Archived: Dane End House

We found the following examples of good practice.

¿ When people had to isolate on the first floor, staff put in place a live video link between the first floor and the kitchen area. This allowed people to see and communicate, using sign language with staff and their peers. The link also meant that everyone ate together at meal times though they were in different locations in the house.

¿ When the registered manager emailed staff to update them on any changes to guidance or explanations of expectations, the emails were also sent to people’s family members. The registered manager told us this ensured transparency and enabled families to know what they should expect from staff.

¿ People and their loved ones were supported to access regular testing to enable them to maintain visits to their families when appropriate. Risk assessments were completed and agreed with family members.

Further information is in the detailed findings below.

Dane End House is a residential care home providing personal care to five people at the time of the inspection. The service accommodates up to five people in one adapted house. People had a range of learning disabilities and some people required support with behaviour that challenged. Four people lived with hearing loss and all used British Sign Language (BSL) to communicate.

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.

The building design fitted into the residential area. 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.

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

People were happy living at Dane End House. There was a positive atmosphere and person-centred culture. Staff focused on people’s wellbeing and ensured all their needs were met in the most appropriate ways. People could be who they wanted to be and were fully involved in all aspects of their care. People were supported to become more independent in line with their wishes. People’s privacy and dignity was promoted.

People’s care was entirely person centred. People were supported to understand their choices and had control of their life’s. There was positive risk management which ensured people were not unnecessarily restricted. People were supported to achieve their goals. People’s communication needs were met to ensure they were fully engaged with their care. People were supported to develop relationships and spend their time doing things they enjoyed. Some people were supported with employment.

The registered manager had developed an open culture and demonstrated strong leadership which had consistently ensured person centred and high-quality care. There was a strong, consistent and happy staff team who aimed to continuously improve the care people received. Quality assurance systems were used effectively to monitor and improve the service. People, relatives and staff were all engaged with the service and asked for their views. People were part of their local communities.

People felt safe and all risks to people were managed safely. People were protected from abuse and avoidable harm. Enough safely recruited and suitable staff were deployed to meet people’s needs. Medicines were managed safely and in line with good practice. Lessons were learnt from accidents and incidents and used to make improvements.

People's needs were fully assessed, and they received the care they needed to achieve the best quality of life from experienced and competent staff. Staff were well supported by the registered manager. People were involved with menu planning, shopping and meal preparations. People were supported to maintain their health and well-being. 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 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.

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 15 February 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.

Dane End House is registered to provide accommodation and personal care for up to five people. There were five people living at the service when we visited. People had a range of learning disabilities. Some people were living with autism and some people required support with behaviours that challenged. Some of the people were living with hearing loss and all used British Sign Language (BSL) to communicate.

The service is in quiet road, close to local shops and the sea. The property is a detached house with a secure garden. There are three bedrooms, a bathroom, a quiet lounge area and kitchen/dining room on the ground floor. With a further two bedrooms, a bathroom and a large lounge on the first floor.

The service is run by a registered manager who was 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. The registered manager shared their time between Dane End House and another residential service for eight people nearby that they also managed. They were supported to do this by two deputy managers and senior support workers.

People’s creativity and achievements were celebrated. The service was decorated with pieces of art created by people, alongside photographs of people taking part in activities. Everyone looked happy in the photographs. Each person’s bedroom was personalised to them, with posters of things they liked and photographs of themselves with friends, family and staff.

People had a real say in how the service was run and were clearly in control of their own lives. Staff encouraged people to make their own decisions and choices with the right balance of support to help when needed, without taking over. One relative told us, “My relative sees Dane End House as home and the people they share with as their friends.”

There were enough staff to support people and the number of staff available was based around people’s activities and needs. Staff had been recruited safely and had the skills and training required to meet people’s needs. All staff were completing the care certificate to refresh their knowledge.

Staff knew people well and were excited to talk about people’s personalities, skills and achievements. Each person had a keyworker who co-ordinated their care and support. People had keyworker meetings weekly which were recorded, this gave people a chance to discuss any worries or concerns and what had gone well in the past week.

People’s care plans were written with them and were in a format they understood. The care plans gave staff guidance on what support people needed and how they liked staff to support them. People looked at their care plans with their keyworker on a regular basis and updated them as needed.

People were supported to live as independently as possible. People took part in a variety of activities, including voluntary work. People were supported and encouraged to take risks and try new things. Staff worked with people to manage the risks and keep them safe in the way they preferred.

People were supported to develop new skills and to look after their home. People were excited to show us around their home and tell us about what they enjoyed doing. People had weekly residents meetings to discuss any issues and plan the menu each week.

People were supported to have a varied and balanced diet. People could access the kitchen whenever they liked and could prepare their own snacks or meals. People were supported to maintain relationships with family and friends, through visits and the use of technology.

People had health action plans in place detailing their health needs and the support they needed. There was information in place for people to take with them if they were admitted to hospital. This laid out important information which healthcare staff should know, such as how to communicate with the person and what medicines they were taking.

People kept their medicines in a locked cupboard in their bedrooms and staff supported them to take their medicines safely. There was an opportunity for people to be more involved in managing their own medicines. This was an area for improvement.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

People had complaint forms in their rooms which included pictures to make them meaningful. There had been no complaints but there was a procedure in place to respond to them should they arise.

Staff told us how they supported people to make their own decisions and choices. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people's capacity to make certain decisions, at a certain time. When people were assessed as not having the capacity to make a decision, a best interest decision was made, involving people who knew the person well and other professionals, when relevant.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The requirements of DoLS were met.

Staff told us that the registered manager was approachable and supportive. Staff had one to one meetings on a regular basis and told us that their ideas and suggestions were listened to. The registered manager and staff knew people well. People often went into the registered manager’s office to chat to them or just say hello. There was a feeling of genuine affection, warmth and equality between everyone.

Accidents and incidents were recorded and shared with the provider using an online tool. A risk management team employed by the provider worked with the registered manager to identify any themes or opportunities for learning.

The registered manager audited the service monthly. The provider had a compliance team who audited the service annually and gave the registered manager an action plan to complete. The area manager followed this up in her quarterly audits. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

People were asked for their views of the service in their weekly meetings. Each person had an annual review and all participants, people, relatives and health and social care professionals were asked for feedback. There was not a system in place to request feedback outside of these meetings. This was an area for improvement.

The registered manager was experienced in working with people with learning disabilities and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with guidance.

Staff understood the need for confidentiality and records were stored securely.