Archived: The Dell

This is the summary of what we found:

Is the service safe?

Care records were generally updated to ensure that people received the care they needed to keep them safe. We did find some records which were not completed appropriately and which could have put some people at risk.

The service worked with other healthcare professionals to help meet people's healthcare needs.

We saw that regular checks were carried out on equipment and systems, such as the fire alarm system, to make sure they were safe to use.

We looked at staffing rotas and found that there were enough trained and experienced staff on duty to meet people's needs and ensure their safety. We saw that new staff and agency staff had received an induction to ensure they were informed about how to meet the needs of the people who used the service and keep them safe.

Staff were trained to deliver care and support safely.

We found that staff were fully aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and had been trained in their use. We saw that the service had recently made multiple DoLS applications and were waiting to see the outcome of these.

We were concerned that in one bungalow a person was being restrained by the use of a lap belt in a wheeled armchair.

Is the service effective?

People's health and care needs were assessed in consultation with either the person themselves or relatives. People's care plans reflected their healthcare needs and the service worked in conjunction with support from outside professionals to meet them.

We found that recent training in monitoring people's nutritional health had not been put into place.

People who used the service told us that they were happy and we observed that most people attended a variety of activities and were involved in their local community if they chose to be.

We saw that people were supported to increase their independent living skills.

We were concerned that one bungalow on the site was not providing care that met all the needs of the people who lived there.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff engaging positively with people and encouraging them to increase their independent living skills.

People who used the service told us they were happy with the care provided and spoke positively about the staff. One person told us, 'It's good here'.

We were concerned about the way staff supported people in one bungalow and raised our concerns with the registered manager.

Is the service responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals.

People's preferences and choices had been recorded in their care plans and we observed that generally care and support was delivered in accordance with people's wishes. People's chosen preference for a male or female member of staff to support them was recorded and respected.

We were concerned that people living in one particular bungalow were not given the opportunity to make choices and where they had made a choice we saw that it was not always respected.

Is the service well led?

Since our last inspection on 25 February 2014 there had been a change of management at the service. We saw that considerable improvements had been made by the new manager. The service had an effective quality assurance system in place.

We saw that staff received the training they needed to carry out their roles and that they were supervised and supported by the manager.

We were concerned that some poor practice in one bungalow had not been sufficiently addressed. We also questioned the provider's response to a recent safeguarding issue. We were concerned that actions taken did not sufficiently minimise the risk to the people who used the service. This was of particular concern because the Commission is aware that other agencies responsible for investigating safeguarding issues had recently been involved in an unconnected safeguarding issue at the service.

Eight people who used the service spoke with us and told us what they had been doing. In two bungalows we noted there were no observed or planned activities for people on that day. Out of 12 people only one person was attending day services. We were not confident that the provider was employing enough staff to meet the health and welfare of people who used the service. Some staff were working in the bungalows alone and had to ask other staff working in another bungalow for assistance. This meant people had to wait to have their needs met and we observed people left unoccupied so could not be assured of their safety or wellbeing.

The provider had failed to take adequate steps to protect people from harm because they had not carried out proper investigations into concerns raised. We found gaps in record keeping which meant we could not see what actions the provider had taken to ensure people's welfare, safety and health needs were adequately responded to and met.

At the last inspection in December 2013 we found the service was non compliant with consent. We did not follow this up during this inspection because the manager told us they were not fully compliant with this regulation and needed some more time.

We found that the provider had systems in place to maintain the safety and welfare of service users. The care plans examined were person specific and were individualised to the person and their care needs.

We observed that people were treated with dignity and respect, the care plans examined confirmed that people were treated as individuals and were involved in the planning of their care. We saw that people had access to a variety of activities that met their needs.

The provider had domestic arrangements in place, which ensured the service was clean and staff were observed adopting good infection control techniques. Staff had access to plentiful supplies of soaps, hand gels and aprons to ensure barrier protection to minimise the risk and spread of infection.

After lunch we observed 13 people joining in a pottery session. They were making a nativity scheme for Christmas, which was going to be part of a national exhibition. The session was well supported by staff and people were keen to show us their work. People we spoke with told us about the activities they had been doing and said there was something going on most days.

During our inspection we found that the service assessed people's needs and was able to demonstrate how they were being met through effective care planning. Staff were employed in sufficient numbers and received appropriate training to meet people's needs.

The service had comprehensive quality assurance systems in place. This ensured they were able to measure the effectiveness of the service and make improvements where necessary.