DRS Annexe Care Home

DRS Annexe Care Home is registered to provide accommodation and personal care for up to 12 people with mental health needs and learning disabilities. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 11 men living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

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

Right Support:

The model of care and setting maximised people’s choice, control and independence. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. The provider had an effective system in place to ensure people’s consent was obtained in line with legislation.

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.

Right Care:

Care was person-centred and promoted people’s dignity, privacy and human rights. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People using the service were protected from abuse because staff had a good understanding of safeguarding and how to report concerns. People told us they were safe living at the service. Care records contained risk assessments with clear guidance for staff to follow. Medicines were managed safely. Staff were recruited safely. The premises were clean and well maintained.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service lead confident, inclusive and empowered lives. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. People's needs had been assessed before using the service. Care plans reflected these assessments. Relatives told us they were involved in people’s care planning and reviews. Staff were competent in their roles as they had the skills, experience and knowledge to provide quality care. Staff understood people's needs and worked well with health care professionals. The provider had effective auditing systems in place to monitor the quality of care. The service was well-led because the registered manager was knowledgeable and had good oversight of the service and the needs of people.

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 28 November 2018). At this inspection we found the rating remained the same.

Why we inspected

The inspection was prompted in part due to concerns received about the management, staffing levels, staff recruitment and medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

Follow up

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

DRS Annexe Care Home is registered to provide accommodation and personal care for up to 12 people with mental health needs and learning disabilities. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 12 men living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. 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.

The home had a relaxed atmosphere and people told us they were well treated by the staff and felt safe with them. We saw the way that staff interacted with people had a positive effect on their well-being.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements. Staff told us that the management listened to them and acted on their suggestions and wishes.

All parts of the home, including the kitchen, was clean and no malodours were detected.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

The management team worked in partnership with other organisations to support care provision, service development and joined-up care.

DRS Annexe Care Home is a registered to provide accommodation and personal care for up to eighteen people with mental health needs and learning disabilities. At the time of this inspection there were 18 people living at the home.

There was a registered manager in post but they were not present on the day of the inspection. 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.

Recruitment procedures were not always being operated effectively to ensure that suitable people were being employed at the service.

Systems used by the provider to assess, monitor and improve the quality and safety of the service were not always effective. These systems had not identified potential problems with the quality of care planning, the safety of medicines management or the safety of the premises.

Medicines were not always being managed safely.

People enjoyed the food provided and were offered choices of what they wanted to eat. However, safe food hygiene practices where not being followed and staff were not always following the advice of healthcare professionals regarding nutritional supplements.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, it was not always clear from records that people had or were able to give their consent to care and treatment.

People’s care plans did not always contain sufficient detail in order to make sure people’s preferences in relation to their care and chosen activities were being met.

People told us they liked the staff at the home and friendly and supportive relationships had developed between staff and people using the service.

Individual risks to peoples’ safety had been identified and staff were aware of the actions they needed to take to mitigate these risks.

People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff were aware that the people they supported needed help to stay safe and they understood their responsibilities to keep people safe from potential abuse and discrimination.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received with their learning and development.

People using the service and their relatives told us they could raise any concerns they had with the staff and management of the home.

People using the service, their relatives and other stakeholders were asked about the quality of the service and had made comments about this.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to staff recruitment, safe care and treatment, consent, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

'I have no concerns.'

'[I am] good today.'

'I like it here and I'm not just saying that.'

'Yeah, it is good. The staff are nice.'

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system available.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

There was evidence that people's views and experiences were taken into account in the way the service was provided. People using the service told us they were able to express their views of the service and we saw evidence of their involvement in their care. Some people using the service suggested they might like to have more culturally specific food.

People experienced care, treatment and support that met their needs and protected their rights. There was evidence people using the service had their individual needs assessed and the care was delivered in a manner that met these.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had access to appropriate training and were supported in their roles.

The registered person had not ensured that confidential records were kept securely. When we visited we found old files containing personally identifiable information being stored in a communal area.