The Dunes

The Dunes is a residential care home providing accommodation and personal care for up to four people with learning disabilities. The service is a single-floor bungalow with a large rear garden. There were three people living at the home at the time of the inspection.

Services for people with learning disabilities and or autism are supported

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 is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Staff knew what signs and symptoms could indicate people are experiencing abuse or harm. Staff felt confident management would listen and act if they raised concerns. There were enough staff to keep people safe and meet people’s individual needs. Staff had a good understanding of people’s individual risks and how to minimise them without being unduly restrictive. There were robust processes in place to ensure the safe recruitment of staff.

People were supported by staff who had received the necessary training and ongoing support to help them meet their diverse needs with confidence. Staff competency was monitored on an ongoing basis through observation, regular supervision and appraisals.

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 consistently applied 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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff understood the principles of the Mental Capacity Act 2005 (MCA 2005) and how it applied to the people there. This provided protection for people who do not have capacity to make decisions for themselves.

Staff interacted with people in a consistently kind and caring way. There was a relaxed and friendly atmosphere at the home. People were given time to interact at their pace using their preferred means of communication. Staff responded to people with patience and understanding. People’s right to privacy and dignity was respected at all times.

People’s support needs, abilities and desired outcomes were identified, assessed and monitored in personalised care plans. People were encouraged and supported to maintain relationships with relatives and friends and socialise in their local community. Staff demonstrated a good understanding of the people living there and created opportunities for maximising their independence and life skills.

People’s care needs were monitored and regularly reviewed. The provider had established good relationships with health and social care professionals and relatives who were consulted and involved. Relatives felt listened to and involved in their family member’s lives.

People’s desire to socialise and participate in meaningful activity was met through a varied range of activities tailored to their tastes and abilities. This enabled them to lead full and active lives. The support people received recognised their needs as individuals and as part of a small community of people living in the same home.

Staff felt motivated and supported by their colleagues and the management; telling us the staff team were “like a family.” The manager had the skills, knowledge and passion to manage the service and work with staff and the provider to identify where it could be improved. People, relatives and staff were frequently consulted with their feedback used to influence what happened at the home.

A range of audits and checks helped ensure service quality was maintained and areas for improvement identified. Learning was shared with staff and used to develop the service.

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 March 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.

There was a registered manager at the home. 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. The provider notified CQC about significant events that happened in the care home and had acted in line with regulatory requirements.

People felt safe living at The Dunes. People appeared relaxed and comfortable in their home environment. Family’s members told us that their relatives were happy living at the home. Staff treated people with dignity and respect and the service encouraged people to decorate their environment in a way personal to them.

Risks relating to individuals were managed safely. Staff were knowledgeable about following care plans that identified risks, and were confident in taking action to ensure people were safe and positively supported to manage their anxieties and reduce need for medicines. The registered manager and provider analysed incidents to identify causes and triggers, putting measures put in place to reduce risk and likelihood of reoccurrence.

People were supported to maintain their health and wellbeing. Medicines were managed safely. Staff knowledge around storage and safe administration was robust and effective. People were encouraged to maintain a healthy, balanced diet in line with their health or medical conditions. They were encouraged to make choices and participate in their meal preparation.

There were suitable numbers of staff employed who had the right skills, training and support to work effectively with people. There was a clear management structure in place. Staff felt supported, motivated and clear about their roles and responsibilities. Staff were knowledgeable about safeguarding and were confident in taking appropriate action to keep people safe if they had concerns.

People received personalised care and support and had access to a range of meaningful activities tailored to their individual interests. Staff demonstrated a good awareness of people’s individual needs and people’s care plans were person centred and regularly reviewed to respond to changes. Peoples were involved in their care planning and the service had developed ways in which to aid communication and feedback with people who spoke different languages or struggled with verbal communication.

Staff followed legislation designed to protect people’s rights and freedoms. People were cared for with kindness and compassion by staff that understood the importance of obtaining consent and following legal guidelines where people were unable to consent.

The service had an open and transparent culture. The registered manager had an open door policy for people and staff. Families were kept informed about changes to people’s health and wellbeing. Staff were confident in raising concerns to the registered manager, and were knowledgeable about the provider’s whistleblowing policy. A set of ‘easy read’ policies including complaints and safeguarding were clearly displayed throughout the home and staff took time to go over any concerns or issues people may have experienced.

Auditing and quality assurances processes carried out by the registered manager and provider resulted in the home being maintained as a safe environment for people to live in.

We spoke with all three people, observed staff supporting one person who had complex needs, spoke with two staff and the acting manager.

We observed that people were relaxed in the house and freely approached and communicated with staff. One person smiled when we asked about the home and another person said 'good'.

People had been involved in choosing and planning their meals and their privacy was respected. People experienced care and support that met their needs and protected their rights.

Medicines were managed, administered and stored safely.

There were systems in place to regularly check and monitor the quality of the service.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged.

We found evidence that recording showed relevant people had on most occasions not been consulted on decisions about their care and support. This means that systems and safeguards to ensure people experience appropriate care and support and to protect there human rights were not in place.

People who lived at the home had been assessed as not having the capacity to make choices and decisions which affected their lives.

We spoke with the manager and staff and found they were not aware of their roles and responsibilities in relation to capacity and best interest decisions and this means people could be at risk of abuse or neglect.

We found people did not have choices around main meals, written menu information was not accessible, and people were restricted due to the behaviours of one individual living at the home in making alternative choices.

We observed staff being kind and respectful and listening to what people wanted. One individual living at the home likes music and staff had a radio/cd in the hall and conservatory so they could listen to music.

There were not appropriate arrangements to manage people's medicines safely.