Dove House

Dove House is a residential care home providing personal care to up to 4 people. The service provides support to people with a learning disability or autistic people. At the time of our inspection there were 4 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right Support: People were safeguarded from abuse and avoidable harm. The provider assessed risks to ensure people were safe. Staff took action to mitigate any identified risks. There were enough staff to meet peoples needs and staff had received training to support people with a learning disability. People received their medicines safely and were protected from risks of infection.

Right Care: People's capacity was assessed and they were able to make decisions about their care. The provider learned lessons and took action when things had gone wrong. People were supported by staff and a volunteer to access their local community for activities.

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 Culture: Managers and staff were clear about their roles and understood their responsibilities. Relatives were able to visit without restriction and were kept informed. The provider and registered manager were open and transparent. The provider engaged with people and staff involved them with the running of the service. People and staff were encouraged to share and celebrate their own cultures.

Based on our review of safe and well led, the service was able to demonstrate how they were meeting the underpinning principles of “Right Support, Right Care, Right Culture.

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 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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

We inspected this service on 13 September 2018 and the inspection was unannounced and undertaken by one inspector. At our previous inspection in February 2016, the service was meeting the regulations that we checked and received an overall rating of Good. At this inspection we found the service remained Good.

Dove House is a care home located in the village of Doveridge in Derbyshire and is registered to accommodate four people. At the time of our inspection four people were using the service.

People continued to receive safe support. Sufficient numbers of staff were available to support people. The staff understood their role in protecting people from the risk of harm. Risks to people were identified and managed in a way that supported people to take reasonable risks; to promote their independence. Environmental risks were managed well to ensure people’s safety was considered. The practices in place supported people to take their medicine when they needed them. Staff suitability was checked before they commenced employment. People were protected by the systems in place for the prevention and control of infection.

People continued to receive effective support. People were supported by staff that received support and training. 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. People and their representatives were involved in reviews of their care. This supported them to make decisions about how they wanted to receive support in their preferred way. People received support to eat a balanced diet that met their preferences and were supported to access healthcare services. People received coordinated support because the registered manager worked with other organisations and healthcare professionals to achieve this.

People continued to receive caring support. People liked the staff team who knew them well and promoted their independence and autonomy. People’s privacy and dignity was respected and upheld by the staff team and they were supported to maintain relationships with those who were important to them.

People continued to receive responsive support. People were supported to maintain their interests and be part of the local community to promote equality and integration. The registered manager actively included people and their representatives in the planning of care. The processes in place for people to raise any complaints and express their views were provided in an accessible format; to enable people to give their opinions about the service provided.

People continued to receive well led support. People were supported by staff that understood their roles and responsibilities and were empowered by the registered manager to maintain a positive culture that promoted good outcomes for people. The registered manager and provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

Further information is in the detailed findings below.

Dove House provides accommodation and support for up to four people who have a learning disability. At the time of this inspection there were three people living at the home.

At our last inspection carried out in June 2014 we found that the provider was not keeping people safe because the care plans did not contain sufficient information on how to care for people. We also found that the provider had not ensured systems for monitoring quality were fully effective in assessing and managing risks relating to the health, welfare and safety of people at the service. At this inspection we found that these concerns had been addressed.

The service had a registered manager in post. The home is required to have a registered manager. 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. At the time of the inspection the manager had applied for registration with the Care Quality Commission.

People were safe and the provider had effective systems in place to safeguard people. Their medicines were administered safely and they were supported to access other healthcare professionals to maintain their health and well-being.

People were given the opportunity to plan their meals and had a choice of nutritious food and drink throughout the day. People were supported to maintain their interests and hobbies. The provider had a complaints policy in place to ensure people could have any problems or issues dealt with.

There were sufficient, skilled staff to support people at all times and they were recruited using thorough recruitment processes. Staff were trained and used their training effectively to support people. The staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

Staff were caring and respected people’s privacy and dignity. They ensured they had people’s consent before care was delivered. People had their independence promoted. Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values. There was an effective quality assurance system in place.

We considered all the evidence we gathered under the outcomes we inspected. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were being used by staff to ensure people were being kept safe. The manager had previously been made aware that incidents involving restraint should be reported under safeguarding and this was now in place.

Appropriate Deprivation of Liberty Safeguards had been applied for when restrictions had been identified as required to keep people safe.

There was no record that one person with diabetes had seen the podiatrist for nail care at the frequencies identified in their care plan.

Is the service effective?

Staff told us that they had useful and regular supervision. We found staff training was up to date and relevant to their job role. One member of staff told us, 'There is always someone to go to for advice if I need it.' Another member of staff told us, 'The manager is always putting new things up on the notice boards for us to read.'

We found that people were supported to do things that were important and of interest to them.

We found staff communicated well with people using the service.

Is the service caring?

Staff knew about people's interests and we saw that staff were friendly and warm in their interactions with people who used the service.

Staff put effort in to finding activities and outings that people using the service would enjoy.

Is the service responsive?

Reviews of care plans and risk assessments had not been completed for one person when they showed repeated behaviour that challenged. Actions had been identified that could possibly help a person manage their own positive behaviour however these had not been implemented. Input into the strategies and training used by staff from a behaviour therapist to help manage a person's behaviour had been delayed.

Staff had taken on board people's preferences to arrange activities that people would enjoy.

Staff had responded to changes in people's methods of communication as these had developed and changed over time.

Is the service well-led?

Audits had been used by the service and improvements had been identified. However, not all risks regarding window restrictors had been identified.

People's views had not been gathered to inform the manager's view on the quality of the service.

Regular checks were in place to make sure equipment used in the service was working effectively.

Staff reported accidents and incidents appropriately and the manager had investigated when a complaint had been received.

At our last visit in September 2013 capacity assessments were not in place when people lacked capacity to make specific decisions regarding their care and treatment. Records of best interest meetings were not in place to demonstrate how decisions were made. We have now received written evidence to demonstrate that capacity assessments and records of best interest decisions are in place where people lack capacity to make decisions. This demonstrates that the provider has acted in accordance with legal requirements when people lacked capacity to make specific decisions.

At our last visit in September 2013 one person's medication support record was not accurate. We have now received written evidence to demonstrate that the information on their support record corresponds with their prescribed medication.

At our last visit in September 2013 protocols were not in place for 'as required' medication. We have now received written evidence to demonstrate that protocols are in place for 'as required' medication. This meant staff had detailed guidance regarding when to administer this medication and ensured that people using the service were supported in a safe way with their 'as required' medication.

The provider did not have suitable arrangements in place for obtaining the consent of people using the service or their representatives.

We found that although care plans were very detailed and specific to the person, they did not always contain up to date information.

We found that the provider did not have relevant protocols in place for medication that is administered 'when required'. This meant that people's needs may not have been met.

The provider had carried out sufficient out pre employment checks on all staff members to help ensure that they were suitable to work in this environment.

The provider had received two complaints in the last 12 months. There was evidence that these had and were being investigated and appropriate action had been taken.

One person we spoke with stated that they liked living at the home. People told us that that were involved in decisions about their lives. People felt listened to and that staff respected them.

We found that care plans and risk assessments were very detailed and updated on a regular basis. People who used the service told us that they were involved with their care plans.

The provider had systems in place to monitor the quality of the service. Not all people had received supervision in line with the provider's policy but we saw that the provider had plans in place to rectify this.