professionals to respond to concerns about people's health.
People were encouraged to be as independent as possible. People had their rights respected in terms of privacy, dignity and independence.
Activities were provided though provision was limited and needed to be expanded to respond to people's preferences.
Complaints had been followed up, though the complaints procedure did not contain full information as to how to make a complaint which may have prevented the service responding to concerns that would otherwise have been made.
The provider had internal quality and monitoring procedures in place. These needed to be strengthened to prove that necessary actions had been implemented to provide a well led service.
The manager enabled staff to share their views about how the service was provided by way of staff meetings and supervision. Staff said management provided good support to them. These issues were well led.