Archived: Dunsland

Updated 16 July 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

Two inspectors and one medicine inspector.

Service and service type

Dunsland is a 'care home'. People in care homes receive accommodation and nursing or 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.

The service had a manager in post who was registered at another one of the provider’s services. They were providing managerial oversight to both services and had applied for dual registration with the Care Quality Commission at the time of the inspection. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with five people, and observed care and support provided in communal areas. We spoke with the manager, two deputy managers, the head of adult and community services and the maintenance person. We looked at five people's care and support records and seven people's medicine records. We observed the morning medicine round. We also reviewed staff files as well as records relating to the management of the service, recruitment, policies, training and systems for monitoring quality.

After the inspection

Due to risks identified during the inspection, we asked the service to send us additional information and updates on actions taken as an outcome, this information was provided within agreed timescales. We spoke with two care staff, and two relatives by telephone.

Updated 16 July 2020

About the service

Dunsland is a residential care home providing personal care and support for up to 14 people aged 18 years and over living with learning disabilities, autism, physical and mental healthcare needs. At the time of the inspection, 10 people were living at the service.

The service has not been developed and designed fully in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The service was a large home, bigger than most domestic style properties, and larger than current best practice guidance for people with learning disabilities and autism.

The size of the service was having a negative impact on some of the people due to building design and layout, and the number of people sharing communal areas of the service. Not all the principles had been applied to the service provided, to ensure 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 includes having control, choice, and independence. People using the service should also receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were not being supported by consistently caring and suitably trained staff. This was confirmed by our observations and feedback received from people living at the service.

We identified ongoing significant environmental risks and concerns impacting on the standards of safe care being provided. People living at the service were not always able to assess risks independently and relied on staff for support. Leadership and governance arrangements within the service had further deteriorated since the last two inspections.

We identified new and repeated breaches of regulation and the provider, in the absence of a registered manager, was not meeting their legal regulatory responsibilities to ensure people received good standards of care or that sufficient action was being taken to address shortfalls from the last two inspections.

People were not always supported to have maximum choice and control of their lives. We observed examples of restrictive practice. Staff did not always support them in the least restrictive way possible; policies and systems in the service were not followed to support good practice or reflecting the principles and values of Registering the Right Support.

We continued to identify concerns regarding the levels of activities and social stimulation for each person. This had less impact on those people able to access the community independently. The service had not implemented recommendations made in the last comprehensive inspection report regarding people’s end of life care planning, and care records did not consistently contain protected characteristics in relation to personal choice and preferences.

The care environment remained unclean, with ongoing concerns regarding infection, prevention and control risks to people. We continued to identify concerns regarding people’s medicines management at the service.

Rating at last inspection

Dunsland was previously inspected 09 May 2019 and rated as Inadequate overall, with breaches of regulation and the service was placed into special measures. The report was published 27 August 2019.

A focussed inspection visit looking at safe and well-led, in response to concerns received was completed 17 October 2019, the service remained rated as Inadequate, with breaches of regulation and remained placed in special measures. The report was published 22 November 2019.

This will be the third, consecutive inspection where the service has been rated inadequate and remained in special measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified repeated breaches of regulation in relation to the provision of safe care and treatment, keeping people safe from risk of harm or abuse, maintenance of the care environment and good governance processes. We have also identified breaches of regulation relating to adherence with the Mental Capacity Act (2005), staffing levels; training and competence, provision of dignified and person-centred care and support, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service remains 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.